迁移性咽和颈段食管异物4例

目的：探讨迁移性咽和颈段食管异物的临床特征、诊断及治疗方法。方法：对位于腔壁内的异物，应尽量选用内镜下切开黏膜取出；若异物已移至腔外，则采用颈侧切开术。结果：4例患者均顺利取出异物，3例无并发症发生，1例声带麻痹。结论：颈部薄层CT扫描是证实异物迁移的重要手段，并对手术时定位异物有重要价值；食入异物出现迁移者，可产生致命性并发症，应及时处理。     

咽喉部鱼刺异物迁移致颈部脓肿分析

目的　探讨咽喉部鱼刺异物迁移致颈部脓肿的临床特征、辅助检查、治疗手段及预防策略。方法　回顾性分析8例咽喉部鱼刺异物迁移致颈部脓肿的临床资料。结果　7例有异物误咽史。2例鱼刺迁移至胸锁乳突肌内,3例至舌骨舌肌内,1例至甲状软骨上角与颈动脉鞘之间,1例至咽后间隙,1例至甲状腺内侧。6例行彩色B超检查,5例发现异物。所有患者均行颈部CT检查,4例发现异物。全部患者均通过颈外侧入路颈部探查取出异物。结论  对伴有异物吞咽史的颈部脓肿患者首先考虑异物迁移。彩色B超检查有明确价值,薄层CT及三维重建可作为补充检查手段,手术为首选。医疗安全教育、提高医患警惕为主要预防手段。     

Multiple laryngeal foreign bodies composed of dried fish vertebral bones: a case report

We present a rare case of tracheostomy for removal of laryngeal foreign bodies consisting of three connected fish vertebral bones in a 15-month-old girl. Recent endoscopic techniques have made it possible to extract nearly all tracheobronchial foreign bodies with rigid bronchoscopes. However, the three connected foreign bodies in this report could not be extracted entirely by single endoscopy because the glottis as an exit was narrow due to severe oedema. Accordingly, tracheostomy was required to assist ventilation, prevent prolonged post-operative endotracheal intubation, remove the secondary tracheal foreign bodies and to provide a conduit for the introduction of a bronchoscope. This suggests that tracheostomy should be considered to avoid the potential dangers of severe laryngeal oedema and to secure the route for removal of foreign bodies from the trachea when treating patients with multiple laryngeal foreign bodies and laryngeal oedema.     

Migratory pharyngeal foreign bodies and related complications: Analysis of 20 cases

PurposeTo explore the diagnostic approach and therapeutic method of migratory pharyngeal foreign bodies and related complications, to improve the understanding of such disease and to reduce misdiagnosis and missed diagnosis.Material and methodsA retrospective study was performed by collecting patients who were treated because of the related complications caused by migratory pharyngeal foreign bodies from 2012 to 2020.ResultsA total of 20 patients were admitted to hospital due to the related complications. 14 cases showed cervical mass; 3 cases showed abscess of the mouth floor; 1 cases showed retropharyngeal abscess; 1 cases showed laryngeal granuloma; 1 cases showed mass of tongue. All patients received imaging examination of B-ultrasonography or computed tomography (CT). 19 patients were treated by surgery, and 1 patient was taken conservative treatment. All foreign bodies was successfully removed. As for the type of foreign bodies, there have 15 cases of fishbone, 2 cases of crabshell, 2 cases of shrimp shell, 1 cases of duck bone.ConclusionsMigrating foreign bodies and related complications are rare in clinic, much attention should be paid to avoid missed diagnosis or misdiagnosis.     

咽部放线菌病6例临床分析

目的 总结咽部放线菌病患者的临床资料,探讨其临床特征和诊疗方法。 方法 回顾性分析2015年9月至2019年10月收治的咽部放线菌病6例,行电子鼻咽喉镜检查、特异性感染筛查、分泌物培养、组织活检病理检查。采用青霉素类抗生素、局部清理、雾化吸入等综合治疗。 结果 所有病例均确诊为放线菌病,经治疗后症状全部改善,病灶消失,随访3个月~1年无复发。 结论 咽部放线菌病与局部慢性病变相关,主要依靠病理学检查确诊,抗生素、雾化、局部清理的综合治疗效果确切。     

个体化治疗咽喉部海绵状血管瘤二例

正咽喉部海绵状血管瘤临床上较少见,其发病机制尚不清楚,目前对于治疗该病无统一方式。基于海绵状血管瘤自身的病变特点加之咽喉部位特殊,临床表现可从毫无征兆到突发性死亡[1],故我们认为本病的治疗应以症状控制为首要原则,不同患者采取不同治疗方式。现报告我科收治2例典型病例资料,并结合文献学习,借以更加规范有效的治疗该病。1病例资料1.1病例1患者,男,53岁,因"呼吸困难1周"于     

Perforating and migrating pharyngoesophageal foreign bodies: a series of 5 patients

Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.     

Tracheobronchial aspiration of foreign bodies in children: a study of 94 cases

Over the last seven years, there has been an increase in the number of children admitted to our hospital because of aspirated foreign bodies. An inhaled foreign body can become a serious matter if it results in acute respiratory distress or if it remains unrecognized for a long period in the bronchial system. Then, as a result of inflammatory tissue reactions, it can be extracted only with great difficulty. Of our 94 children with foreign body aspiration, 24% had been treated initially on the basis of a different diagnosis. In 30% of all cases, the children were admitted more than 3 days after aspiration. One third of the patients already had signs of marked inflammation on admission. Early treatment, under general anaesthesia, proved to be safe even for small babies. Bronchoscopic examinations should not last more than approximately 1 hour. All children who had complications after bronchoscopy (6%) recovered fully after treatment, except for one child who died of respiratory failure. A diminution of complications in children with inflammatory signs on admission was observed when they were treated before the operation with antibiotics and methylprednisolone.     

Long-term clinico-radiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases.

The endoscopic division of the pharyngeal pouch wall with a mechanical stapling device has become increasingly popular. When compared to open excision, the reduced operative time, early resumption of oral intake, and short in-patient stay with no early recurrence of symptoms, are the proposed advantages. Small pouches or thick walled pouches are not suitable for stapling. From December 1996 to December 1999, 32 patients were admitted to the Aberdeen Royal Infirmary for endoscopic stapling of a pharyngeal pouch. Five patients were unsuitable for stapling. In addition, three patients were treated for pouch recurrence after an external approach. Two patients required repeat stapling at a later date. Our results are encouraging in terms of short operation time and hospital admission, improvement of symptoms and minimal complication rate. Fifteen patients were assessed 24 months after the procedure with satisfaction surveys and contrast swallow X-rays. Subjective improvement was sustained throughout this period, despite radiological evidence of persistence of the pharyngeal pouch.     

以咽异物感为表现的食管型颈椎病1例

1病例报告患者,男,38岁,因咽部异物感半年就诊。半年前无明显诱因出现咽部异物感,在当地医院诊断为慢性咽炎,给予药物(用药不详)、微波治疗后未见好转。鼻内镜、胃镜检查考虑为鼻后滴漏综合征、反流性食管炎,给予鼻窦炎口服液、鼻炎康、奥美拉唑、果胶铋及吗丁啉等药物治疗后仍不见好     

治疗食管特殊异物17例报告

报告经治17例食管特殊异物吞食钉子的患者临床资料，介绍取出特殊异物的几种方法，并对治疗中出现的并发症的处理进行讨论。     

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Objectives

Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives.

Methods

We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy.

Results

Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB.

Conclusions

Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.     

下咽黏膜下异物3例临床分析

目的探讨包埋型下咽黏膜下异物的诊治方式,以期减少漏诊、选取合适手术方式取出异物。方法3例包埋型下咽黏膜下异物患者通过询问病史、影像学检查、电子鼻咽喉镜检查而确诊,在支撑喉镜下使用显微喉镜钳、CO2激光辅助治疗等方式切开黏膜组织取出异物,并观察预后情况。结果3例患者均成功取出异物,术中出血少、创伤小,术后给予禁食水、补液、抗感染等治疗,患者恢复快,均治愈出院。结论包埋型异物较为少见,详细了解异物进入病史及依据CT影像学等辅助检查准确定位制定手术方案,咽后间隙、黏膜下及其间隙的异物可考虑行支撑喉镜下异物取出术,异物在颈动脉间隙、甲状腺等处或毗邻重要血管、器官时可考虑行颈部开放手术。通过准确定位增加该病治疗成功率。     

Removal of a metallic foreign body in the neck with a magnet: A case report

A 26-year-old man, presented to our department with history of a metallic foreign body in the neck. On wound exploration under local anaesthesia, the foreign body was not readily palpable. It was removed with the help of a magnet.     

Management of foreign bodies in the ear: a retrospective review of 123 cases in Nigeria

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.     

ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit

Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications.ObjectiveTo analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011.MethodCross-sectional retrospective historical cohort study based on digitized patient charts.ResultsFB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed.ConclusionIn our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.     

小儿气管支气管异物180例

目的 分析小儿气管支气管异物的临床特点及治疗体会,提高气管支气管异物的诊治水平。方法 回顾性分析180例小儿气管异物的临床资料。结果 180例中,植物性异物173例、金属性异物2例、塑料性异物2例、其他3例;在表麻下Hopkin支气管镜经口取出异物176例,经气管切开后取出异物4例,经二次手术取尽异物15例,均未有严重并发症发生,术后3d复查胸透(片)均未见异物残留征象。结论 异物吸入史、症状及体征,结合影像学检查可诊断气管支气管异物,表麻下气管异物取出是一种简易、有效的手术方式,症状严重者应考虑及时行气管切开。     

Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases

In our series of 400 Chinese children with foreign body aspiration (FBA), 343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per cent of cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 per cent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.     

Inhalation of foreign bodies in chinese children: A review of 400 cases

A retrospective review of 400 Chinese children who had inhaled foreign bodies was undertaken. There has been a yearly increase in the total number of cases of airway foreign bodies removed in our hospital. Fifty-eight percent of the children presenting were from the countryside; 42% were townspeople. Approximately 90% of the patients were under 3 years of age, with the peak incidence of foreign body inhalation occurring between 1 and 2 years of age (57.8%). The male-female ratio was about 1.2:1. About 95% of the removed foreign bodies were organic in origin. The majority of the foreign bodies were found most often in the right bronchial tree (46%). A positive history of foreign body inhalation was obtained in 98% of the cases. Twenty-eight percent of the children presented at the hospital within 24 hours, 71% within 1 week, and 29% more than 1 week after inhaling the foreign body. The most common presenting symptoms of lar-yngotracheal foreign bodies were cough, wheezing, dyspnea, and hoarseness; those of bronchial foreign bodies were cough, wheezing, decreased air entry, and rhonchi. More than two-thirds of the children with laryngotracheal foreign bodies had normal x-ray findings. The most common fluoroscopic findings in those children with bronchial foreign bodies were mediastinal shift (36.8%), obstructive emphysema (35.7%), and normal findings (35%). A total of 348 (87%) bronchial foreign bodies were removed by rigid bronchoscopy (81%), rod-lens bronchoscopy (5%), and spontaneous expulsion (1%); 52 (13%) laryn-geal and tracheal foreign bodies were removed by direct laryngoscopy (12%) and tracheotomy (1%). A single endoscopic procedure successfully removed 92.5% of 400 foreign bodies detected in the airways. One child died during bronchoscopy, for a mortality rate of 0.25%.