小儿双侧支气管异物的临床特点及围手术期处理

目的 研究小儿双侧支气管异物的临床特点、诊断要点、围手术期处理技巧，减少漏诊、误诊，提高救治率，减少并发症的发生。方法 回顾性分析诊治的25例双侧支气管异物患儿的临床资料，对其临床特点、手术技巧及诊治原则进行总结。结果 25例中22例有明确异物吸入史，3例异物史不明确。术前22例患者完成64排螺旋CT三维成像(MDCT)，其中10例显示双侧支气管异物，12例显示单侧支气管异物;另外3例患者病情较重考虑主气管异物直接急诊手术未做CT检查。手术均在全身麻醉下由经验丰富的医生实施硬质支气管镜取出，12例术前显示单侧支气管异物但术中为双侧支气管异物，可能与异物较碎、患儿剧烈咳嗽时引起异物变位有关，异物均取出顺利，无并发症发生。结论 双侧支气管异物具有病程短、临床症状重、出现呼吸困难时间短的特点，易误诊为单侧支气管或主气管异物。根据患儿有异物呛入后短时间内出现咳喘、呼吸困难进行性加重、听诊时双肺呼吸音相同程度或不同程度的减低及配合影像学检查可初步诊断是否为双侧支气管异物，一经诊断应尽快实施气管镜取出异物，减少死亡及并发症发生率。

Clinical features and perioperative management of bilateral bronchial foreign bodies in children

Objective To explore the clinical characteristics, diagnosis and perioperative management of bilateral bronchial foreign bodies in children so as to reduce the missed diagnosis and misdiagnosis, increase the curative rate and reduce the complications. Methods Clinical data of 25 children with bilateral bronchial foreign bodies were retrospectively analyzed, and the clinical features, surgical techniques and principles of diagnosis and treatment were summarized. Results Of all the 25 cases, 22 had the history of foreign body aspiration. Preoperative spiral computerized tomography (CT) 3D imaging was performed in 22 patients, and 3 cases didn''t receive CT examination due to critical situation. The preoperative CT revealed bilateral bronchial foreign bodies in 10 cases and unilateral bronchial foreign body in 12. Successful foreign body retrieval by using rigid bronchoscope under general anesthesia was performed in all the patients. Bilateral bronchial foreign bodies were disclosed intraoperatively in the 12 with preoperatively-diagnosed unilateral bronchial foreign body. Conclusions With characteristics of short disease course, heavy clinical symptoms and short onset time of dyspnea, bilateral bronchial foreign bodies are easy to be misdiagnosed as unilateral bronchial or tracheal foreign body. The preliminary diagnosis of bilateral bronchial foreign bodies should be considered based on the emergence of cough and asthma as well as progressively aggravated dyspnea shortly after foreign body aspiration, the same or different degree of reduction of breath sounds in both lungs during auscultation, and imaging examination if possible. Foreign bodies should be removed by bronchoscopy as soon as possible to reduce the incidence of death and complications.