Foley管取小儿食管异物的观察及护理

食管异物通常由仓促进食或口中含物时误咽等引起，常规治疗方法是对患者实施全麻或局麻后，在食管镜或胃镜下取出。而形状圆钝光滑如硬币、纽扣电池等的异物，则可用Foley管取出。2003年5月-2005年5月，我科收治此类食管异物患儿共26例，在无麻醉条件下采用Foley管取出异物，效果显著，现就其治疗和护理情况总结如下。     

Foley管法取儿童食管异物138例临床分析

目的探讨Foley管法（F管）取儿童食管异物的安全性和有效性。方法回顾性分析成都市第三人民医院耳鼻喉科1998年1月至2008年1月138例儿童用F管取食管异物的效果、操作方法、并发症及其异物种类。结果 138例中用Foley管法不施麻醉顺利取出异物126例（91.3%）,全麻下食管镜术取出7例,5例自行滑入胃内排出。F管操作时间平均5.1min,无1例并发症发生;硬质食管镜手术时间平均15min,1例术中出现呼吸困难。138例异物分别为硬币类98例,纽扣类14例,象棋围棋子13例,钥匙环4例,塑料瓶盖3例,扁圆形电池3例,戒指3例。结论 F管法适于取儿童钝圆形食管异物,安全有效。     

Foley管法食管硬币取出术的护理

[目的]探讨食管硬币Foley管法取出术护理配合及意义。[方法]回顾研究我科收治的28例食管硬币异物病人,均在Foley管取出中,加强护理配和,保障了异物顺利取出。[结果]28例采用Foley管法食管硬币均完整取出,未发生任何并发症。[结论]术中护理积极配合,手术成功率达100%,比传统的食管异物取出术效率高,费用少,无需麻醉,家长满意。     

气囊导尿管在小儿食管异物取出术中的应用观察

小儿由于年龄的特点,喜欢把各类物品放入口中,很容易误咽使部分物品嵌顿于食管,造成食管异物,尤其以金属硬币多见。对于食管异物的取出,传统方法是采用硬直食管镜法直接钳取或电子胃镜活检钳钳取。2008～2010年我院应用无菌乳胶导尿管（简称For1ey管,亦称气囊导尿管）成功取出12例小儿食管异物（硬币和纽扣），现报告如下。 1 临床资料     

Foley管用于30例食管异物取出术疗效分析

分析两组分别采用Foley管和全麻插管 +硬质食管镜取异物特点。结果Foley管取异物在无创无麻醉的条件下术后反应轻。Foley管适用于固钝、光滑异物。具高效、无麻醉、损伤小、术后反应轻等特点。     

农村食管异物住院患者的护理——附128例病例报告

目的 探讨农村食管异物住院患者的护理。方法 对128例住院的食管异物患者进行临床统计分析。结果 本组患者除1例石块食管异物经颈侧切开取出者外，其余均经食管镜取出，痊愈出院。结论 128例住院食管异物患者，经过精心的护理和积极的支持疗法，在常规检查后，及时地上食管镜取出和颈侧切开取出异物，所有患者均迅速康复，无并发症发生，治愈率在100％。     

小儿不同类型食管异物36例治疗分析

目的 探讨不同类型、不同部位的小儿食管异物治疗方法及疗效.方法 36例小儿食管异物病例中,3例经抗炎治疗观察;36例全部行硬食管镜检查术.结果 3例表面光滑食管异物患者临床症状消失,异物随粪便一起排出;33例患者经硬食管镜下行异物取出术.其中4例出现并发症,1例食管穿孔,2例术后出现阻塞性呼吸困难,1例术后发生食管炎.结论 不同类型、不同部位的食管异物应采取不同的治疗方法,以减少术后并发症.     

9例特殊食管异物临床分析

目的：探讨几种特殊食管异物的诊治方法，提高其诊治水平。方法：对9例特殊食管异物的临床资料进行回顾性分析。结果：有8例异物经食管镜取出，1例经颈侧切开取出。食管损伤5例，食管穿孔2例，全部治愈。结论：特殊食管异物的处理应准备充分，采用最佳取出方法，防止并发症的发生。     

不同种类食管异物取出方法分析

目的 探讨不同种类食管异物取出方法.方法 79例种类不同食管异物患者分别在全身麻醉硬腔食管镜下、口咽黏膜表面麻醉前联合镜下、无痛纤维食管镜下异物取出术及颈侧切开异物取出术.结果 78例均顺利取出异物,其中1例食管上段穿孔者,因纵膈障反复感染致全身衰竭死亡.结论 根据异物种类、性质及患者自身条件,选择不同麻醉方式及手术方法,可获满意治疗效果.     

58例食管中段异物的诊断和处理评价

目的：评价食管中段异物的诊断及内镜下治疗措施。方法：在内镜直视下根据不同类型的异物应用不同的器械将异物取出。结果：58例食管中段异物，内镜下取出53例，成功率91．40％，除1例发生纵隔气肿外，均无其它并发症发生。未能取出异物的5例，均系病程超过48h，有穿孔并发症迹象，其中鱼刺4例，义齿1例。经外科治疗后死亡2例。结论：内镜下食管中段异物取出术是一种安全、有效的治疗方法。     

Esophageal foreign bodies

An impacted esophageal foreign body is most often an urgent, rather than a life-threatening, medical situation. Pharmacologic or mechanical methods can be used to relieve the impaction, depending on the patient, as well as the location and physical properties of the foreign body. Flexible fiberoptic esophagoscopy is the accepted standard of care for removal of an object that is not smooth, radiopaque, inert or recently impacted. Although controversial, balloon catheter extraction may be an acceptable alternative in selected cases of esophageal impaction. Intravenous glucagon is useful in relieving distal impaction.     

Esophageal foreign bodies

Over 80 per cent of ingested foreign bodies pass through the gastrointestinal tract without incident. Sharp (bones, pins, needles, wire) or long (greater than 6.5 cm) foreign bodies are most commonly implicated in perforation. Food boluses are most common in obstruction seen in adult patients and associated esophageal pathology is common in patients aged 60 years and older. Adults with nonfood foreign bodies have a high incidence of psychiatric, social, or chemical derangements. Pediatric patients most commonly ingest coins. Ingestions tend to occur during nonschool months or in high-risk situations, and repeat ingestions are not uncommon. Fatalities and other major complications are linked to type of foreign body, location, and duration of the impaction. Deaths have also occurred with endoscopic and enzymatic modalities of treatment. Glucagon and Foley catheter removal are safe techniques in selected patients, provided resuscitative skill and equipment are available. Based on these data, an algorithmic approach to the management of esophageal foreign bodies by the emergency physician is recommended (Table 5).     

Foreign body ingestion in children

Because many patients who have swallowed foreign bodies are asymptomatic, physicians must maintain a high index of suspicion. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. Foreign bodies lodged in the esophagus should be removed endoscopically, but some small, blunt objects may be pulled out using a Foley catheter or pushed into the stomach using bougienage [corrected] Once they are past the esophagus, large or sharp foreign bodies should be removed if reachable by endoscope. Small, smooth objects and all objects that have passed the duodenal sweep should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical intervention is indicated if significant symptoms develop or if the object fails to progress through the gastrointestinal tract.     

Esophageal bougienage in the emergency department with a substitute Hurst dilator

Impacted esophageal foreign bodies typically first present to the emergency department, with coins being most common in children and food boluses most common in adults. Controversy exists regarding the best treatment options in these cases. We report two cases, one pediatric and one adult, where the use of a novel substitute Hurst dilator constructed of materials regularly found in all EDs was successfully used to treat impacted esophageal foreign bodies.     

食管异物252例临床分析

摘要：目的??探讨食管异物的临床特点及相应的治疗方法。方法?收集2010年6月－2018年6月该院收治的252例食管异物患者的临床资料。其中,男114例,女138例,年龄1～87岁,中位年龄52岁。所有患者均有明确的误吞或自食异物病史,并伴有吞咽困难及吞咽疼痛等症状,均行胸部X线、CT或食管钡剂检查以确诊。结果?成人异物种类以植物性最多见,枣核为67.06%;其次为动物性,骨头为15.87%。小儿异物绝大部分为硬币,占8.33%。异物停留部位最多为食管上段（93.25%）,其次为食管中段,占4.76%,食管下段极其少见。行硬性食管镜取出异物者占绝大多数（92.85%）,所有患者中出现严重并发症者13例。结论?食管异物为耳鼻咽喉科常见的急诊之一,多见于老年人及儿童,应及时就诊,延误治疗可引起一系列并发症。     

B超监视下宫腔镜治疗复杂性宫内异物 (附32例临床分析)

目的 探讨B超监视下宫腔镜治疗复杂性宫内异物的价值。方法 宫内节育器、残留胚物、胎骨残留和取环钧断头嵌顿32例，曾经行常规取环或刮宫未能取出，全部患者在B超监视下行宫腔镜宫内异物取出术。结果 32例患者在B超监视下宫腔镜成功取出宫内异物，无术中、术后并发症。一次治疗总有效率达100％。结论 B超监视宫腔镜下治疗复杂性宫内异物是一项安全、有效、微创的方法，值得临床推广。     

小儿支气管异物130例临床分析

目的探讨小儿支气管异物的临床特点,总结纤维支气管镜在小儿支气管异物中的诊治价值及操作注意事项。方法对应用纤维支气管镜诊治的130例患儿支气管异物的临床资料进行回顾性分析。结果本组130例支气管异物全部由纤维支气管镜成功取出。结论支气管异物好发于小儿哭闹时,纤维支气管镜可确诊及有效治疗呼吸道异物,但手术操作必须迅速、细致、准确。     

胃镜治疗小儿上消化道异物45例分析

目的 探讨成人胃镜治疗儿童上消化道异物的临床疗效。方法 采用Olympus GIF-XQ 240胃镜和相关器械对45例误吞异物的儿童进行上消化道取异物治疗。结果 小儿上消化道异物34例取异物获成功，术中、术后无1例出现并发症。结论 成人胃镜治疗儿童上消化道异物的费用低、疗效好、安全性高，值得临床推广。     

老年人食管异物取出术采用全麻与表面麻醉的比较

目的探讨老年人食管异物取出术麻醉方法选择，以提高手术效果。方法对1986年至2003年采用表面麻醉或全麻食管镜下取老年人食管异物81例临床资料回顾分析。结果对危险异物，全麻组食管损伤小于表面麻醉组（P＜0．01）；表面麻醉组2例食管镜下取异物失败。结论老年人食管镜下取异物，术前需全面分析，针对危险异物应采用全麻，以减少潜在危险性。