Risk factors and treatment strategies of digestive tract foreign body perforation

Hong ZHANG; Shaosong YE; Yanhong WANG; Yaowei ZHANG; Zhaohui LUAN; Hui LIN; Jianying BAI; Shiming YANG; Chaoqiang FAN

doi:10.16016/j.2097-0927.202110022

您当前的位置：

首页 >

文章列表页 >

Risk factors and treatment strategies of digestive tract foreign body perforation

Clinical Medicine | 更新时间：2026-01-09

- Risk factors and treatment strategies of digestive tract foreign body perforation
- Journal of Army Medical University Vol. 44, Issue 4, Pages: 379-384(2022)
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院消化内科
  2.637000 四川南充，川北医学院附属医院消化内科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81972315);the City-College Joint Project of Nanchong City(19SXHZ0288)
- DOI：10.16016/j.2097-0927.202110022
  CLC： R57;R649.4;R656
- Received：07 October 2021，
  
  Revised：2021-11-15，
  
  Published：28 February 2022
- 稿件说明：
移动端阅览
Hong ZHANG, Shaosong YE, Yanhong WANG, et al. Risk factors and treatment strategies of digestive tract foreign body perforation[J]. Journal of Army Medical University, 2022, 44(4): 379-384.
DOI：

Hong ZHANG, Shaosong YE, Yanhong WANG, et al. Risk factors and treatment strategies of digestive tract foreign body perforation[J]. Journal of Army Medical University, 2022, 44(4): 379-384. DOI： 10.16016/j.2097-0927.202110022.

摘要

目的

探讨消化道异物的临床和内镜下特点，分析异物引起穿孔的相关危险因素，总结异物引起消化道穿孔的治疗策略。

方法

回顾性分析陆军军医大学第二附属医院2014年1月至2021年1月因消化道异物就诊患者的临床资料，总结其临床及内镜下特点。采用单因素和Logistic多因素分析引起异物穿孔的相关危险因素。

结果

共有422例患者纳入分析。异物常见嵌顿部位由高到低分别为食管(75.8%，320/422)、肠(9.0%，38/422)、胃(7.8%，33/422)、咽部(7.3%，31/422)。异物嵌顿时间＜6 h、6~23 h、24~72 h和＞72 h的患者分别占10.7%(45/422)、13.0%(55/422)、39.3%(166/422)和37.0%(156/422)。异物穿孔发生率为24.2%(102/422)，以食管异物穿孔(22.9%，97/422)最为常见，咽部和胃各2例穿孔，肠异物穿孔1例。Logistic多因素分析结果显示，年龄≥60岁[

＜0.001，

(95%

): 2.840(1.531~5.423)

]

、异物嵌顿时间＞72 h[

=0.001，

(95%

): 81.288 (10.194~648.189)

]

、异物边缘锐利[

＜0.001，

(95%

): 122.686 (14.054~1 071.015)

]

等因素与异物穿孔相关。穿孔患者在内镜下取出异物后，通过内科保守治疗97.06%(99/102)治愈出院，2例合并出血致死亡，1例穿孔严重，异物取出困难

转外科手术治疗。

结论

患者年龄≥60岁、异物形状尖锐、嵌顿时间＞72 h及嵌顿部位为食管上段是消化道异物并穿孔的危险因素；异物引起的消化道穿孔在排除大血管损伤的前提下内科保守治疗效果好。

Abstract

Objective

To explore the clinical and endoscopic characteristics of gastrointestinal foreign body

analyze the risk factors of gastrointestinal perforation caused by foreign body

and summarize the treatment strategies of the perforation.

Methods

The clinical data of patients treated due to foreign body in digestive tract in the Second Affiliated Hospital of Army Medical University from January 2014 to January 2021 were collected and retrospectively analyzed

and the clinical and endoscopic characteristics of the patients were studied. Single variate and multivariate logistic analyses were used to analyze the risk factors of foreign body perforation.

Results

A total of 422 patients were included in the analysis. The most common sites of foreign body incarceration were the esophagus (75.8%

320/422)

intestine (9.0%

38/422)

stomach (7.8%

33/422) and pharynx (7.3%

31/422). The patients with foreign body incarc

eration for

6~23

24~72 and

72 h accounted for 10.7% (45/422)

13.0% (55/422)

39.3% (166/422) and 37.0% (156/422)

respectively. The incidence of foreign body perforation was 24.2% (102/422)

with esophageal foreign body perforation most common (22.9%

97/422)

followed by the perforation in the pharynx

stomach and intestine [0.5% (2/422)

0.5% (2/422) and 0.2% (1/422)

]

. Multivariate logistics analysis showed that age ≥60 years (

0.001

=2.840

95%

: 1.531~5.423)

foreign body incarceration time

72 h (

=0.001

=81.288

95%

: 10.194~648.189)

and sharp-edged foreign body (

0.001

=122.686

95%

: 14.054~1 071.015) were associated with foreign body perforation. After foreign bodies were removed under endoscope

97.06% (99/102) of patients were cured and discharged after internal conservative treatment. Two cases died due to hemorrhage

and one was transferred to surgery because of serious perforation and difficulty for foreign body removal.

Conclusion

Age ≥60 years

sharp-edged shape

incarceration time >72 h

and incarceration at the upper esophagus are risk factors for gastrointestinal foreign body perforation. Internal conservative treatment shows good efficacy on the perforation caused by foreign body on the premise of eliminating the damage to large vessels.

关键词

Keywords

references

LONGSTRETH G F, LONGSTRETH K J, YAO J F. Esophageal food impaction: epidemiology and therapy. A retrospective, observational study[J]. Gastrointest Endosc, 2001, 53(2): 193-198. DOI: 10.1067/mge.2001.112709.

XIA Y, ZHANG F, XU H, et al . Use of the blue cotton screen method with endoscopy to detect occult esophageal foreign bodies[J ] . Videosurg Other Miniinvas Tech, 2017, 12(4): 428-436. DOI: 10.5114/wiitm.2017.72326.

中国企业管理研究会公共卫生与医疗健康管理研究院, 浙江长三角健康科技研究院老年病急救技术研究部, 浙江省增龄与理化损伤性疾病诊治研究重点实验室, 等. 成人食管异物急诊处置专家共识(2020版)[J]. 中华急诊医学杂志, 2021, 30(1): 25-30. DOI: 10.3760/cma.j.issn.1671-0282.2021.01.007.Public

Health and Medical Health Management Research Institute of China Enterprise Management Research Association, Geriatric Emergency Technology Research Department of Zhejiang Yangtze River Delta Health Science and Technology Research Institute, Zhejiang Provincial Key Laboratory of Diagnosis and Treatment of Aging and Physical and Chemical Injury Diseases, et al . Expert consensus on emergency management of esophageal foreign body in adults (2020 Edition)[J ] . Chin J Emerg Med, 2021, 30(1): 25-30. DOI: 10.3760/cma.j.issn.1671-0282.2021.01.007.

肖永光, 王土生, 黄杰, 等. 胸段食管骨性异物穿孔的分类与外科治疗[J]. 中华胃肠外科杂志, 2010, 13(5): 363-365. DOI: 10.3760/cma.j.issn.1671-0274.2010.05.019.

XIAO Y G, WANG T S, HUANG J, et al . Surgical treatment of traumaticintrathoracic esophageal perforations by foreign bone[J ] . Chin J Gastrointest Surg, 2010, 13(5): 363-365. DOI: 10.3760/cma.j.issn.1671-0274.2010.05.019.

LI Z S, SUN Z X, ZOU D W, et al . Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China[J ] . Gastrointest Endosc, 2006, 64(4): 485-492. DOI: 10.1016/j.gie.2006.01.059.

邓彦超, 孙清超, 张海平, 等. 复杂性食管异物伴食管穿孔的外科治疗体会[J]. 新疆医科大学学报, 2015, 38(10): 1276-1278. DOI: 10.3969/j.issn.1009-5551.2015.10.018.

DENG Y C, SUN Q C, ZHANG H P, et al . Surgical treatment of complication foreign body in the esophagus[J ] . J Xinjiang Med Univ, 2015, 38(10): 1276-1278. DOI: 10.3969/j.issn.1009-5551.2015.10.018.

BOO S J, KIM H U. Esophageal foreign body: treatment and complications[J]. Korean J Gastroenterol, 2018, 72(1): 1-5. DOI: 10.4166/kjg.2018.72.1.1.

SALTIEL J, MOLINSKY R, LEBWOHL B. Predictors of outcomes in endoscopies for foreign body ingestion: a cross-sectional study[J]. Dig Dis Sci, 2020, 65(9): 2637-2643. DOI: 10.1007/s10620-019-06033-3.

AKRAM J, AMIN F M, TOFT J G, et al . Treatment of foreign body impactions inoesophagus[J ] . Ugeskrift Laeger, 2013, 175(10): 640-643.

AL-SEBEIH K, ABU-SHARA K A, SOBEIH A. Extraluminal perforation complicating foreign bodies in the upper aerodigestive tract[J]. Ann Otol Rhinol Laryngol, 2010, 119(5): 284-288. DOI: 10.1177/000348941011900502.

BIRK M, BAUERFEIND P, DEPREZ P H, et al . Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline[J ] . Endoscopy, 2016, 48(5): 489-496. DOI: 10.1055/s-0042-100456.

LIN H H, LEE S C, CHU H C, et al . Emergency endoscopic management of dietary foreign bodies in the esophagus[J ] . Am J Emerg Med, 2007, 25(6): 662-665. DOI: 10.1016/j.ajem.2006.12.012.

WU W T, CHIU C T, KUO C J, et al . Endoscopic management of suspected esophageal foreign body in adults[J ] . Dis Esophagus, 2011, 24(3): 131-137. DOI: 10.1111/j.1442-2050.2010.01116.x.

MAISS J, RAITHEL M, NÄGEL A. Foreign bodies in the upper gastrointestinal tract[J]. HNO, 2012, 60(9): 792, 794-797.

LEE C Y, KAO B Z, WU C S, et al . Retrospective analysis of endoscopic management of foreign bodies in the upper gastrointestinal tract of adults[J ] . J Chin Med Assoc, 2019, 82(2): 105-109. DOI: 10.1097/jcma.0000000000000010.

中华医学会消化内镜学分会. 中国上消化道异物内镜处理专家共识意见(2015年, 上海)[J]. 中华消化内镜杂志, 2016, 33(1): 19-28. DOI: 10.3760/cma.j.issn.1007-5232.2016.01.003.

Branch of Digestive Endoscopy of Chinese Medical Association, Consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract in China (2015, Shanghai)[J]. Chin J Dig Endosc, 2016, 33(1): 19-28. DOI: 10.3760/cma.j.issn.1007-5232.2016.01.003.

MAURICIO E B M, JAVIER A M U, ANA K H G, et al . Foreign body in esophagus: Case report[J ] . Int J Surg Case Rep, 2021, 87: 106417. DOI: 10.1016/j.ijscr.2021.106417.

DOMEKI Y, KATO H. Foreign body in esophagus[J]. Kyobu Geka, 2015, 68(8): 706-710.

LEE H J, KIM H S, JEON J, et al . Endoscopic foreign body removal in the upper gastrointestinal tract: risk factors predicting conversion to surgery[J ] . Surg Endosc, 2016, 30(1): 106-113. DOI: 10.1007/s00464-015-4167-0.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Clinical characteristics and endoscopic treatment of suprasellar Rathke cleft cysts

Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa

Cold versus hot snare polypectomy in treatment of small colorectal polyps: a retrospective study on safety and efficacy

Transcatheter aortic valve replacement: clinical researches and progress of application

Risk factors of lower limb deep venous thrombosis after traumatic brain injury: a retrospective case-control study

Related Author

Ao QIAN

Xiaoshu WANG

Gang YANG

Xin ZHANG

Gang HUO

ZHENG Xipeng

PAN Huilin

WU Linyu

Related Institution

Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University

Department of Pathology， Army Medical Center of PLA/Daping Hospital of Third Military Medical University， Chongqing

First Clinical College of Chongqing Medical University

Department of Gastroenterology， Chongqing Key Laboratory of Precise Prevention and Treatment of Digestive Malignancies

Department of Gastroenterology, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰