Hopkins内镜可视系统指导食管异物取出术的效果及手术成功的影响因素分析

Efficacy of endoscopic removal of esophageal foreign bodies guided by Hopkins endoscopic visualization system and factors affecting the treatment success rate

摘要:

目的 探讨Hopkins内镜可视系统指导食管异物取出术的效果及手术成功的影响因素分析。方法 选取2018年1月—2022年1月甘肃省人民医院就诊的186例食管异物患者。采用单纯随机抽样法分为观察组和对照组，各93例。观察组在Hopkins内镜可视系统指导下行异物取出术，对照组采用传统异物取出术。比较两组手术成功率和手术时间，收集所有患者一般资料，包括性别、年龄、异物种类、异物形态、异物长度、嵌顿位置、嵌顿时间、处理器械、是否使用透明帽、操作者职称等，采取多因素Logistic回归分析食管异物内镜取出术成功的影响因素；以受试者工作特征（ROC）曲线分析影响因素预测模型对食管异物内镜取出术的预测价值。结果 观察组义齿取出率较对照组高（P <0.05）。两组患者枣核、动物骨头及其他异物取出率比较，差异无统计学意义（P >0.05）。观察组取出义齿、枣核、动物骨头手术时间较对照组短（P <0.05）。两组患者取出其他异物手术时间比较，差异无统计学意义（P >0.05）。观察组并发症总发生率较对照组低。未成功取出组异物种类为义齿、嵌顿时间> 24 h、处理器械为多种工具、操作者职称为住院医师、接受传统异物取出术占比较成功取出组高（P <0.05）。两组性别、年龄、异物形态、异物长度、使用透明帽比较，差异无统计学意义（P >0.05）。多因素Logistic逐步回归分析结果显示：异物种类［O^R=3.107（95 %CI：1.625，5.941）］、嵌顿时间［O^R=2.862（95% CI：1.502，5.453）］、处理器械［O^R=2.053（95% CI：1.217，3.463）］、操作者职称［O^R=2.649（95% CI：1.538，4.563）］、手术方法［O^R=3.381（95% CI：1.735，6.589）］是食管异物内镜取出术成功的影响因素（P <0.05）。ROC曲线分析结果显示，当临界值3.162时，曲线下面积为0.958（95% CI：0.917，0.982），敏感性为87.4%（95% CI：0.833，0.915）、特异性为81.6%（95% CI：0.775，0.857）。结论 Hopkins内镜可视系统指导食管异物取出术有利于提高异物的取出率，缩短手术时间，此外异物种类、嵌顿时间、处理器械、操作者职称等因素可能影响异物取出术的取出率。

Abstract:

Objective To investigate the efficacy of endoscopic removal of esophageal foreign bodies guided by Hopkins endoscopic visualization system and factors affecting the success rate of treatment.Methods A total of 186 patients with esophageal foreign bodies in Gansu Provincial People's Hospital from January 2018 to January 2022 were included in this study. They were divided into an observation group and a control group by simple random sampling, with 93 cases in each group. The observation group underwent foreign body removal under the guidance of the Hopkins endoscopic visualization system, while the control group underwent traditional foreign body removal. The success rate and operative duration between the two groups were compared. The general information of all patients was collected, including gender, age, the type, shape and length of foreign bodies, the site and duration of impaction, treatment equipment, whether the operation was cap-assisted, and the professional rank of the operator. Multivariable Logistic regression analysis was used to determine the factors affecting the success rate of endoscopic removal of esophageal foreign bodies. The value of the prediction model based on the aforementioned influencing factors in predicting the success of endoscopic removal of esophageal foreign bodies was analyzed with the receiver operator characteristic (ROC) curves.Results The success rate of denture removal in the observation group was higher than that in the control group (P < 0.05). There was no difference in the success rates of date pits and animal bones removal between the two groups (P > 0.05). The operative duration for removal of denture, date pits and animal bones in the observation group was shorter than that in the control group (P < 0.05). There was no difference in the operative duration for removal of other foreign bodies (P > 0.05). The overall incidence of complications in the observation group was lower than that in the control group (P < 0.05). The proportions of denture removal, duration of impaction > 24 h, treatment with multiple instruments, the operator being a resident physician, and the traditional approach for foreign body removal were higher in the removal failure group compared with the removal success group (P < 0.05). There was no difference in the gender composition, age, shape of the foreign bodies, length of the foreign bodies, and proportion of cap-assisted operation (P > 0.05). The multivariable Logistic regression analysis revealed that the type of foreign bodies [O^R = 3.107 (95% CI: 1.625, 5.941) ], duration of impaction [O^R = 2.862 (95% CI: 1.502, 5.453) ], treatment equipment [O^R = 2.053 (95% CI: 1.217, 3.463) ], the professional rank of the operator [O^R = 2.649 (95% CI: 1.538, 4.563) ], and the surgical approach [O^R = 3.381 (95% CI: 1.735, 6.589) ] were factors affecting the treatment success rate of endoscopic removal of esophageal foreign bodies (P < 0.05). ROC curve analysis showed that the optimal cut-off value for the risk prediction model was 3.162, with the area under the ROC curve being 0.958 (95% CI: 0.917, 0.982), the sensitivity being 0.874 (95% CI: 0.833, 0.915), and the specificity being 0.816 (95% CI: 0.775, 0.857).Conclusions Hopkins endoscopic visualization system improves the success rate of endoscopic removal of esophageal foreign bodies, and reduces the operative duration. In addition, factors such as the type of foreign bodies, duration of impaction, treatment equipment, and the professional rank of the operator may affect the success rate of foreign body removal.