171例食管上段异物的内镜治疗

摘要/Abstract

摘要： 目的：评估食管上段异物嵌顿后并发症的发生率,比较软式及硬式内镜治疗效果。方法：回顾性分析北京大学第三医院2008年1月至 2012年12月经内镜治疗的171例食管上段异物病例资料。结果：126例食管上段异物行硬式内镜治疗，45例行软式内镜治疗： (1)软式内镜组所取异物的平均长径和短径与硬式内镜组比较差异无统计学意义（P=0.495，P=0.125）；（2）硬式内镜组异物嵌顿时间［（25.8±28.6） h］比软式内镜组［（13.9±14.5） h］更长，差异有统计学意义（P=0.009）；（3）90例（71.4%，90/126）硬式内镜组患者于24 h内就诊，19例（ 15.1%，19/126）于24～48 h就诊，17例（13.5%,17/126）超过48 h就诊；软式内镜组88.9%（40/45）于24 h内就诊，4例（8.9%，4/45）于24 ～48 h就诊，仅有1例（1/45，2.2%）超过48 h就诊；（4）硬式内镜组85例（67.5%，85/126）异物一端或两端刺入食管壁，而软式内镜组上述比例为35.6%（16/45）；（5）硬式内镜和软式内镜治疗前上消化道钡剂造影诊断异物的阳性率分别为98.3%和100%，而胸片或腹平片对异物诊断的阳性率两组分别为23.6%和14.3%；（6）硬式内镜组治疗成功率、并发症发生率及穿孔率分别为100%、38.1%和6.3%。软式内镜组则分别为 95.6%、48.9%和2.2%，二者比较差异均无统计学意义（P均>0.05）。结论：硬式内镜与软式内镜相比二者取食管异物并发症发生率和穿孔率无区别，二者取异物成功率均较高，但软式内镜无需全身麻醉，患者恢复快，费用低。

关键词: 食管, 异物, 食管内镜

Abstract: Objective：To assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FBs) in adults. Methods: A retrospective analysis was conducted on the medical records of 171 adult patients with the upper esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012. Results: In the study, 126 patients with the upper esophageal foreign body impaction were treated with RE, while 45 patients received FE. (1)The size of FBs in FE group was the same as RE group （P=0.495, P=0.125）. (2)The period impacted in the esophagus of RE group (25.8±28.6) h was longer than that of FE group (13.9±14.5) h（P=0.009）. (3)71.4% of the patients in RE and 88.9% in FE group went to hospital for treatment within 24 hours from being impacted, while 15.1% in RE group and 8.9% in FE group were between 24 and 48 hours.13.5% in RE and 2.2% in FE group went to hospital beyond 48 hours.(4)The proportion of FBs puncturing into one or two esophageal walls in RE group (67.5%) was higher than that in FE group (35.6%).(5) The positive rates with the upper gastrointestinal barium contrast and chest X-ray or abdominal plain film were 98.3%,23.6% and 100%,14.3% for diagnosing esophageal FBs in RE and FE groups.(6)The successful rate, complication rate and perforation rate were 100%，38.1% and 6.3%and 95.6%，48.9%，and 2.2% in RE and FE groups, respectively with no statistical difference （P>0.05）. Conclusion: Both RE and FE were effective in the extraction of upper esophageal FBs with no difference in the complication and perforation rates. But FE was cheaper and no need for general anesthesia.

Key words: Esophagus, Foreign bodies, Esophagoscopes

闫秀娥，王丽，周丽雅，林三仁,王晔，程志蓉. 171例食管上段异物的内镜治疗[J]. 北京大学学报（医学版）, 2014, 46(1): 160-164.

YAN Xiu-e, WANG Li, ZHOU Li-ya, LIN San-ren, WANG Ye, CHENG Zhi-rong. Analysis for 171 cases of esophageal foreign bodies impacted in upper esophagus with endoscopic treatment[J]. Journal of Peking University(Health Sciences), 2014, 46(1): 160-164.

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