消化道异物并穿孔的危险因素分析及治疗策略

张红; 叶少松; 王彦宏; 张耀巍; 栾兆辉; 林辉; 柏健鹰; 杨仕明; 樊超强

doi:10.16016/j.2097-0927.202110022

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消化道异物并穿孔的危险因素分析及治疗策略

临床医学 | 更新时间：2026-01-09

- 消化道异物并穿孔的危险因素分析及治疗策略
- Risk factors and treatment strategies of digestive tract foreign body perforation
- 陆军军医大学学报 2022年44卷第4期页码：379-384
- 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：
  
  [樊超强，E-mail: fcqxhkwjs@126.com FAN Chaoqiang, E-mail: fcqxhkwjs@126.com
- 基金信息：
  
  国家自然科学基金面上项目(81972315);南充市市校合作(19SXHZ0288)
- DOI：10.16016/j.2097-0927.202110022
  中图分类号： R57;R649.4;R656
- 收稿：2021-10-07，
  
  修回：2021-11-15，
  
  纸质出版：2022-02-28
- 稿件说明：
移动端阅览
张红, 叶少松, 王彦宏, 等. 消化道异物并穿孔的危险因素分析及治疗策略[J]. 陆军军医大学学报, 2022,44(4):379-384.

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.
张红, 叶少松, 王彦宏, 等. 消化道异物并穿孔的危险因素分析及治疗策略[J]. 陆军军医大学学报, 2022,44(4):379-384. DOI： 10.16016/j.2097-0927.202110022.

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

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