儿童消化道内异物614例分析：一项单中心回顾性研究

doi:10.12372/jcp.2025.24e1146

摘要/Abstract

摘要：

目的总结儿童消化道内异物的临床特征，分析不同消化道异物的诊治和结局，为临床诊疗和儿童误服风险的管理提供借鉴。方法回顾性收集2021年7月至2024年7月收治的消化道内异物患儿临床资料，进行统计分析描述。结果纳入患儿共614例，男女比例约1.7∶1。年龄（4.12±3.07）岁，1~3岁患儿最多见，为314例（52.34%）。表面光滑圆润的钝性异物共372例（60.58%）；腐蚀性异物52例（8.47%）；其他不易归类的异物13例（2.12%）。153例（24.92%）经内科保守治疗后异物自行排出，内镜及外科探查取出异物共442例（71.99%），19例（3.09%）为液体类误服。其中食管为异物最常嵌顿部位。152例（24.76%）患儿留有不同程度的并发症，较多见的为不同部位的消化道黏膜轻度损伤，表现为轻度充血、糜烂或少量出血，29例（4.72%）患儿合并消化性溃疡（多于异物嵌顿位置出现），38例（6.19%）出现消化道穿孔（其中1例合并气管穿孔），12例（1.95%）存在消化道腐蚀伤，4例（0.65%）损伤后遗留食管狭窄。部分患儿存在消化道基础疾病或心理、认知障碍。消化道异物并发症的出现与患儿性别、年龄无相关性（P>0.05），而与入院间隔、异物是否尖锐或具有腐蚀性、异物位置（上消化道/下消化道）、是否存在基础疾病、常住地及就诊时有无症状等因素明显相关（P<0.05）。异物尖锐或具有腐蚀性、异物滞留时间>24 h、异物位于上消化道、就诊时存在症状是消化道异物并发症发生的危险因素（P<0.05）。结论消化道内异物及时取出可减少并发症的发生。异物类型对临床处理方式和预后有重要影响，新型异物和特殊异物的处理尤应得到关注。

关键词: 消化道异物, 内镜, 儿童

Abstract:

Objective To summarize the clinical characteristics of gastrointestinal foreign bodies in children, analyze the diagnosis, treatment, and outcomes of different types of foreign bodies, and provide references for clinical management and risk prevention of pediatric foreign body ingestion. Methods Clinical data of 614 pediatric patients with gastrointestinal foreign bodies from July 2021 to July 2024 were retrospectively collected and analyzed. Results A total of 614 cases were included, with a male-to-female ratio of 1.7:1. The mean age was 4.12 ± 3.07 years, and the highest incidence was among children aged 1-3 years (52.34%). Blunt foreign bodies with smooth and round surfaces were the most common (60.58%), followed by corrosive foreign bodies (8.47%) and other unclassifiable objects (2.12%). Among the cases, 153 (24.92%) were managed conservatively and excreted spontaneously, 442 (71.99%) were removed via endoscopy or surgical exploration, and 19 (3.09%) involved liquid ingestion. The esophagus was the most common site of impaction (48.05%). Complications occurred in 152 (24.76%) children, with mild gastrointestinal mucosal injury being the most common, followed by peptic ulcers (4.72%), gastrointestinal perforations (6.19%), corrosive injuries (1.95%), and esophageal strictures (0.65%). The occurrence of complications was not associated with gender or age (P>0.05), but was significantly related to factors such as admission interval, sharp or corrosive nature of the foreign body, location (upper vs. lower gastrointestinal tract), presence of underlying diseases, habitual residence, and symptoms at presentation (P<0.05). Risk factors for complications included sharp or corrosive foreign bodies, retention time >24 hours, location in the lower gastrointestinal tract, and symptoms at diagnosis (P<0.05). Conclusion Timely removal of gastrointestinal foreign bodies can reduce the incidence of complications. The type of foreign body significantly influences clinical management and prognosis, with particular attention needed for novel or special types of foreign bodies. Strengthening preventive care and avoiding foreign body ingestion are crucial in reducing the incidence of such cases.

Key words: gastrointestinal foreign bodies, endoscopy, child

李闵, 邓芳. 儿童消化道内异物614例分析：一项单中心回顾性研究[J]. 临床儿科杂志, 2025, 43(4): 264-270.

LI Min, DENG Fang. Foreign bodies ingestion in children: a single-center retrospective study of 614 cases[J]. Journal of Clinical Pediatrics, 2025, 43(4): 264-270.

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参考文献 17

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项目	总数[n(%)]	有无并发症		检查方式
项目	总数[n(%)]	有	无	自行排出	内镜	手术
性别
男	387（63.03）	100	287	44	327	16
女	227（36.97）	52	175	27	191	9
年龄
≤3岁	343（55.86）	100	243	37	290	16
4~6岁	142（23.13）	52	90	22	120	0
7~9岁	81（13.19）	0	81	8	73	0
≥10岁	48（7.82）	0	48	4	35	9
异物位置
食管上段	185（30.13）	56	129	0	185	0
食管中段	84（13.68）	30	54	0	84	0
食管下段	26（4.23）	5	21	0	26	0
胃腔	114（18.57）	35	79	37	71	6
十二指肠	28（4.56）	10	18	4	20	4
肠道	177（28.83）	16	161	161	1	15
异物类型
钝性无腐蚀性	372（60.58）	80	292	55	307	10
尖锐/腐蚀性	229（37.30）	72	157	16	199	14
其他	13（2.12）	3	10	0	12	1
基础疾病
消化道内	31（5.05）	27	4	0	30	1
消化道外	21（3.42）	12	9	9	10	2
无	562（91.53）	113	449	61	479	22
就诊季度
第一季度	129（21.01）	34	75	13	112	4
第二季度	161（26.22）	35	126	25	128	8
第三季度	186（30.29）	46	140	22	157	7
第四季度	138（22.48）	37	101	11	121	6
常居地
城镇	297（48.37）	70	227	35	251	11
乡村	317（51.63）	88	229	36	267	14
就诊间隔
<24 h	491（79.97）	102	389	53	428	10
≥24 h	123（20.03）	50	73	18	90	15

因素		总体	并发症组（n=152）	无并发症组（n=462）	统计量	P
入院间隔[M(P₂₅~P₇₅)]/h		8.00（4.00~24.00）	18.50（5.25~72.00）	6.50（4.00~23.25）	Z=5.24	<0.001
年龄（ x±s）/岁		4.11±3.07	4.00±2.92	4.15±3.12	t=0.50	0.622
性别[n(%)]	男	387(63.03)	100(65.79)	287(62.12)	χ²=0.66	0.474
性别[n(%)]	女	227(36.97)	52(34.21)	175(37.88)
尖锐或具有腐蚀性[n(%)]	是	229(37.30)	72(47.37)	157(33.98)	χ²=8.76	0.004
尖锐或具有腐蚀性[n(%)]	否	385(62.70)	80(52.63)	305(66.02)
年龄[n(%)]	<3岁	343(55.86)	87(57.24)	256(55.41)	χ²=0.16	0.765
年龄[n(%)]	>3岁	271(44.14)	65(42.76)	206(44.59)
异物滞留时间[n(%)]	<24 h	491(79.97)	96(63.16)	395(85.50)	χ²=35.63	<0.001
异物滞留时间[n(%)]	>24 h	123(20.03)	56(36.84)	67(14.50)
异物位置[n(%)]	上消化道	437(71.17)	123(80.92)	314(67.97)	χ²=9.74	0.003
异物位置[n(%)]	下消化道	177(28.83)	29(19.08)	148(32.03)
基础疾病[n(%)]	有	52(8.47)	21(13.82)	31(6.71)	χ²=7.45	0.010
基础疾病[n(%)]	无	562(91.53)	131(86.18)	431(93.29)
常居地[n(%)]	城镇	297(48.37)	61(40.13)	236(51.08)	χ²=5.49	0.024
常居地[n(%)]	乡村	317(51.63)	91(59.87)	226(48.92)
入院症状[n(%)]	有	297(48.37)	105(69.08)	192(41.56)	χ²=36.97	<0.001
入院症状[n(%)]	无	317(51.63)	47(30.92)	270(58.44)

因素	β	SE	OR（95%CI）	P
尖锐或腐蚀性	1.557	0.247	4.744（2.950~7.779）	<0.001
异物滞留时间<24 h	-1.354	0.317	0.258（0.140~0.483）	<0.001
异物位于上消化道	0.969	0.261	2.635（1.602~4.461）	<0.001
存在基础疾病	0.459	0.341	1.582（0.801~3.069）	0.179
入院时有症状	1.332	0.228	3.788（2.440~5.982）	<0.001
常居地为城镇	-0.323	0.230	0.724（0.460~1.137）	0.161