小儿气管支气管异物368例临床诊治分析

目的:探讨小儿气管及支气管异物的临床特征,提高诊治率.方法:回顾性分析368例气管、支气管异物患儿的临床资料.分析患儿的年龄、性别、病史、异物部位和种类及并发症等.368例患儿中,3例在术前将异物咳出,2例因病情危重未取异物,其他均在全身麻醉下行气管镜检查及异物取出术.结果:3例在术前将异物自行咳出,4例死亡,2例患儿遗留缺氧缺血性脑病、癫痫,余均手术取出异物.结论:对于儿童气管及支气管异物,应详细询问异物吸入史,进行体格检查和胸部X线或CT检查,以避免延误病情和出现误诊、误治.     

儿童呼吸道特殊异物49例临床分析

目的:探讨儿童呼吸道内特殊异物的临床特点及取出技巧。方法:回顾性分析我科收治的49例呼吸道特殊异物患儿的临床特点,并对其治疗方法进行总结。结果:所有患者中有47例均经硬性支气管镜取出异物后痊愈出院,1例转胸外科开胸取出异物,1例死亡。结论:儿童呼吸道特殊异物的临床特点不完全等同于普通异物,术前、术中及术后的处理亦不完全等同于普通异物。     

食管异物误诊误治分析

食管异物是耳鼻咽喉科的常见病，一般情况下异物大多能在食管镜下经口取出；但由于食管解剖部应隐蔽深在，有时异物不易发现，加上诊疗上的失误，少数病例会造成严重后果甚至死亡[1]。为了解临床上食管异物患者情况究竟如何，本文对我院历年因食管异物住院的病例进行了总结和分析。一、临床资料我院自1980年以来住院的食管异物患者共46例，有完整病历者31例（见附表）。从表中可以看到，初诊时误诊误治率较高，31例中就有14例（占45．16％fy有误诊误治情况，其中误诊7例，虽诊断明确但误治者3例，病人或家属延误者《例，这些病例都出现了不…     

儿童鼻腔牙4例并文献复习

目的 探讨儿童鼻腔牙的发病及诊疗特点,提高儿童鼻腔牙诊疗水平,减少鼻腔牙误诊误治。 方法 回顾分析4例儿童鼻腔牙的临床资料,分析其好发部位、主要症状、诊断、手术方法、随访结果等特征。 结果 4例患者鼻腔牙生长部位均为鼻腔底部,左侧2例、右侧1例、双侧1例。症状以鼻塞、流涕、鼻出血、鼻腔异味为主,鼻腔CT有助于诊断,均经鼻内镜下鼻腔牙切除术,术后随访3个月至3年,未见复发,术后未出现鼻腔黏连和硬腭瘘等。 结论 儿童鼻腔牙以单侧鼻腔牙为主,也有双侧鼻腔牙病例,易误诊为鼻腔异物;发病年龄较儿童鼻腔异物患儿大,6岁以上鼻腔异味的患儿需要考虑鼻腔牙的可能;鼻内镜下鼻腔牙切除术是治疗鼻腔牙的主要手段。     

小儿鼻腔异物误诊18例临床分析

鼻腔异物多见于小儿，为进一步提高临床医生对该病的认识(尤其是儿科医生)，减少误诊率，现将我科2001～2003年在门诊收治的小儿鼻腔异物误诊误治18例临床资料分析如下。     

小儿呼吸道特殊异物20例治疗分析

小儿呼吸道异物是严重危及儿童生命的急症，非植物性的小儿呼吸道特殊异物在治疗过程中难度大，并发症多，死亡率高，对其采取及时有效的治疗措施是非常重要的。现就这类特殊类型的呼吸道异物20例进行总结。     

2例特殊类型儿童气管异物的临床分析

目的：分析儿童气管异物误诊原因,减少临床误诊率。方法：对2例诊断为儿童气管异物的病例进行回顾性分析。结果：1例无明确异物吸入史的患者证实为鼻腔脓性痂皮致主气管异物,1例高度怀疑为气管异物患儿最终诊断为有机磷中毒。结论：对疑似气管异物的儿童患者,应仔细采集病史,注意特有体征,减少误诊。     

气管切开术在儿童呼吸道特殊异物中的应用

目的探讨气管切开术在儿童呼吸道特殊异物取出术中的作用。方法回顾性分析159例儿童呼吸道异物的临床资料,5例（3.14%）经气管切开术取出,其中2例为特殊类型异物。结果 159例儿童呼吸道异物中156例（占98.1%）经硬质支气管镜检查取出异物,1例使用特殊类型导管取出,2例死亡。5例患者行气管切开术取异物（0.63%）,2例为特殊异物。结论当呼吸道异物阻塞较为严重或常规支气管镜检查难以取出的特殊异物时,气管切开术可以迅速缓解呼吸困难,吸出呼吸道分泌物并有助于异物取出。     

小儿呼吸道异物误诊原因分析

我院1970～1995年收治住院的小儿呼吸道异物中误诊误治63例。误诊持续时间平均为29d（10d～2年），80％以上病例由基层误诊转来。结合典型病例，概括其误诊、误治主要原因报告如下。1临床资料在误诊的63例中，5岁以内高达78．29％，男女性别比例约为1．2：l。按性别、年龄构成统计，结果见表1。本组病例误诊持续时间经中位数处理，平均为29d（10d～2年），其中1个月以内者约占50％。多数病例因反复发作就诊3～4次，最多者达6次，且经过多种抗生素治疗。本组病例中59例（占93．65％）为植物性异物（包括多种瓜籽、花生米和豆类等），其他则为…     

阻塞性睡眠呼吸暂停低通气综合征误诊误治

目的　分析阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome,OSAHS)误诊误治原因 ,增强对OSAHS的认识。方法　报道 6例误诊、误治病例 ,并对误诊、误治的具体原因进行分析。结果　OSAHS易被误诊为原发性高血压、神经官能症、儿童弱智、缺钙、心律失常、哮喘等。OSAHS误诊、误治原因主要有 :①OSAHS患者症状和并发症较多 ,主诉可能为OSAHS或其并发症的任何症状之一 ;②缺乏对OSAHS的认识。结论　分析OSAHS误诊、误治原因 ,增强对OSAHS的认识 ,及时诊断和治疗     

Plastic laryngeal foreign bodies in children: a diagnostic challenge

OBJECTIVE: To review Children's Hospital and Regional Medical Center experience with pediatric airway foreign bodies, and examine the incidence and treatment of laryngeal foreign bodies. To determine if plastic laryngeal foreign bodies present differently than other laryngeal foreign bodies. METHODS: A retrospective review of all cases of children (1874 patients) undergoing direct laryngoscopy and/or bronchoscopy from 1st January 1997 to 9th September 2003 at a tertiary care children's hospital. Patients with endoscopically documented laryngeal foreign bodies were identified and the medical record reviewed in more detail. Patient age, gender, foreign body location, foreign body type, duration of foreign body presence, radiographic findings, endoscopic findings and treatment complications were recorded. RESULTS: One hundred and five aspirated foreign bodies were identified. The nine laryngeal foreign bodies included five clear plastic radiolucent items, two radiolucent food items, and two sharp radioopaque pins. Time to diagnosis and treatment was on average 11.6 days with 17.6 days for thin/plastic foreign bodies and 1.6 days for metal/food foreign bodies. CONCLUSION: Laryngeal foreign bodies represent a small portion of all pediatric airway foreign bodies. Difficulty in identifying laryngeal foreign bodies, especially thin, plastic radiolucent foreign bodies can delay treatment. Thin plastic foreign bodies can present without radiographic findings, can be difficult to image during endoscopy and can be particularly difficult to diagnose. A history of choking and vocal changes is associated with laryngeal foreign bodies. Laryngeal foreign bodies should be in the differential diagnosis of all children presenting with atypical upper respiratory complaints especially if a history suggestive of witnessed aspiration and dysphonia can be obtained.     

螺旋CT多平面重建在小儿可疑气道异物诊断中的应用

目的：探讨多层螺旋CT多平面重建（MPR）在不典型X线穿透性异物的诊断价值。方法:对71例可疑呼吸道异物患儿行螺旋CT扫描多平面重建。结果：35例MPR直观显示异物的位置、大小、形态及与周围组织关系,其中气管异物6例、右主支气管异物16例、右下支气管异物5例、左主支气管异物7例、左下支气管异物1例、双侧主支气管异物1例;排除异物35例,手术未证实异物1例。结论:MPR对气管支气管异物显示率高、定位准确,在可疑气道异物诊断及鉴别诊断中有重要意义。     

Airway foreign bodies (FB): a 10-year review

A retrospective chart review of children who had airway foreign body removed via direct laryngoscopy and bronchoscopy (DLB) from 1987-1997 was conducted in Children's Hospital, Boston. Patient characteristics noted included age, sex, and clinical presentation. Pre-operative radiographic findings, reason for delay in evaluation, DLB findings, length of procedure, reason for repeat DLB, and types of foreign body etc. were recorded. Serious complications from aspirated foreign bodies such as severe airway obstruction and death tend to occur in infants and younger children because of their small airway size. A history compatible with foreign body aspiration dictates diagnostic endoscopy with or without radiologic confirmation. Chest and airway radiographs supplemented by fluoroscopy can increase the ratio of correct and early diagnosis. Fluoroscopy should be universally accepted as an initial diagnostic technique in airway foreign body evaluation. Fluoroscopy is not a worthwhile investigation if a preceeding chest radiograph suggests the presence of a foreign body. Long-standing airway foreign bodies are associated with considerable morbidity, and early diagnosis remains the key to successful and uncomplicated management of foreign body aspiration. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach.     

Laryngeal foreign bodies in children revisited

To review our experience with inhaled laryngeal foreign bodies in children, we performed a retrospective review of all admissions to our institution between March 1989 and March 2002 with the diagnosis of an inhaled laryngeal foreign body. We included only cases in which the diagnosis was confirmed at endoscopy under general anesthesia. Two children were dead on arrival at our institution as a result of upper airway obstruction following a choking episode and did not undergo endoscopy; they were not included. Nine children (5 male, 4 female) were identified. The age range was 5 months to 13 years 9 months, although only 1 child was older than 32 months. The foreign body was removed within 24 hours of a witnessed choking episode in 4 children, and the diagnosis was delayed in 5 children for a period between 4 days and 2 months, including 2 in whom a history of a choking episode had been initially obtained. One complication occurred in a child in whom the diagnosis was delayed; he developed laryngeal edema after foreign body removal and required endotracheal intubation for 1 week.     

Bronchial granuloma - where's the foreign body?

Airway masses are uncommon in children. The majority of bronchial tumors are granulomata secondary to an inhaled foreign body. However, other rare diseases like primary bronchopulmonary tumors should always be considered in the evaluation of a bronchial granuloma in children. The differential diagnosis of bronchial granuloma is presented. We report a 7-year-old girl with a 3-year history of recurrent cough and fevers who was found to have a bronchial granuloma in the left upper lobe bronchus. The diagnosis of foreign body-related granuloma was eventually made after combined and repeated rigid and flexible bronchoscopy. This case highlights the need to search aggressively for a foreign body in the presence of an airway granuloma in children, even in the absence of a history of aspiration.     

Rigid bronchoscopy for the suspicion of foreign body in the airway

OBJECTIVE: Airway foreign bodies present a diagnostic dilemma and has been recognized for many years. Since aspiration of foreign bodies can be a serious and sometimes fatal problem, early intervention and proper management is vital. METHOD: In this retrospective study, the results of 1887 bronchoscopies, which were performed between the years 1973 and 2004 for the suspicion of foreign body aspiration in children, were presented. Various instruments and techniques were used over 31-year period and rigid bronchoscopy was the preferred method of foreign body extraction. RESULTS: There were 1106 boys and 781 girls with the median age of 2.3 years. Seventy-four percent of patients were less than 3 years old. The most common type of foreign body (89.9%) was organic; watermelon seeds (39.7%) were the most frequent organic foreign bodies. Eight hundred and twenty-three patients (43.6%) were referred to our clinic within the first 24h of the event while 4.5% of the patients were admitted to the hospital with the suspicion of foreign body in the airway later than one month. At bronchoscopy, a foreign body was identified in 79.1% of patients and no foreign body was seen in 20.9% of patients. Foreign bodies were encountered in 96.3% of the patients with positive history whereas 28.1% of the patients with negative history had foreign body. Of the patients with foreign bodies, 93.2% had positive history. Overall, the positive history was obtained from 85.2% of patients. The incidence of postbronchoscopic tracheotomy, thoracotomy, and overall mortality rate were 0.47, 0.15, and 0.21%, respectively. CONCLUSION: Otolaryngologists should consider foreign body aspiration in the airway in the differential diagnosis of any patient with the complaints of stridor, dyspnea, sudden onset of cough and intractable and recurrent lower respiratory tract infections. A careful history and physical examination were strong indicators of the diagnosis and raised the index of suspicion of an aspirated foreign body. Timely intervention with the experienced surgical team would decrease the complication rate and mortality rate. However, prevention of aspiration with the education of parents and caregivers is very important.     

婴幼儿喉异物诊治分析

摘要：目的探讨婴幼儿喉异物的诊治方法及误诊原因,提高诊治率,降低误诊率、死亡率。方法回顾性分析我科收治的68例婴幼儿喉异物的临床资料。分析异物部位和种类、检查方法、手术方式、误诊原因等。结果68例患儿均成功取出异物,其中2例行二次手术,无行气管切开或死亡病例。结论提高看护人员及医师对婴幼儿喉异物特点的认识是降低误诊率、死亡率的关键,可疑病例应首选电子喉镜检查,必要时行影像学检查,麻醉及手术方法的选择亦至关重要。     

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。     

Delayed diagnosis of a pediatric airway foreign body: case report and review of the literature

Foreign body aspiration is a common pediatric problem that affects children of all ages, including those who are well into their adolescence. We describe the case of a 9-year old boy with an airway foreign body that had gone unrecognized for 3 months. We also review the literature on pediatric airway foreign bodies, with a focus on delayed diagnosis. A diagnosis of foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms that are refractory to medical treatment and are consistent with airway obstruction.