呼吸道异物的X线表现及异物移位机制分析

目的:探讨呼吸道异物和异物移位的X线征像和机制及对临床治疗的意义。方法:回顾性分析103例呼吸道异物患者的病例资料。异物类型:植物类66例、金属类18例、动物类7例、塑料类9例、玻璃类3例。103例均摄X线胸片,同时行透视检查者34例、摄侧位片者67例。结果:22例气管异物中X线显示异物11例,主要为金属和动物类异物;异物形状往往不规则,异物最长径超过患者(患儿)气管内径一半以上18例、异物的一端较锐利位于声门下区(气管开口区域)4例。支气管内的异物类型以植物类为主,异物体积通常较小、形状多为不规则形或近似锥形、圆形等。88例支气管异物术前X线诊断74例。X线诊断异物位于右侧支气管内46例,有37例与术后结果相符;X线诊断异物位于左侧支气管内28例,有23例与术后结果相符。其余不符合者由于异物移位所致的不典型间接征象(对侧或不典型的支气管阻塞性改变)。结论:呼吸道内异物的X线表现多种多样,与异物的性质(如植物类中的花生等)、大小、形状、有无移位有一定联系;细致询问有关病史,了解异物类别,有助于提高X线诊断的准确性。

Study of the X-ray Findings of Respiratory Tract Foreign Bodies and the Mechanism of the Paradoxical Phenomenon

Objective:To evaluate the clinical value of X-ray findings of foreign body within respiratory tract as well as the mechanism of paradoxical phenomenon due to displacement of the foreign body.Methods:Of 103 cases had respiratory tract foreign body,the origin of the foreign body included plant (n=66),metal (n=18),animal (n=7),plastic (n=9),and glass (n=3).All of the 103 cases had chest films with anterior-posterior view (n=103) and lateral view (n=67);fluoroscopy with complete records (n=34).Results:Foreign body located within trachea (n=22),most of them were metallic of animal in origin.They were mostly irregular in shape,with one sharp pole and located in the subglottic area (the opening of trachea).The long dimension of the foreign body was usually larger than the radius of interior dimension of trachea (n=18).Intra-bronchial foreign bodies were mostly plant in origin;small,round,cone-like or irregular in shape.Of the 88 cases with right (or left) bronchial foreign bodies,71 cases had correct diagnosis prior to operation.Of the 46 (right)/28 (left) cases had foreign body located within right or left bronchus,the X-ray diagnosis of 37 (right)/23 (left) cases were accord with the final post-operation diagnosis respectively.The rest of them showed paradoxical phenomenon (contra-lateral or unapt(unexpected),atypical pulmonary emphysema,obstructive pneumonitis,atelectasis etc) due to displaced foreign body.Conclusion:X-ray findings of respiratory tract foreign body varied,which are in accord with the location,size,shape,origin as well as displacement of the foreign body.Correlation of the X-ray features with history,origin of the foreign body can provide helpful information to improve the accuracy of diagnosis.