气管,支气管异物取出术1268例报告

报告１９９０￣１９９５年１５年间气管、支气管异物取出术１２６８例，无一例术中、术后死亡。就诊断、术前准备、手术时机、麻醉方法、手术方法、特殊异物的处理、术中窒息的处理、并发症的处理等方面进行了讨论。     

全麻在气管异物取出术中的应用

气管异物多发生于幼儿,病情急重,需要紧急救治。由于本病关键性治疗是尽快取出异物,以解除呼吸道梗阻。故手术成败直接关系到患儿预后。然而抢救这种在严重缺氧状态下机体,风险与机会并存。作者认为在全麻下施术对抢救工作十分有利。     

气管内镜在疑难气管异物取出术中的应用

目的 探讨气管内镜在疑难气管异物取出术中的应用价值.方法 对10例疑难气管异物患者实施气管镜检查,并辅助应用气管内镜,观测异物的形态、位置及其与气管壁的关系,并取出异物.结果 10例疑难气管异物中,9例一次性成功取出,术后无气胸、纵膈气肿等并发症;1例手术失败,转胸科实施开胸手术取出异物.结论 气管内镜的应用有助于查明疑难气管异物的形状、位置及其与气管壁的关系,利于该类异物的取出.     

支气管灌洗在小儿支气管异物取出术中的应用

目的探讨支气管灌洗(Bronchiallavage.BL)在小儿支气管异物并发肺部感染或伴有肺不张病例行支气管异物取出术后的应用价值.方法对16例患儿行支气管镜检并异物取出术后进行病变支气管段灌洗(BL组),与12例单纯行异物取出术的病例(对照组)进行治疗后的起效时间与病程作比较.结果灌洗后起效时间和病程明显缩短.结论支气管异物取出术加灌洗,能有效清除阻塞物,改善肺通气,并通过局部使用抗生素等药物,提高局部药物浓度,促进病变好转,缩短病程.     

脉搏氧饱和度计在气管异物取出术中的应用

脉搏氧饱和度计在气管异物取出术中的应用尚跃东，陶振峰，赵国庆，赵超英，吴彦桥，韩艾伦，汤龙信脉搏氧饱和度计是一种无创伤性血氧饱和度（ＳＯ２或ＳａＯ２）监测器，近几年已在麻醉科、急诊科、ＩＣＵ、ＣＣＵ和呼吸科应用；但在气管异物取出术中的应用尚未见报道。...     

应用附有Hopkins潜望镜的支气管镜取气管支气管异物

2000年7月～2003年11月我们收治气管、支气管异物54例，均在电视监视下应用附有Hopkins潜望镜的支气管镜行异物取出术，报道如下。     

气管切开Ⅰ期缝合在儿童气管支气管异物取出术中的应用

目的探讨儿童复杂气管支气管异物取出术中,气管切开并同期行气管切开口缝合的可行性和可能并发症。方法对5例4～6岁复杂气管支气管异物的患儿行气管切开异物取出术。异物分别为塑料笔帽1例、光滑圆柱状塑料串珠2例、光滑金属球1例、光滑陶瓷棒1例。均行保留自主呼吸的静脉麻醉,硬支气管镜下将异物松动并牵拉至声门下,于3～4气管环间横形切开气管,直视下将异物经气管切开处取出。观察呼吸状况至平稳,Ⅰ期缝合气管切开口。结果5例均成功取出异物。气管切开处I期缝合后,均未出现呼吸困难、皮下气肿,术后感染等并发症。随访均1年以上,未出现气管狭窄。结论气管切开取儿童复杂气管支气管异物,同期气管切开口缝合是可行的。轻柔操作和避免多次经声门试取是减轻喉水肿、保持呼吸通畅的关键。     

介绍一种自制简易特殊支气管异物取出器

1985年5月我科收治1例误将自动铅笔锥形套吸入气管的7岁小学生，在用普通支气管异物钳和反张支气管异物钳试取失败时（异物钳插不进自动铅笔套内）．根据其内壁有螺纹的特点，急中生智．临时利用28自行车辐条一端的螺纹旋入异物腔内取出。在充分研究了自动铅笔套这种特殊异物特     

无自主呼吸全身麻醉气管支气管异物取出术

近年来全身麻醉下气管支气管异物取出术已经被广泛采用，但一般均保留自主呼吸。我科于2002年起采用肌肉松驰、无自主呼吸全身麻醉方法进行气管支气管异物取出术，取得满意的效果，报告如下。     

特殊类型气管支气管异物手术取出方法探讨

目的：探讨特殊类型气管支气管异物手术取出的有效方法。方法：针对不同的异物,研制和借用一些特殊器械,采用多种不同的治疗方法,取出特殊类型气管支气管异物61例,分析各类特殊类型气管支气管异物手术特点。结果：61例患者支气管异物分别使用异物钩（31例）、笔帽螺丝取出器（11例）、异物网（13例）、特制微抱式三爪倒齿异物钳（3例）、细倒齿式食管异物钳（3例）等均顺利取出。无明显并发症,无死亡病例。除已行气管切开的5例外,其他患者未行气管切开。结论：根据各类特殊类型异物特点和患者的情况设计相应的器械和选择适宜的手术方法是保证治疗成功的关键。     

Lung recovery after rigid bronchoscopic removal of tracheobronchial foreign bodies in children

OBJECTIVE: Foreign body (FB) aspiration affects lung function and often results in pulmonary complications. We have assessed the clinical and radiological predictors of delayed lung recovery after rigid bronchoscopic removal of airway FBs. METHODS: The demographic data, clinical presentations, treatment profiles, pre- and post-treatment chest radiographs, and treatment outcomes were reviewed retrospectively in 104 pediatric patients who underwent removal of tracheobronchial FBs by rigid bronchoscopy. The clinical and radiological factors predicting delayed (>or=5 days) lung recovery time were statistically analyzed by logistic regression. RESULTS: Preoperative chest radiographs showed infiltrates consistent with inflammation in 21 patients (20.2%). Successful bronchoscopic removal of all FB fragments was achieved in 100 patients (96.2%). Immediate postoperative aggravation was observed in 10 patients (9.6%). Mean post-treatment pulmonary recovery was 3.8 days. On univariate and multivariate analyses, preoperative inflammation, immediate postoperative aggravation, and unsuccessful removal of airway FBs were significant predictors for delayed lung recovery. The preoperative inflammatory and immediate postoperative chest radiologic findings were significantly correlated (p<0.001). CONCLUSIONS: Delayed lung recovery after rigid bronchoscopic removal of tracheobronchial FBs can be predicted by FB-induced inflammatory chest radiologic findings and the unsuccessful or complicated removal of airway FBs.     

儿童气管支气管异物取出术发生低氧血症的相关因素分析

目的 探讨全麻下硬性支气管镜下儿童气管支气管异物取出术发生低氧血症的相关因素。方法 回顾性研究432例全麻下气管支气管异物患儿的临床资料,分析患儿术中发生低血氧血症的程度与其年龄、异物停留位置、异物停留时间及术前肺部并发症的相关性。结果 患儿术中发生轻度、中度低氧血症与其年龄、异物停留位置、异物停留时间及术前肺部并发症之间不存在相关性(P>0.05),而患儿术中发生重度低氧血症与其年龄、异物停留位置、异物停留时间及术前肺部并发症之间存在相关性(P<0.05)。结论 患儿年龄、异物停留位置、异物停留时间及术前肺部并发症和术中重度低氧血症发生存在相关性。     

Sharp foreign bodies in the tracheobronchial tree

Aspiration and/or ingestion of foreign bodies is a common occurrence. Six cases of scarf pin aspiration are described. Scarf pin inhalation as a cultural and ethnic hazard in an Arab woman is highlighted. [Editorial comment: The authors illustrate the dangers of holding a straight pin in the mouth. Management of these sharp, potentially penetrating foreign bodies is described.]     

外源性气管支气管异物900例

目的 总结气管支气管异物的临床病例特点,为临床诊断治疗、减少术后并发症提供可靠的依据.方法 回顾性分析疑似外源性气管支气管异物患者1076例临床资料,最终经全麻硬性支气管镜确诊患者900例.其中经口支气管镜检查取出异物885例,经气管切开口支气管镜检查取出异物10例,开胸取出异物5例.结果 900例中,异物种类包括植物性异物817例,动物性异物24例,金属、塑料异物59例;异物位于右主支气管397例,左主支气管333例,总气管77例;左肺下叶支气管27例,声门下16例,气管隆突10例,左肺上叶支气管15例,右肺下叶支气管18例,右肺上叶支气管7例;术后肺部感染1例,气胸、纵隔气肿1例,心衰3例.山东省内患者845例,省外患者55例.结论 及早诊断、支气管镜检查,对预防术后并发症发生和气管支气管异物的成功治疗至关重要.     

Anesthesia for tracheobronchial foreign bodies removal via self-retaining laryngoscopy and Hopkins telescopy in children

This study attempted to explore suitable anesthetic methods used for removal of tracheobronchial foreign body (FB) via self-retaining laryngoscopy and Hopkins telescopy in children. 92 cases had undergone FB removal via self-retaining laryngoscopy and Hopkins telescopy or rigid bronchoscopy in our hospital since 2006, of which 56 cases were under intravenous anesthesia and endotracheal intubation with muscle relaxation (IAEI with MR), and the other 36 cases were under intravenous anesthesia with spontaneous breathing (IASB). Operative parameters and intraoperative vital signs were analyzed. Tracheobronchial foreign body was successfully removed in 87 cases, and not found in the other 5 cases. SpO₂ was below 90% transiently in 41 cases, 29 cases of which were under IAEI with MR and 12 cases were under IASB. Laryngospasm and choke were found in 12 cases under IASB. Vital signs including P_ETCO₂ and heart rate were stable in all the cases. The mean surgical time, anaesthetic induction and recovery time of IAEI with MR via self-retaining laryngoscopy group were (5.69 ± 3.43) min, (9.68 ± 1.66) min and (26.13 ± 6.94) min, IASB via self-retaining laryngoscopy group were (21.35 ± 17.25) min, (13.71 ± 3.79) min and (24.64 ± 5.44) min, IAEI with MR via rigid bronchoscopy group were (10.20 ± 5.01) min, (10.31 ± 3.56) min and (25.13 ± 6.21) min, and IASB via rigid bronchoscopy group were (25.35 ± 13.25) min, (14.71 ± 3.61) min and (26.22 ± 5.65) min. It’s a new and wonderful surgical procedure that combining self-retaining laryngoscopy and Hopkins telescopy for removal of tracheobronchial foreign body. IAEI with MR is suitable for bronchial FBA cases via them, while IASB is better for tracheal FBA or complicated cases.     

小儿气管支气管异物临床分析

目的探讨儿童气管支气管异物术前诊断依据,提高术前明确诊断率,减少不必要的手术创伤。方法回顾分析1260例小儿气管支气管异物,按照病史、症状和检查结果分组,统计每组的术前诊断与手术明确异物存在的符合率,统计异物存在的侧别差别。结果异物史明确,有咳喘症状并且听诊一侧肺呼吸音减低或消失以及胸透可见一侧肺不张或肺气肿时,异物存在率97.6%;异物史明确并且有咳喘,而听诊无呼吸音减低,胸透心肺膈无改变,异物存在率90.1%;无明确异物史,但患儿有咳喘等症状并且听诊一侧肺呼吸音减低,胸透有纵隔摆动、一侧肺不张或肺气肿,异物存在率34.1%。异物于左侧支气管发病率略高于右侧。结论对于儿童气管支气管异物的病例需要详细追问病史,观察患儿症状,仔细分析术前患儿检查结果,不同情况具体分析,尽量减少不必要的支气管镜检查。注意异物存在左侧支气管的几率稍高于右侧,尽量降低手术的盲目性。     

小儿气管支气管异物临床诊治

目的 探讨小儿气管支气管异物的临床特征、诊断和处理。 方法 回顾150例气管支气管异物的临床资料,分析患儿的年龄、病史、异物部位和种类、确诊方法、治疗特点等。结果 除2例死亡外,均在全麻下行支气管镜检查和异物取出术。术中和术后无并发症,均临床治愈出院。 结论 小儿气管支气管异物应及早确诊,尽早行异物取出,降低患儿的死亡率。     

气管、支气管异物取出术中潜窥镜与普通支气管镜的应用

目的 比较应用潜窥镜与普通支气管镜在气管、支气管异物取出术中的不同效果,提高诊疗水平,减少并发症发生。方法 分析206例气管、支气管异物患者的诊断、麻醉、手术方法和疗效;对潜窥镜视频监视下与普通支气管镜取异物进行对比观察。结果 采用潜窥镜异物取出术均一次性手术成功;普通支气管镜行二次手术10例,术中出现喉痉挛8例、支气管痉挛12例,术后出现纵隔气肿1例、气胸2例、皮下气肿4例、心衰2例,行气管切开5例,无异物变位性窒息,气管、支气管损伤等严重并发症。结论 潜窥镜下气道异物取出术具有明视、放大等特点,避免了普通支气管镜的盲目性,提高了气道异物取出术的成功率和安全性。