摘要
目的总结异物致食管穿孔后形成移行性颈部异物的临床特点、诊断治疗方法及相关危险因素。方法回顾性分析2018年1月—2025年1月南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科收治的误咽异物的74例患者。术前通过颈部CT定位示异物已穿透食管移行至颈段食管外周围组织患者31例,男性13例,女性18例;年龄29~91岁,平均60.9岁。并以同期收治的43例CT示异物仍位于食管内异物患者作为对照组,男性18例,女性25例;年龄24~90岁,平均58.7岁。根据患者异物所在位置选择合理的手术方案。收集患者一般资料、手术情况、术后并发症及临床转归,对比两组患者嵌顿异物种类、首次就诊时间、胃管留置时间及住院时间等,分析异物移行的危险因素。结果移行性颈部异物组患者的临床症状表现包括吞咽痛20例(64.5%)、异物感17例(54.8%)、颈部疼痛13例(41.9%)、发热6例(19.4%)、呼吸不畅3例(9.7%)等;异物种类为鱼刺25例(80.6%)、金属丝3例(9.7%)、鸡骨头3例(9.7%);异物移行至颈部出现的并发症有颈部脓肿11例(35.5%)、纵隔脓肿5例(16.1%)、咽后壁脓肿1例(3.2%);本组中31例患者均行颈侧切开异物取出,伴有颈部、纵隔脓肿时同期行脓肿切开引流治疗;术后并发症主要为声音嘶哑1例(3.2%)、进食呛咳3例(9.7%)。而食管内异物组患者以咽痛、吞咽痛、异物感及颈部局部疼痛为主要临床症状;异物种类包括鱼刺29例(67.4%)、鸡骨头5例(11.6%)、鸭骨头4例(9.3%)、猪骨头2例(4.7%)、枣核2例(4.7%)及假牙套1例(2.3%);该组患者术前未见明显并发症,且行食道镜下异物取出术,术后亦无明显并发症发生。两组相比,摄入鱼刺[25(80.6%)vs.29(67.4%),OR=2.01]、首次就诊时间>24 h[27(87.1%)vs.9(20.9%),OR=25.50]是食管异物移行至食管外的重要危险因素(P均<0.05)。结论误咽异物发生食管嵌顿多为尖锐异物。尖锐异物及首次就诊时间>24 h是引发食管穿孔、异物发生移行的危险因素。移行性颈部异物需行开放性手术处理,手术效果良好。食管异物需及早处理,否则容易发生移行,出现严重并发症。
Objective To summarize the clinical characteristics,diagnostic and therapeutic approaches,and associated risk factors of migratory cervical foreign bodies secondary to esophageal perforation.Methods A retrospective analysis was conducted on 74 patients with ingested foreign bodies admitted to our department between Jan.2018 and Jan.2025.Among them,31 cases(13 males,18 females;mean age 60.9 years,ranging 29-91 years)exhibited esophageal perforation with migratory cervical foreign bodies into the periesophageal tissues,as confirmed by preoperative cervical CT.A control group of 43 patients(18 males,25 females;mean age 58.7 years,ranging 24-90 years)with esophageal foreign bodies admitted during the same period,as indicated by CT,was included.Surgical strategies were tailored based on the location of the foreign body.Basic data,surgical details,postoperative complications,and clinical outcomes were collected.The two groups were compared regarding the types of ingested foreign bodies,mean initial medical consultation time,duration of nasogastric tube retention,and hospitalization length.Risk factors for foreign body migration were analyzed.Results Clinical manifestations of the 31 patients with migratory cervical foreign bodies included odynophagia in 20 cases(64.5%),foreign body sensation in 17 cases(54.8%),neck pain in 13 cases(41.9%),fever in 6 cases(19.4%),and dyspnea in 3 cases(9.7%).The types of foreign bodies were fish bones in 25 cases(80.6%),metal wires in 3 cases(9.7%),and chicken bones in 3 cases(9.7%).Complications arising from migratory cervical foreign bodies included neck abscess in 11 cases(35.5%),mediastinal abscess in 5 cases(16.1%),and retropharyngeal abscess in 1 case(3.2%).All the 31 patients underwent lateral neck incision for foreign body removal,with concurrent abscess incision and drainage performed when neck or mediastinal abscesses were present.Postoperative complications mainly included hoarseness in 1 case(3.2%)and choking during eating in 3 cases(9.7%).In contrast,patients with esophageal foreign bodies primarily presented with pharyngeal pain,odynophagia,foreign body sensation,and localized neck pain.The types of foreign bodies in this group included fish bones in 29 cases(67.4%),chicken bones in 5 cases(11.6%),duck bones in 4 cases(9.3%),pork bones in 2 cases(4.7%),jujube pits in 2 cases(4.7%),and dentures in 1 case(2.3%).No significant preoperative complication was observed in this group,and esophagoscopic foreign body removal was performed without notable postoperative complications.Compared to patients with esophageal foreign bodies(n=43),those with migratory cervical foreign bodies(n=31)showed that fish bone ingestion[25(80.6%)vs.29(67.4%),OR=2.01]and initial medical consultation time>24 h[27(87.1%)vs.9(20.9%),OR=25.50]were significant risk factors for foreign body migration outside the esophagus(all P<0.001).Conclusion Esophageal impaction of ingested foreign bodies predominantly involves sharp objects.Sharp foreign bodies and an initial medical consultation time>24 h are risk factors for esophageal perforation and foreign body migration.Migratory cervical foreign bodies require open surgical intervention,with favorable surgical outcomes.Esophageal foreign bodies should be managed promptly to prevent migration and severe complications.
作者
马登滨
卫亚楠
李嘉怡
顾亚军
沈晓辉
钱晓云
高下
Ma Dengbin;Wei Yanan;Li Jiayi;Gu Yajun;Shen Xiaohui;Qian Xiaoyun;Gao Xia(Department of Otolaryngology-Head and Neck Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《创伤外科杂志》
2025年第11期819-824,共6页
Journal of Traumatic Surgery
基金
国家自然科学基金重大项目(82192862)
江苏省重点研发计划(BE2023653)
江苏省医学重点学科/实验室(ZDXK202243)。
关键词
食管穿孔
移行
异物
外科手术
Esophageal perforation
Migration
Foreign bodies
Surgery
