摘要目的 分析食管异物嵌顿后并发症发生的相关影响因素及软式内镜的治疗效果.方法 回顾性分析北京大学第三医院消化科2005年1月至2012年12月经北京大学第三医院消化科软式内镜下治疗的101例食管异物病例资料,其中男52例、女49例,年龄(49±21)岁.所有患者在行咽部局部麻醉并禁食4h以上后于消化科内镜中心行软式内镜下治疗.t检验或x2检验比较组间差异.结果 (1)异物嵌顿于食管上段及中段占到了所有食管异物的87.1％(88例),异物嵌顿后至异物取出的间隔时间在食管上、中、下段差异无统计学意义(P＞0.05).(2)82.2％(83例)的食管异物患者在24h内就诊,99.0％(100例)的食管异物患者在48 h内就诊.嵌顿的异物中食物类(包括食物团块、鱼刺、鸡骨及枣核)占到了76.2％(77例).(3)上消化道造影诊断食管异物阳性率91.3％(21/23),胸部或腹部X线片诊断食管异物阳性率为24.1％(7/29),软式内镜取食管异物成功率94.1％(95例).(4)所有异物中义齿取出难度最大,11例义齿嵌顿中4例失败.(5)并发症(除轻度划伤)发生率为48.5％(49例),穿孔率为3.0％(3例).异物嵌顿食管后是否出现并发症与患者年龄、嵌顿位置、嵌顿时间、异物大小均无关(均P ＞0.05),而与异物是否刺入食管壁、合并食管狭窄、异物种类有关(均P ＜0.01).异物嵌顿食管壁后是否出现穿孔则与上述因素均无关.结论 异物在嵌顿食管后尤其是边缘锐利、刺人食管壁的异物,应尽可能在24 h内取出.

abstractsObjective To analyze the related factors of complications and treatment efficacy with flexible endoscopy for esophageal foreign body (FB).Methods In a retrospective study with consecutive data,101 adults including 52 males and 49 females with esophageal FB impaction between January 2005 and December 2012 admitted into Department of Gastroenterology's Endoscopic Unit at Peking University Third Hospital were included,aged (49 ± 21) years.Results (1) FB impaction in upper and middle esophagus accounted for 87.1％ (n =88) of all esophageal FBs.No significant difference existed in interval time from impaction to removal of FB impacted between upper,middle and lower esophagus(P ＞ 0.05).(2) Patients with esophageal FB seeking hospital treatment accounted for 82.2％ (n =83) within 24 h and 99.0％ (n =100)within 48 h.Food lump,fish bone,chicken bone and fruit seeds accounted for 76.2％ (n =77).(3)Positive rates were 91.3％ (21/23)and 24.1％ (7/29)with upper gastrointestinal barium contrast and chest or abdominal plain film.The success rate was 94.1％ (n =95) with flexible endoscopy for removal of FB.(4) Denture was the most difficult FB for removal.Four patients in all 11 patients with denture impacted were not removed successfully with flexible endoscopy.(5) The complication (except for mild scratch) rate was 48.5％ (n =49) and the perforation rate 3.0％ (n =3).Whether complications took place or not was independent of age,location of impaction,time from impaction to removal and size of FB (all P ＞ 0.05),but dependent on piercing into esophageal wall,concomitant with esophageal stricture and types of FB (all P ＜ 0.01).Whether perforation or not was independent of any above factor.Conclusion Esophageal FB should be removed as soon as possible within 24 h especially for those with sharp edges and piercing into esophageal wall.