王代红 刘磊峰 姚俊 黎琪 李诗华 江枫 邱海涛

【摘要】 目的：分析探讨老年人食管异物并发症的相关危险因素。方法：回顾性收集并分析272例确诊食管异物并行食管镜下异物取出的老年患者（≥60岁）临床资料。结合患者术前影像检查、胃镜及食管镜，将食管异物损伤并发症定义为食管黏膜糜烂、食管溃疡、食管撕裂、食管穿孔。结果：272例老年食管异物患者中，男131例，女141例，平均年龄（72.2±8.2）岁;食管异物损伤并发症发生率44.1%（120/272），其中食管黏膜糜烂43例、溃疡24例、撕裂16例、食管穿孔37例。多因素logistic回归分析显示中性粒细胞占白细胞总数的比例（N%）>70%、尖锐异物、异物≥3 cm、異物嵌顿时间≥24 h均是老年食管异物发生并发症的独立危险因素（P<0.05）;发热、N%>70%、中段食管嵌顿、尖锐异物、异物≥3 cm、异物嵌顿时间≥24 h均是老年人食管异物发生食管穿孔的独立危险因素（P<0.05）。结论：老年人食管异物并发症发生率高，正确识别其危险因素，对于高危患者，及时临床干预，避免病情迁延而增加并发症发生风险。

【关键词】 食管异物 老年人 并发症 穿孔 危险因素

[Abstract] Objective： To detect the risk factors of complications of esophageal foreign body in elderly. Method： The clinical data of 272 elderly patients （≥60 years old） with confirmed esophageal foreign body and esophageal foreign body removal were retrospectively collected and analyzed. Combined with preoperative imaging examination， gastroscopy and esophagoscopy， the complications of esophageal foreign body injury were defined as esophageal mucosal erosion， esophageal ulcer， esophageal tear and esophageal perforation. Result： Among 272 elderly patients with esophageal foreign body， there were 131 males and 141 females， with an average age of （72.2±8.2） years. The complication rate of esophageal foreign body injury was 44.1% （120/272）， including 43 cases of esophageal mucosal erosion， 24 cases of ulcer， 16 cases of tear and 37 cases of esophageal perforation. Multivariate logistic regression analysis showed that the proportion of neutrophil to total white blood cell （N%） >70%， sharp foreign body， foreign body ≥3 cm， foreign body insertion time ≥24 h were independent risk factors for complications of elderly esophageal foreign body （P<0.05）. Fever， N%>70%， middle esophageal incarceration， sharp foreign body， foreign body ≥3 cm， foreign body insertion time ≥24 h were independent risk factors for esophageal foreign body perforation in the elderly （P<0.05）. Conclusion： The incidence of complications in the elderly with esophageal foreign body injury is high， and the risk factors should be correctly identified. For high-risk patients， timely clinical intervention should be conducted to avoid the risk of increased complications due to the delay of the disease.

[Key words] Esophageal foreign body Elderly Complication Perforation Risk factors

First-authors address： Affiliated Hospital of Guangdong Medical University， Zhanjiang 524000， China

doi：10.3969/j.issn.1674-4985.2021.09.005

食管异物是耳鼻咽喉科常见的急症之一。食管异物的常见临床症状包括咽痛、异物感、吞咽困难和胸骨后疼痛等。大多数被吞下的异物（80%～90%）能自发通过食管，10%～20%食管异物嵌顿的患者需要通过内镜取出异物，不足1%的患者需通过外科手术取出异物或处理并发症[1]。食管异物的诊治被耽误可致严重并发症，甚至危及生命[2]。食管异物最容易发生在儿童和老年人，关于儿童食管异物并发症的危险因素已有相关研究[3]，但针对老年人的研究尚缺乏。有研究报道食管异物并发症的发生率在老年人群中的发生率更高，尤其60岁以上[4-5]。本文……