儿童食管异物误诊及合并损伤的原因分析

Analysis of causes of misdiagnosis and accompanied injuries of esophageal foreign bodies in children

摘要:

目的 分析造成儿童食管异物误诊以及合并损伤的相关因素，为及时诊断和治疗提供参考。方法 对苏州大学附属儿童医院2011年3月—2019年3月收治的食管异物病例资料进行回顾性分析。采集异物吞入事件目击史、异物种类、异物形状、异物X线透光性、异物嵌顿时间、合并损伤等资料。依据治疗史，患者分为及时诊断组（A组）和误诊组（B组）。主诉症状分为消化道症状、呼吸道症状、其他症状、无症状。食管损伤分为0级、Ⅰ级、Ⅱ级、Ⅲ级。结果 食管异物患者共398例。1~2岁是发病的高峰年龄。A组平均年龄（3.98±3.27）岁，B组平均年龄（1.97±1.29）岁，两者差别具有统计学意义（P<0.05）。A组有目击史占比92.4%；B组目击史占比20%，两者差异具有统计学意义（P<0.05）。A组主诉消化道症状占比81.3%，B组主诉消化道症状占比56.7%，两者差异具有统计学意义（P<0.05）。A组主诉呼吸道症状占比1.4%，B组主诉呼吸道症状占比36.7%，两者差异具有统计学意义（P<0.05）。异物嵌顿时间、嵌顿位置、异物形状和合并损伤呈正相关（P<0.05）。所有异物种类中，纽扣电池的并发症发生率（100.0%）和Ⅲ级食管损伤的比率（33.3%），为所有异物种类中比率最高。结论 小年龄、目击史缺乏、主诉症状的差异是造成儿童食管异物误诊的主要因素。合并损伤和异物的嵌顿时间、异物形状、异物种类相关。纽扣电池是最危险的食管异物。

Abstract:

Objective To provide reference for timely diagnosis and treatment, it was analyze for the related factors of misdiagnosis and accompanied injuries of esophageal foreign bodies in children. Methods It was analyzed retrospectively for the data of the patients with esophageal foreign bodies admitted to Children's Hospital Affiliated to Soochow University from March 2011 to March 2019. These data were collected including witness of foreign body ingestion, chemical characters, shape, X-ray penetrability, embedding time and accompanied injuries. According to the treatment history, the patients were divided into the timely diagnosis group (Group A) and the misdiagnosis group (Group B). The main complaints were divided into digestive tract symptoms, respiratory tract symptoms, other symptoms and asymptomatic. Esophageal accompanied injuries can be divided into grade 0, grade I, grade II and grade III. Results There were 398 cases of esophageal foreign body. The peak age of onset is 1 to 2 years old.The peak age of onset is 1 to 2 years old. The average age of the Group A (3.98±3.27) years old, and that of group B was (1.97±1.29) years old. The difference between the two groups was statistically significant (P<0.05). The rate of witness in the Group A was 92.4%, and that in the Group B was 20%. There was a significant difference between the two groups (P<0.05). The proportion of chief complaints of digestive tract symptoms was 81.3% in group A and 56.7% in group B respectively. There was a significant difference between the two groups (P<0.05). The proportion of chief respiratory symptoms in group A was 1.4%, and that in group B was 36.7%, the difference between the two was statistically significant (P<0.05). There was a significant positive correlation between the embedding time, location, shape of foreign bodies and accompanied injuries (P<0.05). Among all chemical characters of foreign bodies, the complication rate of button battery (100.0%) and the rate of Ⅲ grade esophageal injury (33.3%) were the highest. Conclusion The main factors of misdiagnosis of esophageal foreign body in children are the young age, lack of witness and the difference of main symptoms. The accompanied injuries of esophageal foreign body were related to the embedding time, shape and type of foreign body. Button batteries are the most dangerous esophageal foreign body.