Hemali P Shah, Craig Cameron Brawley, Lauren Gabra, John Maddalozzo, Sarah Maurrasse, Douglas Johnston
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引用次数: 0
Abstract
Objective(s): Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We aimed to assess and compare the safety, efficacy, and efficiency of two different techniques for pediatric cervical esophageal coin removal.
Methods: Retrospective chart review identified patients who underwent esophageal coin removal from January 2017-August 2023 at one of two tertiary academic centers: Ann & Robert H. Lurie Children's Hospital and Yale-New Haven Hospital. Patients with foreign bodies other than coins were excluded. Patients underwent one of two approaches for cervical esophageal coin removal depending on surgeon preference: (1) induction of general anesthesia, intubation, rigid esophagoscopy, and coin extraction with optical forceps (esophagoscope group) or (2) mask ventilation, insertion of a straight laryngoscope blade into the esophagus orifice, and coin extraction with alligator forceps (straight laryngoscope group). Primary outcomes were successful removal of the esophageal coin, regarded a marker of efficacy, as well as operative and anesthesia times, which were regarded as measures of efficiency. Secondary outcomes were postoperative complications, regarded as markers of safety.
Results: Of the 108 patients meeting inclusion criteria, 23 (21.3%) were in the straight laryngoscope group and 85 (78.7%) in the esophagoscope group. Mean operative time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (2.8 ± 1.5 minutes vs 13.8 ± 17.2 minutes, respectively, p < .0001). Mean anesthesia time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (24.2 ± 6.4 minutes vs 44.7 ±1 6.2 minutes, respectively, p < .0001). There were no intra- or post-operative complications in the straight laryngoscope group and two minor complications in the esophagoscope group.
Conclusions: Esophagoscopy using a straight laryngoscope blade under mask anesthesia can represent a safe and efficient alternative for impacted esophageal coin removal.
目的：硬币是儿童最常摄入的异物。虽然刚性食管镜合并插管经常用于切除，但它有潜在的严重并发症。我们的目的是评估和比较两种不同的技术在儿童颈部食管硬币取出术中的安全性、有效性和效率。方法：回顾性图表分析了2017年1月至2023年8月在两个三级学术中心之一（Ann & Robert H. Lurie儿童医院和耶鲁-纽黑文医院）接受食管硬币取出术的患者。排除除硬币外的异物患者。根据术者的选择，患者可选择两种方法进行颈部食管硬币取出术：(1)全麻诱导、气管插管、硬食管镜检查、光学钳取出硬币（食管镜组）或(2)面罩通气、直喉镜刀片插入食管口，鳄鱼钳取出硬币（直喉镜组）。主要结果是成功取出食管硬币，这被视为疗效的标志，以及手术和麻醉时间，这被视为效率的衡量标准。次要结局是术后并发症，被认为是安全性的标志。结果：108例符合纳入标准的患者中，直喉镜组23例（21.3%），食管镜组85例（78.7%）。与食管镜组相比，直喉镜组的平均手术时间明显缩短（分别为2.8±1.5分钟和13.8±17.2分钟）。结论：面罩麻醉下使用直喉镜刀片进行食管镜检查是一种安全有效的方法。
期刊介绍：
The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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