[1]陈巍,王晓曼,刘婷婷,等.儿童消化道异物21例手术治疗分析[J].临床小儿外科杂志,2021,20(08):778-784.[doi:10.12260/lcxewkzz.2021.08.014]
　Chen Wei,Wang Xiaoman,Liu Tingting,et al.Clinical experience of ingested intraabdominal foreign bodies in children requiring surgical intervention[J].Journal of Clinical Pediatric Surgery,2021,20(08):778-784.[doi:10.12260/lcxewkzz.2021.08.014]
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儿童消化道异物21例手术治疗分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第20卷 期数: 2021年08期 页码: 778-784 栏目: 论著 出版日期: 2021-08-10
Title:
Clinical experience of ingested intraabdominal foreign bodies in children requiring surgical intervention
作者:
陈巍1;  王晓曼2;  刘婷婷3;  王大勇1;  张廷冲1;  陈亚军1
1. 国家儿童医学中心(北京), 首都医科大学附属北京儿童医院普通外科(北京市, 100045);
2. 国家儿童医学中心(北京), 首都医科大学附属北京儿童医院腹部超声科(北京市, 100045);
3. 国家儿童医学中心(北京), 首都医科大学附属北京儿童医院急诊科(北京市, 100045)
Author(s):
Chen Wei1;  Wang Xiaoman2;  Liu Tingting3;  Wang Dayong1;  Zhang Tingchong1;  Chen Yajun1
1. Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, Children’s National Medical Center, Beijing 100045, China;
2. Department of Ultrasound, Beijing Children’s Hospital, Capital Medical University, Children’s Natio
关键词:
胃肠道; 外科手术; 异物/外科学; 异物/影像诊断; 治疗结果; 儿童
Keywords:
Gastrointestinal Tract; Surgical Procedures;  Operative; Foreign Bodies/SU; Foreign Bodies/DG; Treatment Outcome; Child
分类号:
R726.56;R726.1
DOI:
10.12260/lcxewkzz.2021.08.014
摘要:
目的 总结需要手术治疗的儿童腹部消化道异物的临床诊治经验。方法 回顾性分析首都医科大学附属北京儿童医院2007年5月至2017年8月收治的21例行腹部手术的儿童消化道异物患者资料，其中男17例，女4例，平均年龄（3.15±2.89）岁，年龄范围10个月至11岁4个月。结果 哭闹、腹痛（11例，68.8%）和呕吐（10例，62.5%）是需手术治疗的儿童腹部消化道异物患者的主要症状。所有患者中，X线平片检查提示消化道异物阳性者13例，包括尖锐性金属异物3例、硬币1例、纽扣电池1例、单个磁性异物1例、多个磁性异物6例；X线平片检查提示消化道异物阴性者8例，包括泡发球5例、枣核2例、棒棒糖棍1例。超声检查对腹部消化道异物的诊断准确率为100%，而X线平片诊断准确率仅61.9%。所有患者接受开腹手术治疗；5例无消化道并发症患者中，4例行消化道切开异物取出术，1例（异物为钢针）开腹手术时发现钢针位于腹股沟疝囊，予以取出。16例存在消化道并发症的患者（胃穿孔1例，肠穿孔10例，肠梗阻5例）中，除1例泡发球致肠梗阻患者行开腹手术肠外手法捏碎异物外，其余均行穿孔修补、肠切开或肠切除吻合术。术后随访3~6个月，均恢复良好。结论 儿童消化道异物可引起较为严重的并发症。吞食多个磁性异物及泡发球易引起消化道并发症，需要患者家长及儿科医生重点关注。
Abstract:
Objective To summarize our clinical experiences of managing children with abdominal digestive tract foreign bodies (FB) requiring surgical intervention. Methods A retrospective study was performed for 21 children with FBs in digestive tract undergoing surgery between May 2007 and August 2017. There were 17 boys and 4 girls (M:F=4.25:1) with a mean age of (3.15±2.89) years (10 months to 11.3 years). The clinical data were analyzed and the clinical experiences of diagnosis and treatment summarized. Results The major clinical manifestation included crying & abdominal pain (n=11, 68.8%) and vomiting (n=10, 62.5%). All children underwent abdominal radiography and abdominal ultrasonography pre-operation. Thirteen cases of positive foreign body on radiography included sharp metal foreign body (n=3), coin (n=1), button battery (n=1), single magnetic foreign body (n=1) and multiple magnetic metal foreign bodies (n=6). Eight cases of radiography negative digestive tract foreign bodies included 5 cases of superabsorbent objects, 2 cases of jujube nucleus, and 1 case of lollipop stick. The ultrasonic diagnostic rate of abdominal foreign body was 100% while only 61.9% of intraabdominal foreign bodies were positive on radiograph. All children underwent laparotomy and 4/5 of them without gastrointestinal complications underwent enterotomy for removing foreign bodies. One cases had a steel needle in inguinal hernia sac. The gastrointestinal complications include gastric rupture (n=1), intestinal perforation (n=10) and intestinal obstruction (n=5). In one case of intestinal obstruction by a superabsorbent object, foreign body was crumbed during laparotomy. Other children underwent perforation repair through enterotomy or enterectomy. There were no postoperative complications. The children recovered well after a follow-up period of 3-6 months. Conclusion Foreign bodies in digestive tract of children may cause serious complications. Swallowing multiple magnetic foreign bodies and superabsorbent object lead to gastrointestinal complications. It should attract the attention of parents and pediatricians.

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备注/Memo

收稿日期:2019-12-19。
基金项目:北京市医院管理局儿科学科协同发展中心专项经费资助（编号：XTYB201824）
作者简介:陈巍,Email:chenwei710@hotmail.com

更新日期/Last Update: 1900-01-01