儿童纽扣电池食管异物临床治疗
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摘要
目的分析儿童纽扣电池食管异物临床诊断、治疗及预后特征,为纽扣电池类食管异物临床处理提供参考。方法选取本院2016年4月～2018年5月收治的341例食管异物中8例纽扣电池食管异物的患儿,结合纽扣电池大小、嵌顿时间、术中食管黏膜损伤情况及预后,综合分析纽扣电池类食管异物的临床特征。结果 8例患儿均为学龄前儿童;最短异物嵌顿时间3小时20分钟,最长243小时35分钟;7例异物位于食管第一狭窄,1例位于食管第二狭窄;食管黏膜轻度充血水肿1例;黏膜明显烧伤4例;食管狭窄,可疑穿孔1例;食管穿孔1例;气管食管瘘1例。术后胃肠减压最短3天,最长12天,1例气管食管瘘予空肠营养127天后治愈。结论儿童纽扣电池类食管异物需急诊手术取出,门急诊需警惕纽扣电池类食管异物;术中需仔细检查食管黏膜损伤情况,并彻底清洗创面;术后并发症种类较多,需密切观察和积极对症治疗。
OBJECTIVE To analyze the routine diagnosis, treatment and prognosis of button cell esophageal foreign body in children, so as to provide reference for clinical treatment of button cell esophagus foreign body. METHODS In our hospital from April 2016 to May 2018, the clinical data of 8 children with button cell esophageal foreign body from 341 esophageal foreign bodies were studied. The clinical characteristics of button cell esophageal foreign bodies were analyzed in combination with the size of button cells, the time of foreign body lodged, the damage of esophagus mucosa and the prognosis. RESULTS All the 8 patients were preschool children. The shortest foreign body lodged time was 3 hours 20 minutes, the longest time was 243 hours and 35 minutes. The foreign body in 7 cases were located in the first stenosis of the esophagus, 1 case in the second stenosis of the esophagus, 1 case with mild hyperemia and edema in the esophageal mucosa, 4 cases with severe burns, 1 case with esophageal stenosis and suspected perforation, 1 case with perforation of esophagus and 1 case with tracheoesophageal fistula. The shortest postoperative gastrointestinal decompression was 3 days, the longest was 12 days. 1 case with tracheoesophageal f istula were cured after 127 days of jejunal nutrition. CONCLUSION Children with button cell esophageal foreign bodies need to be removed by emergency operation. There are many kinds of complications during and after operation. Close observation and positive symptomatic treatment are needed.
OBJECTIVE To analyze the routine diagnosis, treatment and prognosis of button cell esophageal foreign body in children, so as to provide reference for clinical treatment of button cell esophagus foreign body. METHODS In our hospital from April 2016 to May 2018, the clinical data of 8 children with button cell esophageal foreign body from 341 esophageal foreign bodies were studied. The clinical characteristics of button cell esophageal foreign bodies were analyzed in combination with the size of button cells, the time of foreign body lodged, the damage of esophagus mucosa and the prognosis. RESULTS All the 8 patients were preschool children. The shortest foreign body lodged time was 3 hours 20 minutes, the longest time was 243 hours and 35 minutes. The foreign body in 7 cases were located in the first stenosis of the esophagus, 1 case in the second stenosis of the esophagus, 1 case with mild hyperemia and edema in the esophageal mucosa, 4 cases with severe burns, 1 case with esophageal stenosis and suspected perforation, 1 case with perforation of esophagus and 1 case with tracheoesophageal fistula. The shortest postoperative gastrointestinal decompression was 3 days, the longest was 12 days. 1 case with tracheoesophageal f istula were cured after 127 days of jejunal nutrition. CONCLUSION Children with button cell esophageal foreign bodies need to be removed by emergency operation. There are many kinds of complications during and after operation. Close observation and positive symptomatic treatment are needed.
引文
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[2] Altokhais TI,Al-Saleem A, Gado A,et al. Esophageal foreign bodies in children:Emphasis on complicated cases. Asian J Surg,2017, 40(5):362-366.
[3] Lee JH, Lee JH, Shim JO, et al. Foreign Body Ingestion in Children:Should Button Batteries in the Stomach Be Urgently Removed. Pediatr Gastroenterol Hepatol Nutr, 2016, 19(1):20-28.
[4]饶凯成,李隽,王智楠,等.儿童扣式电池食管异物临床分析.临床耳鼻咽喉头颈外科杂志,2010, 24(9):409-410.
[5] Liao W, Wen G, Zhang X. Button battery intake as foreign body in Chinese children:review of case reports and the literature.Pediatr Emerg Care, 2015, 31(6):412-415.
[6]中华医学会消化内镜分会.中国上消化道异物内镜处理专家共识意见.2016,33(1):19-28
[7] Loh WS, Leong JL, Tan HK. Hazardous foreign bodies:complications and management of button batteries in nose. Ann Otol Rhinol Laryngol,2003, 112(4):379-383.
[8] Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood:our experience and review of the literature. Eur J Emerg Med, 1998, 5(3):319-323.
[9] Simonin M,D'Agostino I,Lebreton M,et al. Bilateral vocal palsy following coin cell lithium battery ingestion:a case report and review. Eur J Pediatr,2013, 172(7):991-993.
[10] Brumbaugh DE, Colson SB, Sandoval JA, et al. Management of button battery-induced hemorrhage in children. J PediatrGastroenterol Nutr, 2011, 52(5):585-589.
[11] Soni JP, Choudhary S, Sharma P, et al. Pneumopericardium due to ingestion of button battery. Ann Pediatr Cardiol, 2016, 9(1):94-95.
[12] Litovitz T, Whitaker N, Clark L, et al. Emerging battery-ingestion hazard:clinical implications. Pediatrics, 2010, 125(6):1168-1177.
[13] Litovitz T, Whitaker N, Clark L. Preventing battery ingestions:an analysis of 8648 cases. Pediatrics, 2010, 125(6):1178-1183.
[14]王洁,罗仁忠,周丽枫,等.食管异物钮扣电池对家兔食管的损伤及机制研究.现代预防医学,2012,(13):3322-3325.
[15] Nazir Z, Khan MAM, Qamar J. Recurrent and acquired tracheoesophageal fistulae(TEF)-Minimally invasive management. J Pediatr Surg, 2017, 52(10):1688-1690.
[16] Houas Y,Sahli S, F Fitouri F,et al. Spontaneous Resolution of a Tracheoesophageal Fistula Caused by Button Battery Ingestion.JAMA Otolaryngology Head Neck Surg, 2016, 142(6):609-610.
[17]陈小波,陈德晖,苏柱泉,等.儿童获得性气管食管瘘内科保守治疗二例并文献复习.中华临床医师杂志(电子版),2013, 7(18):8265-8269.
[18] Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children:flexible versus rigid endoscopy. Surg Endosc,2011,25(3):919-922.
[19] Gmeiner D,von RBH,Meco C,et al. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc, 2007, 21(11):2026-2029.
[2] Altokhais TI,Al-Saleem A, Gado A,et al. Esophageal foreign bodies in children:Emphasis on complicated cases. Asian J Surg,2017, 40(5):362-366.
[3] Lee JH, Lee JH, Shim JO, et al. Foreign Body Ingestion in Children:Should Button Batteries in the Stomach Be Urgently Removed. Pediatr Gastroenterol Hepatol Nutr, 2016, 19(1):20-28.
[4]饶凯成,李隽,王智楠,等.儿童扣式电池食管异物临床分析.临床耳鼻咽喉头颈外科杂志,2010, 24(9):409-410.
[5] Liao W, Wen G, Zhang X. Button battery intake as foreign body in Chinese children:review of case reports and the literature.Pediatr Emerg Care, 2015, 31(6):412-415.
[6]中华医学会消化内镜分会.中国上消化道异物内镜处理专家共识意见.2016,33(1):19-28
[7] Loh WS, Leong JL, Tan HK. Hazardous foreign bodies:complications and management of button batteries in nose. Ann Otol Rhinol Laryngol,2003, 112(4):379-383.
[8] Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood:our experience and review of the literature. Eur J Emerg Med, 1998, 5(3):319-323.
[9] Simonin M,D'Agostino I,Lebreton M,et al. Bilateral vocal palsy following coin cell lithium battery ingestion:a case report and review. Eur J Pediatr,2013, 172(7):991-993.
[10] Brumbaugh DE, Colson SB, Sandoval JA, et al. Management of button battery-induced hemorrhage in children. J PediatrGastroenterol Nutr, 2011, 52(5):585-589.
[11] Soni JP, Choudhary S, Sharma P, et al. Pneumopericardium due to ingestion of button battery. Ann Pediatr Cardiol, 2016, 9(1):94-95.
[12] Litovitz T, Whitaker N, Clark L, et al. Emerging battery-ingestion hazard:clinical implications. Pediatrics, 2010, 125(6):1168-1177.
[13] Litovitz T, Whitaker N, Clark L. Preventing battery ingestions:an analysis of 8648 cases. Pediatrics, 2010, 125(6):1178-1183.
[14]王洁,罗仁忠,周丽枫,等.食管异物钮扣电池对家兔食管的损伤及机制研究.现代预防医学,2012,(13):3322-3325.
[15] Nazir Z, Khan MAM, Qamar J. Recurrent and acquired tracheoesophageal fistulae(TEF)-Minimally invasive management. J Pediatr Surg, 2017, 52(10):1688-1690.
[16] Houas Y,Sahli S, F Fitouri F,et al. Spontaneous Resolution of a Tracheoesophageal Fistula Caused by Button Battery Ingestion.JAMA Otolaryngology Head Neck Surg, 2016, 142(6):609-610.
[17]陈小波,陈德晖,苏柱泉,等.儿童获得性气管食管瘘内科保守治疗二例并文献复习.中华临床医师杂志(电子版),2013, 7(18):8265-8269.
[18] Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children:flexible versus rigid endoscopy. Surg Endosc,2011,25(3):919-922.
[19] Gmeiner D,von RBH,Meco C,et al. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc, 2007, 21(11):2026-2029.