中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2012年
6期
332-335
,共4页
朱泱蓓%柏愚%邹多武%李兆申
硃泱蓓%柏愚%鄒多武%李兆申
주앙배%백우%추다무%리조신
内窥镜%上消化道异物%取异物
內窺鏡%上消化道異物%取異物
내규경%상소화도이물%취이물
Endoscopes%Upper gastrointestinal foreign bodies%Romove
目的 系统评价国内上消化道嵌顿异物内镜取出失败的影响因素.方法 用循证医学方法,检索中文数据库中有关内镜取上消化道异物的文献并获取全文,根据严格的纳入和排除标准对文献进行筛选,从1975年至2010年10月共纳入215项研究(共904例取出失败),均为回顾性队列研究.然后对入选文献进行数据提取、汇总及归纳分析.结果 结果显示内镜下取金属类异物的失败率较高(23.0％,78/371)；异物吞入24h之后内镜取出失败的比例(97.5％,79/81)明显高于24h内取出失败的比例(2.5％,2/81)；内镜下取嵌顿于食管的异物的失败率(49.8％,213/428)较胃(29.0％,124/428)、十二指肠(17.0％,73/428)、会厌部(4.2％,18/428)的失败率高；特殊人群(被管制人员、精神心理异常患者)较一般患者失败率高[(8.4％,29/346)比(4.2％,875/21071),P=0.0001).术前行胸腹部X线检查和CT检查病例的失败率(3.7％,22/591)低于只行胸腹部X线检查(4.3％,788/18450)或钡餐检查(5.1％,50/980)的失败率.失败患者中有9例死亡病例,均为锐利骨类异物的嵌顿,8例嵌顿于食管中上段,6例嵌顿时间超过24h.结论 异物类型、大小、嵌顿时间、所处消化道位置以及患者的人群特点与内镜下取异物失败率的高低有关.做好充分的术前准备、加强特殊人群管理,改善饮食习惯,及时就诊是控制失败率的关键.
目的 繫統評價國內上消化道嵌頓異物內鏡取齣失敗的影響因素.方法 用循證醫學方法,檢索中文數據庫中有關內鏡取上消化道異物的文獻併穫取全文,根據嚴格的納入和排除標準對文獻進行篩選,從1975年至2010年10月共納入215項研究(共904例取齣失敗),均為迴顧性隊列研究.然後對入選文獻進行數據提取、彙總及歸納分析.結果 結果顯示內鏡下取金屬類異物的失敗率較高(23.0％,78/371)；異物吞入24h之後內鏡取齣失敗的比例(97.5％,79/81)明顯高于24h內取齣失敗的比例(2.5％,2/81)；內鏡下取嵌頓于食管的異物的失敗率(49.8％,213/428)較胃(29.0％,124/428)、十二指腸(17.0％,73/428)、會厭部(4.2％,18/428)的失敗率高；特殊人群(被管製人員、精神心理異常患者)較一般患者失敗率高[(8.4％,29/346)比(4.2％,875/21071),P=0.0001).術前行胸腹部X線檢查和CT檢查病例的失敗率(3.7％,22/591)低于隻行胸腹部X線檢查(4.3％,788/18450)或鋇餐檢查(5.1％,50/980)的失敗率.失敗患者中有9例死亡病例,均為銳利骨類異物的嵌頓,8例嵌頓于食管中上段,6例嵌頓時間超過24h.結論 異物類型、大小、嵌頓時間、所處消化道位置以及患者的人群特點與內鏡下取異物失敗率的高低有關.做好充分的術前準備、加彊特殊人群管理,改善飲食習慣,及時就診是控製失敗率的關鍵.
목적 계통평개국내상소화도감돈이물내경취출실패적영향인소.방법 용순증의학방법,검색중문수거고중유관내경취상소화도이물적문헌병획취전문,근거엄격적납입화배제표준대문헌진행사선,종1975년지2010년10월공납입215항연구(공904례취출실패),균위회고성대렬연구.연후대입선문헌진행수거제취、회총급귀납분석.결과 결과현시내경하취금속류이물적실패솔교고(23.0％,78/371)；이물탄입24h지후내경취출실패적비례(97.5％,79/81)명현고우24h내취출실패적비례(2.5％,2/81)；내경하취감돈우식관적이물적실패솔(49.8％,213/428)교위(29.0％,124/428)、십이지장(17.0％,73/428)、회염부(4.2％,18/428)적실패솔고；특수인군(피관제인원、정신심리이상환자)교일반환자실패솔고[(8.4％,29/346)비(4.2％,875/21071),P=0.0001).술전행흉복부X선검사화CT검사병례적실패솔(3.7％,22/591)저우지행흉복부X선검사(4.3％,788/18450)혹패찬검사(5.1％,50/980)적실패솔.실패환자중유9례사망병례,균위예리골류이물적감돈,8례감돈우식관중상단,6례감돈시간초과24h.결론 이물류형、대소、감돈시간、소처소화도위치이급환자적인군특점여내경하취이물실패솔적고저유관.주호충분적술전준비、가강특수인군관리,개선음식습관,급시취진시공제실패솔적관건.
Objective To systematically review endoscopic failure to remove upper gastrpintestinal foreign bodies in China,Methods We searched literature in Chinese database ( 1975 ～ October,2010) according to inclusion and exclusion criteria,and then data of 215 studies (904 patients) were extracted,summarized and analyzed.Results Patients in 24-hour group accounted for a higher proportion than the within 24-bour group (97.5％ v.s.2.5％ ).The failure rate for esophageal incarceration (49.8％ ) was higher than those for stomach (29.0％ ),duodenum ( 17.0％ ) and epiglottis headquarter (4.2％ ).In mental or psychiatric patients,the failure rate was higher than that of common people ( 8.4 ％ v.s.4.2％ ; P =0.0001 ).Failure rate for those who underwent chest X-rays and CT (3.7％) was lower than that for those who underwent X-rays (4.3％ ) or barium meal examination (5.1％ ) only.There were 9 deaths and the types of the foreign bodies were all bones,in which 8 were located in the upper esophagus and 6 were beyond 24 hours.Conclusion Foreign body type,size,incarceration time,location and population characteristics of patients are closely related to the failure of removing foreign bodies with endoscopy.It is suggested that we should improve the management of special population and offer timely treatment.
