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Management of Esophageal Foreign Bodies: A Retrospective Review of 158 Adult Patients

食道異物的處置:158位成年患者的回溯性研究

摘要


動機:報告吾人對於食道異物的處置經驗,並且分析所觀察到之食道異物的特性。材料和方法:我們追溯分析在一所大學附屬之教學醫院中,於1999年1月至2005年6月期間,曾有食道異物吞食的病史而就醫的158位成年病患。 結果:全部共有158位病患,平均年齡47.7歲,其中104位(65.8%)為女性。吞入的原因幾乎以誤食為主(98.7%),而其中之151位病患(95.6%)以軟式或者硬式的內視鏡治療取出其異物。最常造成食道異物阻塞的物體是魚骨頭(41.1%),而其次依序為雞骨頭(37.3%)、未拆錫箔包裝的藥物(5.7%)、食團(4.4%)、假牙(2.5%)等。大多數物體(79.7%)位於上三分之一的食道;但是88.8%未拆錫箔包裝的藥九卡在中間或下三分之一的食道。有兩位病患不能以內視鏡的方式取出異物(雞和魚骨頭),其中一位因雞骨頭造成阻塞的病患併發延遲性的食道穿孔,兩者進而轉診至外科接受手術。整體而言,手術的比例為1.3%,然而沒有死亡的案例。 結論:成人食道異物吞入常見的原因是誤食,而最常造成異物阻塞的物體是魚骨頭和雞骨頭。因大多數的異物位於上三分之一的食道處,所以我們要更小心的檢查這一段食道,以免造成不必要的傷害或併發症。軟式或硬式的內視鏡檢是值得信賴的處理方法,而外科手術則可保留於內視鏡無法處理的異物或者併發腸胃道穿孔的患者。

關鍵字

內視鏡 食道 異物 腸胃道穿孔

並列摘要


Aims: The characteristics and management of esophageal foreign body ingestion were investigated in an university teaching hospital. Materials and Methods: All patients with a history of foreign body ingestion, gathered between January 1999 and June 2005, were included in this study. Data were collected by retrospective chart review and were statistically analyzed. Results: A total of 158 consecutive patients, had a mean age of 47.7 years, and 104 (65.8%) were female. The cause of ingestion was accidental in almost all patients (98.7%) and most of the ingested materials (95.6%) were successfully extracted using either flexible or rigid endoscope. The objects most frequently ingested, in the order of decreased frequency, were fish bone (41.1%), chicken bone (37.3%), packaged pill (5.7%), meat (4.4%), denture (2.5%) and others. Most of the objects (79.7%) were lodged at the upper esophagus in contrast to 88.8% of packaged pills found at the middle or lower esophagus. Two patients with irretrievable foreign bodies or complicated perforation by chicken bone impaction at upper esophagus were led to surgery. The overall surgery rate was 1.3% and there was no mortality. Conclusions: Swallowed foreign body in the adult population is most commonly secondary to accidental ingestion and is frequently caused by fish and chicken bones. Since most of our patients had the ingested foreign bodies impacted at the upper esophagus, physicians should especially take care of this location to avoid unnecessary injury or complication. Either rigid esophagoscope or flexible panendoscope serves as a reliable method in the treatment of most esophageal foreign body impaction. Surgical intervention is reserved for cases with irretrievable foreign body or esophageal perforation.

並列關鍵字

endoscopy esophagus foreign bodies GI perforation

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