以上气道受累为首发表现的结节病四例并文献复习

目的 了解以上气道(鼻/鼻窦、咽、喉、中耳)受累为发表现的结节病的临床特点,以减少特殊表现结节病的误诊和漏诊.方法 回顾性分析北京同仁医院经组织病理学确诊的以上气道受累为首发表现的结节病4例,复习以“上气道结节病”为首发或主要表现的文献报道,分析上气道结节病的临床特征及诊断方法.结果 4例患者中女性3例,男性1例,年龄分别为52、53、34和15岁,分别以“鼻腔肿物”、“慢性中耳炎”、“声音嘶哑”和“慢性扁桃体炎”就诊;体格检查及影像学检查发现3例伴有肺、淋巴结等器官受累;经支气管黏膜活检、外周肿大淋巴结活检并行耳鼻咽喉病变部位的组织活检最终明确结节病诊断.以“结节病”为关键词,应用CNKI数据库检索中文文献(1915-2011),发现7篇结节病累及上气道的文献报道,均为结节病累及鼻.以相同关键词应用Pubmed数据库检索英文文献,发现结节病累及上气道的发生率为2.3％～6.0％,常伴有肺、淋巴结等其他器官病变,而以中耳、鼻、咽喉症状为首发表现者仅见个案报告.结论 以上气道受累为首发表现的结节病临床少见,是“常规治疗无效”的慢性耳鼻咽喉疾病的病因之一.详细的病史询问、体格检查和必要的辅助检查,特别是对该病特殊表现的充分认识,有助于减少误诊和漏诊.     

咳嗽变异性哮喘36例临床分析

目的探讨咳嗽变异性哮喘的临床特征及治疗效果,提高对该病的认识。方法通过临床观察,实验室检查,逐项分析均给予糖皮质激素及支气管解痉剂等治疗。结果36例中30例治愈,4例有效,2例发展成支气管哮喘。结论对长期慢性咳嗽患者,应仔细询问病史,及时做相关检查,尽可能早期诊断,并给予适当治疗。     

喉结核24例诊治分析

目的探讨近年来喉结核发病的临床特点、诊治方法及误诊原因。方法回顾性分析24例喉结核患者的临床资料。结果本组24例患者经12个月的抗结核治疗,均获治愈。结论目前喉结核的发病原因不具备典型征。详细询问病史、细致的喉镜检查、痰涂片及PPD试验有助于诊断,确诊有赖于病理检查。该病经规范抗结核治疗,效果良好。     

脑动静脉畸形手术治疗体会

目的 讨论颅脑动静脉畸形的临床特征和临床治疗方法 ,以及治疗新进展.方法 分析该病的临床表现、影像学特征、探讨其治疗方法 ,通过两例典型的病例进行讨论.结果 手术全切除59例,占92%,部分切除5例,占8%. 结论 手术治疗是目前治疗脑动静脉畸形并出血的有效方法 .     

肢根型点状软骨发育不良一例

点状软骨发育不良是一组罕见的过氧化物酶体疾病,国内鲜有报道.本文报告1例因发育迟缓,伴白内障、髋关节脱位就诊的男性患者,通过详细询问病史及体格检查,进行相关辅助检查,发现致病基因PEX7突变而确诊.本文旨在提高临床医师对该病的认识,减少误诊、误治.     

老年人耳鼻咽喉疾病的特点：附676例分析

随着增龄,人体各器官老化,耳鼻咽喉各器官也出现老化性退行性改变相功能下降,甚至发生器质性改变。我们于1987年4月至1993年4月对老年干部进行全面普查,对门诊老年人(>60岁)的676例进行了病史调查及耳鼻咽喉科普查。现报告如下。 1 临床资料 1.1 对象 老年耳鼻咽喉科病676例,其中男605例,女71例。年龄60～69岁395例,70～79岁247例,80岁以上34例。 1.2 方法 询问病史及耳鼻咽喉科一般检查,对部分病人行特殊检查(纯音测听、内腔镜检查及咽拭子细菌培养等)。 1.3 结果 676例中,发现患耳病的11种,鼻病13种,咽病5种,喉病6种,异物3种。其中一人患两种病以上者497人,占73.53％。其中构成比最高的     

乙状结肠自发性穿孔的诊治分析

目的探讨自发性乙状结肠穿孔的临床诊断和治疗方法。方法回顾性分析自发性乙状结肠穿孔16例患者的临床资料,总结有关诊断和治疗问题。结果本组平均年龄67.8岁,伴有高血压9例,慢性支气管炎11例,前列腺增生7例,糖尿病6例,16例均经手术及病理报告而明确诊断,术前误诊率为81.2%。术后发生切口感染裂开、肺部感染吻合口瘘等并发症9例,12例治疗痊愈出院;死亡4例(25%)中主要死于肺部感染及感染中毒性休克。结论乙状结肠自发性穿孔多发于老年患者,合并症多、误诊率高、病死率高。应提高对老年急腹症的认识,认真询问病史,早诊断、早手术是治疗本病的根本措施,正确处理穿孔、彻底清洗、充分引流、治疗合并症是治疗该病的关键。     

39例鼻咽喉颈结核临床分析

结核病发病率近年来呈增高趋势,鼻咽喉颈结核因临床症状无特异性,常易误、漏诊,我院自1994～2003年共收治鼻咽喉颈结核39例,现分析报告如下。     

儿童咳嗽变异性哮喘130例误诊分析

目的探讨小儿咳嗽变异性哮喘的误诊原因,提高其诊断水平。方法总结130例误诊的咳嗽变异性哮喘患儿临床资料,分析其误诊原因。结果咳嗽变异性哮喘以慢性咳嗽为主要表现,缺少肺部体征,临床极易误诊,本组病例在本院确诊前均被误诊,误诊为支气管炎64例,反复呼吸道感染37例,支原体肺炎12例,慢性咽炎9例,百日咳7例,原发性肺结核3例。结论对该病的认识不足、询问病史不详、缺乏必要的辅助检查、滥用激素及凭经验诊治对病情缺乏全面分析等是造成误诊的主要原因,减少误诊的关键是认识该病的特点,提高医师对该病诊断的警惕性。     

鼻睫神经痛18例误诊分析

目的探讨鼻睫神经痛的临床特征,以提高对该病的诊治水平。方法对18例误诊的鼻睫神经痛患者的临床资料进行回顾性分析。结果被误诊为神经性头痛10例,鼻炎、鼻窦炎5例,颈椎病3例。均在鼻内镜下分别行鼻中隔矫正术、中鼻甲部分切除术及骨折外移术,痊愈6例,显效10例,有效2例。术后随访1年,总有效率为100%。结论该病易误诊为鼻窦炎、神经性头痛、颈椎病,细致的鼻内镜检查及鼻窦CT扫描是防止误诊的重要手段,鼻中隔矫正及中鼻甲部分切除加骨折外移术疗效确切,治疗鼻睫神经痛效果满意。     

肺段支气管异物治疗分析

目的探讨肺段支气管异物的发病原因、临床表现和治疗方法。方法发生于肺段的支气管异物一般较小且病史较长,临床症状隐匿或表现为肺部反复感染、肺不张和肺气肿等,对3例肺段支气管异物患者实施电视监控带鼻内镜检查,辅助应用气管内镜、纤维支气管镜,观察异物的形态、位置、大小及与气管壁的关系,并取异物。结果 3例肺段支气管异物全部一次成功取出,其中2例行气管切开术,术后无气胸、纵隔气肿等并发症。结论对于异物较小、临床症状复杂的肺段支气管异物,要做详细的术前检查,术中要选择应用适宜的异物钳、气管内镜、纤维支气管镜等,必要时辅助气管切开以缩短手术路径,并注意防止气胸等并发症的发生。     

10年气管、支气管异物诊治回顾性分析

目的探讨气管、支气管异物发生的人群特征、临床特点及支气管镜诊治经验。 方法以"异物"一词对唐都医院支气管镜报告系统中的镜下描述及结论部分进行检索，起止时间：2008年9月至2018年8月，对检索出的有效病例的一般资料、异物种类、诊疗方法、异物存在部位、病变特点进行回顾性分析。 结果共检索出有效病例171例；其中男性117例，女性55例，平均年龄50.8岁(7～84岁)；病史最短1 h，最长18年；仅35例有明确异物吸入病史，占20.47%；58.48%的异物发生在41～70岁人群；食物是最常见的气管、支气管异物种类，占本组病例的70.17%，包括干辣椒皮、骨头、坚果等，其次为各种工业制品及牙齿(主要为假牙)；84.21%的异物在局麻下使用支气管镜经口或经鼻腔取出；右肺下叶是异物最常发生的部位，占39.18%(67/171)，65.38%(34/52)的辣椒皮位于右肺下叶；常用的异物钳取工具为异物钳、活检钳和冷冻方式，分别占45.78%、25.9%和24.7%，仅17例患者使用2种或2种以上工具取出异物；本组60.82%的患者异物局部伴有明显的肉芽组织增生。 结论异物的发生与性别和年龄有关，且具有地域特色，症状往往不典型，易误诊；异物最易发生在右肺下叶，大多数异物可使用异物钳、活检钳或冷冻等单一工具取出，对复杂性异物需要联合支气管镜下其他治疗手段，肉芽组织增生是最常见的并发症；支气管镜检查是确诊和治疗气管及支气管异物最直接而有效的办法。     

Extraction des corps étrangers du tractus digestif haut par voie endoscopique : expérience d’un service de gastro-entérologie. À propos de 92 cas

Background

Foreign body ingestion is frequent in children and in specific high risk groups of adults such as those with underlying esophageal disease, prisoners, the mentally retarded and those with psychiatric illness.

Aims

To report the management and outcomes of patients with suspected ingestion of foreign bodies treated by endoscopic extraction.

Methods

Between 1985 and 2007 a total of 72 patients with 102 suspected foreign bodies underwent endoscopic procedures.

Results

A total of 92 foreign bodies were found in 62 patients. In the pediatric population, coins were the most frequent foreign body ingested (57 %) and in prisoners, metal objects were the most frequent (82 %). Bolus food impaction was located in the esophagus, coins and metallic foreign bodies in the stomach. Endoscopic extraction was possible in 92 % of cases without any complications.

Conclusion

Endoscopic removal of foreign bodies located in the upper gastro-intestinal tract is safe and successful.     

多层螺旋CT联合支气管镜诊治老年患者支气管异物的临床分析

目的探讨多层螺旋CT联合支气管镜对老年患者支气管异物的诊治价值。方法回顾性分析28例老年患者支气管异物的临床表现、肺部CT影像表现、支气管镜下特征及治疗方法。结果主要临床表现为发热、咳嗽、咳脓痰、喘鸣、胸闷、咯血。常误诊为肺炎、肺癌、肺结核、支气管扩张等疾病,误诊时间1m～5年。17例肺部多层螺旋CT检查可见异物的直接表现,28例均经支气管镜成功钳出异物。23例镜下直接见到异物,2例异物被肉芽组织包埋,3例吸净脓性分泌物夹除脓苔后见到异物,3例经第2次气管镜检查取出异物,1例异物合并支气管肺癌。结论联合多层螺旋CT及支气管镜检查有助于老年患者支气管异物的诊治。     

False esophageal hiatus hernia caused by a foreign body: A fatal event

Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences.     

A case of bronchial foreign body due to citrus fruit seed aspiration showing multiple pulmonary infiltration repeatedly]

We report a case of a bronchial foreign body in a 76-year-old citrus fruit farmer. The patient was detected patchy infiltration (ground-glass attenuation) of the right upper lung field on the chest X-ray on Dec. 26th, 2003. The shadow tended to disappear after treatment with antibiotics. The same shadow was detected again 10 months later and the patient underwent a bronchoscopic examination. A foreign body was found lodged in the center of the right upper bronchus, associated with bronchial stenosis due to mucosal edema. The abnormal shadow disappeared after the foreign body, which we decided was a citrus fruit seed, was removed. From the time course of the present illness and a retrospective evaluation of previous chest X-rays, the patient had aspirated the foreign body 18 months prior to his admission for bronchoscopy. We should be careful of the possibility of foreign bodies even when the elderly do not present a history of foreign body aspiration. It is important to consider the possibility of a bronchial foreign body in patients with repeated pneumonia, and to perform bronchoscopy aggressively.     

多层螺旋CT检查对气道异物的诊断价值

目的：探讨多层螺旋CT对气道异物的诊断价值。方法对门诊收治疑似气管异物患者56例,给予多层螺旋CT检查,并与支气管镜检查作对照。结果多层螺旋CT检查共检出气道异物患者52例,1例误诊为肺炎,后经气管镜检查并取出异物,漏诊2例,假阳性1例。多层螺旋CT检查及气管镜对气道异物检出率差异无统计学意义（χ2＝0.61, P ＞0.05）。以支气管镜检查结果为金标准,螺旋 CT 灵敏度为96.23％,特异度为66.67％,诊断符合率为94.64％。结论多层螺旋CT检查气道异物,具有灵敏度高、符合率高特点,诊断时应结合病史、临床体征,以降低误诊率、漏诊率。儿童检查应以最低剂量扫描,避免辐射损伤。     

中国大陆人体水蛭病的地区分布与危害

目的 总结中国大陆近50年水蛭病在人群中的地区分布与危害、水蛭在人体的寄生部位及多种不同的治疗方法. 方法 收集、分析国内50年来不同地区的水蛭病资料,对所获资料进行归类分析. 结果 共收集到1 003例病例资料,分析结果显示中国大陆水蛭病分布在15个省、自治区;患者年龄为1.5岁至73岁不等;以农民、幼女、学生为主,其次为伐木工、采集工;发病季节以夏季为主,秋季次之;患者病程为1～365 d以上不等;虫体寄生部位以鼻腔、阴道、咽喉部较为常见,眼部、上颌窦、肠腔、膀胱、外阴、胃、皮下极为罕见;患者临床表现为失血、贫血、恐惧、紧张、头昏、头痛、腹痛、腹泻、恶心、呕吐、鼻塞、呼吸受阻、血痰、咯血等,部份患者失血量在200～300 ml之间,重者达600 ml. 结论 水蛭病主要发生于国内某些地区,特别是西南的广西、贵州、四川、云南及中南的湖北,沿海的福建、广东等省(自治区)边远山区的农村,对人体的危害尤其对成年劳动者与幼女的危害较大.     

成人下呼吸道异物20例临床分析

目的总结及分析成人下呼吸道异物的临床特点,评价纤维支气管镜(纤支镜)对下呼吸道异物的诊治价值。方法回顾性分析本院近12年收治的成人下呼吸道异物患者的临床资料。结果其中男16例、女4例;年龄28～73岁;左侧2例,右18例。12例明确下呼吸道异物;8例误诊,误诊率40%。在常规纤支镜检查确定为异物后使用异物钳分别对20例患者下呼吸道的异物进行钳取,均获得成功,治愈率达100%,无1例出现并发症。结论部分患者因病史诉说不清,临床缺乏特异性,易误诊为其它呼吸系统疾病,纤支镜可作为对下呼吸道异物诊断和钳取的重要工具,具有重要价值。     

Foreign bodies in the esophagus. A study of causative factors

Two hundred and twenty-nine patients were studied in an attempt to determine the main causative factors behind their having a residual foreign body in the esophagus. Strictures were present in 13%. Fifty-two percent of the patients with stricture had been hospitalized more than once for treatment of foreign body impaction; this was the case in only 8.5% of the rest of the patients (p<0.001). More than half of the patients aged 15 years or younger had a foreign body in the hypopharynx. This location was extremely uncommon in adults (p<0.001). The hypothesis of spasm distal to an esophageal foreign body as the cause for obstruction in patients without esophageal stricture was supported by the following findings: spontaneous disimpaction occurred in more than one-third of the patients and became more frequent as time progressed; 63% of 16 patients given spasmolytic drugs experienced spontaneous disimpaction of the foreign body; half of the patients had the foreign body in the proximal esophagus distal to the narrower passage of the upper esophageal sphincter; foreign body impaction in the esophagus turned out to be a once-only event in 86% of the patients; and 21% of the patients had a disorder of the central nervous system and had been hospitalized significantly more often because of food impaction than the other patients. The findings indicate that adults with a history of impaction of foodstuff lacking sharp bones and who do not have stricture suffer food impaction because of spasm of the esophageal smooth muscle, and can be treated accordingly.