بررسی آندوسکوپی زودهنگام و تاخیری دستگاه گوارش در تعیین نحوه درمان سوختگی ناشی از بلع مواد سوزاننده « مرکز تحقیقات بیماریهای گوارش و کبد »

نوع مقاله: مقاله پژوهشی

نویسندگان

1 اســتادیار گــروه جراحــی عمــومی و طــب اورژانــس، مرکــزتحقیقــات گــوارش و کبــد، دانشگاه علوم پزشکی تبریز، تبریز، ایران

2 دانشیار گروه داخلی، دانشگاه علوم پزشکی تبریز، تبریز، ایران

3 اسـتادیار گـروه جراحـی عمـومی، دانـشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 رزیــدنت طــب اورژانــس، دانــشگاه علــوم پزشکی تبریز، تبریز، ایران

چکیده

مقدمه
آندوسکوپی دستگاه گوارش فوقانی قابل اعتمادترین وسیله جهت ارزیابی بیماران مبتلا به سوختگی ناشی از بلع
مواد سوزاننده است، با این وجود، در مورد زمان مناسب آن توافق وجود ندارد.
روش کار
این مطالعه توصیفی تحلیلی مقطعی بر100 بیمار بالغ با تشخیص قطعی سوختگی ناشی از بلع مواد سوزاننده در
لارنگوسکوپی مستقیم در بیمارستان امام خمینی تبریز در یک دوره 15 ماهه از سال 1387-1386 انجام شدند.
بیماران با علایم آسیب داخلی جدی فورا عمل شدند. در سایر موارد، آندوسکوپی دستگاه گوارش فوقانی به کار
رفت و بر اساس زمان آن، بیماران به دو گروه تقسیم شدند: آندوسکوپی زودرس (زیر 24 ساعت) و آندوسکوپی
دیررس (بالای 24 ساعت). وضعیت بیمارستانی در دو گروه مقایسه گردید. اطلاعات با استفاده از SPSS تجزیه و
تحلیل شد. همچنین از آزمون های تی، کای اسکوئر، فیشر، کانتین جن سی استفاده شد.
نتایج
62 بیمار مونث و 38بیمار مذکر (25/51±9/25 سال) وارد مطالعه شدند. در 83% موارد از مواد قلیایی استفاده شده
بود. 8% موارد فورا عمل شدند و 37% تحت آندوسکوپی فوری و 55% تحت آندوسکوپی تاخیری قرار گرفتند.
نتیجه آندوسکوپی در 11% موارد طبیعی، در 40% آسیب درجه I، در 28% آسیب درجه II، در 7% آسیب درجه III
و در 6% آسیب درجه IV بود. دو گروه از نظر نیاز به عمل جراحی، فاصله پذیرش تا جراحی، نیاز به بستری در
ICU و مدت آن و مرگ و میر طی بستری تفاوت معنی دار آماری نداشتند. با این وجود، فاصله تا جراحی و
پذیرش در ICU در گروه آندوسکوپی زودرس و عوارض بیمارستانی در گروه آندوسکوپی تاخیری ظاهرا از
وضعیت بهتری برخوردار بود.
نتیجه گیری
آندوسکوپی زودرس و تأخیری از نظر وضعیت بیمارستانی بیماران بالغ دچار سوختگی ناشی از بلع مواد سوزاننده
از نظر آماری تفاوت معنی داری ندارند. 

کلیدواژه‌ها


عنوان مقاله [English]

The Role of Early Upper Gastrointestinal Endoscopy (less than 24 hours and after) in the Management of Corrosive Ingestion in Adults "Liver and Gastrointestinal Diseases Research Center"

نویسندگان [English]

  • Farzad Kakaee 1
  • Mohammad Housein Soumi 2
  • Behnam Sanei 3
  • Seyed Housein Montazer 4
1 Assistant Professor of General Surgery, Tabriz University of Medical Sciences,Tabriz, Iran
2 Associate Professor of Internal, TabrizUniversity of Medical Sciences,Tabriz, Iran
3 Assistant Professor of General Surgery, Tabriz University of Medical Sciences,Tabriz, Iran
4 Resident, TabrizUniversity of Medical Sciences,Tabriz, Iran
چکیده [English]

Introduction
Upper gastrointestinal (UGI) endoscopy is the most reliable modality for evaluating patients with caustic injury of GI tract; however there is an ongoing debate on its optimal timing.
 
Materials and Methods
 
100 adult patients with definite diagnosis of injury due to corrosive ingestion on direct laryngoscopy were evaluated in Tabriz Emam Khomeini Hospital during a 15-month period. The patients with signs and symptoms indicating a serious internal injury were operated immediately. In other patients, endoscopy was employed and according to timing, patients categorized in two groups; early (24 h). Inhospital condition of the two groups was compared.
 
Results
 
62 females and 38 males (25.51±9.25 y/o) were recruited. Alkaline materials were used in majority of cases (83%). Eight percent of the patients were operated immediately. Early endoscopy was employed in 37% of patients and 55% underwent late endoscopy. Endoscopy results were normal in 11%, grade I in 36%, grade II in 22%, grade III in 11% and grade IV lesion in 12% of the patients. There was no significant difference between the two groups regarding the need of operation, gap between admission and operation, need of ICU admit and its duration and inhospital morbidity and mortality. However, operation gap and ICU admit were apparently better in early endoscopy group and morbidity was lower in late endoscopy group.
 
Conclusion
 
Early and late endoscopy did not significantly affect inhospital condition of adult patients with corrosive ingestion. However, early endoscopy was apparently along with better results.

کلیدواژه‌ها [English]

  • adults
  • Caustic Injury
  • Upper gastrointestinal endoscopy
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