Objective: To explore the clinical features and complications of foreign bodies in the upper gastrointestinal tract in children and to investigate the effectiveness of endoscopic management. Methods: Data of patients with foreign bodies in upper gastrointestinal tract were collected retrospectively at Endoscopy Center, the Children's Hospital, Zhejiang University School of Medicine, from January 2011 to December 2016. Clinical characteristics, the types of foreign bodies, the location and duration of foreign body impaction were summarized. The risk factors of complications and endoscopic removal failure were analyzed by using Logistic regression analysis. Results: A total of 1 334 patients (825 males and 509 females) were enrolled. The median age was 2.5 years, with a range from 0.25 to 15 years and peak age 1-3 years. Twenty patients had esophageal diseases. The most common foreign body ingested was coin (n=964, 72.3%). Foreign bodies were most commonly located in the esophagus (n=1 002, 75.1%), especially in the upper esophagus (n=857, 85.5%). The duration of foreign body impaction ranged from 3 hours to 5 years. Among 1 334 patients, 252 patients (18.9%) developed complications, including ulcers (n=101, 40.0%) and perforations(n=13, 5.2%). The success rate of endoscopic removal was 96.6% (n=1 288). By Logistic regression analysis, sharp foreign body ingestion (OR=6.893, 95%CI: 4.421-10.746) , esophageal impaction (OR=5.253, 95%CI:3.352-8.233) and foreign body impaction longer than 24 hours (OR=4.336, 95%CI:3.091-6.082) were risk factors of complications. Sharp foreign body ingestion was the risk factor of endoscopic failure (OR=5.372, 95%CI:2.773-10.406) . Conclusions: Coin is the most common foreign body in upper gastrointestinal tract. Sharp foreign bodies impacted in the esophagus over 24 hours increase the risk of complications. Endoscopic removal of foreign bodies from the upper gastrointestinal tract in children has a high success rate. Sharp foreign body ingestion increases the risk of failure in endoscopic removing.
目的： 探讨儿童上消化道异物的临床特点、并发症及内镜治疗的有效性。 方法： 回顾性分析2011年1月至2016年12月浙江大学医学院附属儿童医院经电子胃镜确诊上消化道异物的1 334例患儿的病例资料，Logistic回归分析患儿年龄、性别、异物边缘性质、嵌顿部位及时间与上消化道异物内镜取出失败、异物嵌顿并发症发生的关系，分析可能的危险因素。 结果： 经电子胃镜确诊上消化道异物患儿1 334例，男825例（61.8%），女509例（38.2%）。中位年龄2.5岁（3月龄~15岁），好发年龄为1~3岁（55.6%，742/1 334）。合并食管基础疾病患儿20例。异物最常见类型为硬币（72.3%，964/1 334）；常见嵌顿部位为食管（75.1%，1 002/1 334），尤以食管上段最多见（85.5%，857/1 002）；嵌顿时间3 h~5年余。异物嵌顿并发症的发生率为18.9%(252/1 334)，其中溃疡40.0%(101/252)、穿孔5.2%(13/252)。上消化道异物经电子胃镜取出成功率96.6%(1 288/1 334)。经Logistic回归分析，锐性异物（OR=6.893，95%CI：4.421~10.746）、食管嵌顿（OR=5.253，95%CI：3.352~8.233）及嵌顿时间>24 h（OR=4.336，95%CI：3.091~6.082）是异物嵌顿并发症的危险因素。锐性异物（OR=5.372，95%CI：2.773~10.406）是内镜取出失败的危险因素。 结论： 硬币嵌顿是儿童上消化道异物常见类型，锐性异物、食管嵌顿及嵌顿时间>24 h可导致嵌顿并发症的发生。上消化道异物经电子胃镜取出成功率高，锐性异物增加取出失败的风险。.
Keywords: Foreign bodies; Gastrointestinal tract; Retrospective studies.