食管异物的外科治疗_时辉VIP专享VIP免费

论著#临床研究食管异物的外科治疗时辉沈春辉梅龙勇周渝斌车国卫(四川大学华西医院胸外科,成都610041)摘要:目的探讨食管异物患者外科治疗的效果,为其防治提供借鉴。方法回顾性分析华西医院2005年6月至2010年12月收治的18例食管异物患者的临床资料,其中男13例(72.22%),女5例(27.78%);年龄57.50?15.28岁(30~82岁)。18例患者均有吞食异物史,食管异物以动物骨骼为主(55.55%,10/18),食管胸上段(66167%,12/18)为异物最常见嵌顿部位。2例未检查出确切并发症,16例有不同程度的穿孔、黏膜重度损伤等并发症。15例行手术治疗,3例未行手术治疗。结果15例行手术治疗患者的手术时间136.33?92.86min(50~410min),住院时间16.35?15.80d(4.00~69.92d);3例(其中78岁和82岁各1例)死亡,2例死于多器官功能衰竭,1例死于呼吸衰竭;其余12例顺利出院。3例未手术患者的住院时间为5.06?1.47d(3.71~6163d),均治愈出院。结论食管异物患者应及早就诊以减少相关并发症,手术为主要治疗方法之一。高龄和并发症是手术治疗死亡的主要原因。应在全面评估患者情况的基础上决定是否手术,选择术式。关键词:食管异物;外科治疗;并发症中图分类号:R655.4文献标识码:A文章编号:1007-4848(2011)04-0329-03SurgicalManagementofEsophagealForeignBodiesSHIHui,SHENChun-hui,MEILong-yong,ZHOUYu-bin,CHEGuo-wei.(DepartmentofThoracicSurgery,WestChinaHospital,SichuanUniversity,Chengdu610041,P.R.China)Correspondingauthor:CHEGuo-wei,Email:cheguowei@yahoo.com.cnAbstract:ObjectiveToinvestigatetheeffectofsurgicaltreatmentofpatientswithesophagealforeignbodies(EFBs),inordertoprovideareferenceforitsprevention.MethodsWeretrospectivelyanalyzedtheclinicalrecordsof18patientswithEFBstreatedinWestChinaHospitalfromJune2005toDecember2010.Therewere13malesand5femaleswithanaverageageof57.50?15.28years(30to82years).Allthe18patientshadahistoryofingestingEFBswhichweremainlyanimalbones(10/18).TheEFBsweremostlyintheuppersegmentsoftheesophagus(12/18).Sixteenpatientshadcomplicationslikeperforationsandseveremucosalinjuries,whilecomplicationswerenotdetectedintheother2patients.Fifteenpatientsreceivedsurgicaltreatment,whiletheother3patientsdidn.t.ResultsAsforthe15patientswithsurgicaltreatment,theoperativetimewas136.33?92.86minutes(50to410minutes),andthehospitalstaywas16.35?15.8days(4.00to69.92days).Threepatients(ofwhich,oneagedat78yearsandone82years)died,amongwhomtwodiedofmult-iorganfailure,and1diedofrespiratoryfailure.Alltheother12patientsweredischargedfromthehospital.Forthe3patientswithoutsurgicaltreatment,thehospitalstaytimewas5.06?1.47daysrangedfrom3.71to6.63days.Theywerecuredandleftthehospital.ConclusionEFBsshouldbetreatedasearlyaspossibletoreduceseverecomplications.SurgeryisstilloneofthemostlyusedtreatmentsforEFBs.Senilityandcomplicationsarethemajorcausesofdeath.ItshouldbecomprehensivelyassessedwhethertheEFBspatientsshouldreceiveoperationsandwhichoperativeproceduresshouldbeperformed.Keywords:Esophagealforeignbody;Surgicaltreatment;Complication食管异物占消化道异物的1/3,其诊治方式由异物的大小、形状、嵌顿部位及嵌顿时间决定[1]。大多数异物可由耳鼻喉科医生经内窥镜取出或降入胃肠道排出体外。仅部分因体积大、不规整、位置特殊而难以取出,或异物已引起穿孔、瘘、纵隔脓肿等并发症,需要接受外科治疗[2]。2005年6月至2010年12通讯作者:车国卫,Email:cheguowei@yahoo.com.cn月,我科共收治食管异物患者18例,现总结其临床特征及诊治效果,以期为临床诊治此类患者提供借鉴。1资料与方法1.1临床资料本组共18例,男13例,女5例;年龄57.50?15.28岁(30~82岁)。按照我国对年龄的界定方法,60岁以上为老年。本组中老年患者9例。吞食的异#329#中国胸心血管外科临床杂志2011年8月第18卷第4期ChinJClinThoracCardiovas...