经气管镜气管内取出困难异物治疗方法的回顾性分析

目的：回顾性分析解放军总医院呼吸科49例取出困难的气管内异物的治疗方法。方法收集2010年3月至2014年10月解放军总医院呼吸科收治的49例气管异物临床资料,进行回顾性分析。结果49例气管异物患者有71.4%发生在右侧支气管,有4例误诊,异物种类以动物骨头、花生等食物为主,病理为慢性炎及肉芽组织,用常规活检钳不易取出,后经过氩等离子体凝固、鳄口钳、CO 2冷冻术、剪刀等治疗手段将异物通过气管镜顺利取出。结论气管异物是呼吸科的常见病,有时单纯的钳夹很难将异物取出,需要联合多种治疗手段。     

电子支气管镜取成人支气管异物20例临床分析

目的探讨电子支气管镜在支气管异物取出术中的临床应用价值。方法 2%利多卡因注射液咽、喉、气道表面麻醉后,使用电子支气管镜配合活检钳取20例成人支气管异物。结果 17例获成功,一次成功取出异物为14例占70%,2次成功取出异物为3例占15%,改用纤维支气镜配合异物钳取出3例,占15%。未出现严重操作并发症。结论电子支气管镜在显示屏直视下钳夹并取出异物,具有视野清晰、易发现异物、分离出异物,患者痛苦较小,可保留操作过程资料、便于教学等优点。     

电子支气管镜诊治成人气管及支气管异物135例临床回顾性分析

目的探讨气管及支气管异物(TFBs)发生的临床特点及应用支气管镜取异物的经验。方法选择2007年5月至2014年10月在我院经支气管镜诊治的135例成人气管及支气管异物患者,对其年龄、危险因素、临床表现、影像学特点、异物种类、发病部位等特点进行回顾性分析。结果 135例患者中40~70岁108例占80.0%,其中男性69例(63.9%)女性39例占(36.1%);有96例无明确异物吸入史(71.1%);异物以动物骨类居多,占90例(66.7%);异物最常见的部位是右侧支气管,占113例(83.7%);1例金属义齿经支气管镜移至气管上段时,由于其金属分支刺入气管壁,行气管切开取出,其余134例均成功经支气管镜取出异物。结论成人气管及支气管异物患者因无特异性临床表现,且大多无明确异物吸入史时,容易误诊。支气管镜检查是确诊和治疗成人气管及支气管异物的最有效方法。     

纤维支气管镜诊治气管支气管异物30例体会

目的探讨支气管异物的取出。方法对30例气管、支气管异物的诊断与取出病例进行回顾分析。结果纤维支气管镜成功取出笔帽、塑料口哨、瓜子等异物27例，术前自行咳出2例，1例需外科手术治疗。结论气管支气管异物救治成功的关键是早期明确，早期治疗，疗效明确，无后遗症。     

硬支气管镜下小儿支气管异物取出失败原因分析

硬支气管镜下取异物仍是目前小儿气管支气管异物的主要治疗方法.2001～2006年,本院共收治气管支气管异物患儿1800余例,均于硬支气管镜下取出异物,其中16例发现异物而未能取出.现分析如下.     

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。     

纤维支气管镜诊治成人支气管异物28例临床分析

目的 探讨纤维支气管镜在成人支气管异物诊治中的作用.方法 对经纤维支气管镜诊治的28例成人支气管异物患者进行回顾性分析.结果 一次性成功取出者25例,3例因异物周围炎症肉芽组织粘连严重,分两次成功取出.治愈率100%,无并发症.结论 纤维支气管镜对减少支气管异物的误诊及治疗具有重要价值.     

经支气管镜诊治长期误诊的成人支气管异物分析

目的探讨支气管镜对成人支气管异物的诊治价值。方法回顾性分析37例长期误诊的成人支气管异物的临床表现、支气管镜下特征及钳取异物技巧。主要临床表现为咳嗽、咳脓痰、发热、局限性呼吸音减弱、吸气时干啰音。仅6例胸片或CT可见异物的直接表现。误诊为肺炎、肺癌、支气管炎、支气管扩张、支气管哮喘、肺结核等疾病,误诊时间1个半月~25年。结果37例均经支气管镜成功钳出异物。钳取异物用时最长4 h,最短约15 m in。24例镜下直接见到异物,8例吸净脓性分泌物后见到异物,5例异物被肉芽组织包埋。异物为动物骨头31例,虾、螃蟹脚、金属异物、中药丸、瓜子壳、杨梅核各1例。结论成人支气管异物的误诊应予重视,支气管镜检查是诊治成人支气管异物的最主要手段。     

成人纤维支气管镜在幼儿支气管异物治疗中的应用

目的探讨成人纤维支气管镜在幼儿(11/12～3)支气管异物治疗中的可行性及价值。方法在全麻插管下行气管切开,从切开处将纤维支气管镜缓慢插入气管,观察异物所在部位,并根据异物的性质采用不同的手法取出。结果本组共8例,治疗全部取得成功,无并发症出现。结论在全麻插管控制呼吸下应用成人纤维支气管镜钳取幼儿支气管异物的治疗方法是可行的,尤其适用于异物过深或有多个异物的患儿。     

成人气管支气管异物2222例临床Meta分析

目的探讨我国成人气管支气管异物患者的临床特点和支气管镜下治疗的有效性和安全性。方法将1986年6月至2016年6月治疗的2 222例成人气管支气管异物患者的临床资料进行回顾性分析。结果成人气管支气管异物2 222例,男性1 520例,女性702例。1 318例患者否认异物坠积。1 950例患者无基础疾病。1 952例(87.84%)患者接受局部麻醉下支气管镜镜下治疗,成功取出气道异物。主要的临床症状为咳嗽1 625例(73.1%)。异物来源为动物骨骼1 036例(46.6%),果肉、果核类358例(16.1%),金属异物122例(5.49%),义齿和破损牙齿136例(6.12%)。异物引发的并发症有阻塞性肺炎740例(33.3%),肺不张340例(15.3%)。操作过程中及治疗完成后气道内出血143例(6.43%)。3例患者死于窒息。结论成人的气管支气管异物没有典型的临床症状;在表面麻醉下经支气管镜取出成人气管支气管异物是有效的、安全的。     

Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.

The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy.     

Broncholith removal using cryotherapy during flexible bronchoscopy: a case report

Pulmonary broncholithiasis can cause a management dilemma depending on its location and the possible involvement of vascular structures. Many patients undergo rigid bronchoscopy or surgical interventions for the removal of broncholiths. In this case report, we describe a 38-year-old white man with a history of performing warehouse demolitions who presented with chronic cough, dyspnea on exertion, and recurrent pneumonia. Imaging studies revealed hilar and mediastinal calcifications, as well as a calcification in the right middle lobe bronchus. Flexible bronchoscopy revealed a mobile obstructing calcified mass in the right middle lobe bronchus. Attempts at removing the mass with forceps were unsuccessful. Instead, the mass was removed using cryotherapy with minimal bleeding and complete resolution of the obstruction. Pathologic examination confirmed that the mass was a broncholith, and stains revealed the presence of histoplasma fungal forms. Partially attached broncholiths can be removed safely using flexible bronchoscopy with the aid of cryotherapy.     

Occult coiled drinking straw aspiration

A 23-year-old man had a 7-month history of recurrent right lower lobe pneumonia. Flexible fiber-optic bronchoscopy revealed an occluded bronchus intermedius. Rigid bronchoscopy demonstrated a coiled drinking straw in the bronchial lumen, which was removed by forceps. This article represents the first reported case of an aspirated coiled drinking straw obstructing an airway.     

Foreign body removal by flexible fiberoptic bronchoscopy in infants and children

Rigid bronchoscopy is the preferred method for removal of foreign bodies lodged in the airways, but some studies found that flexible bronchoscopy can also achieve a high success rate. The aim of the present work was to report our experience in using flexible bronchoscopy for foreign body retrieval in infants and children. Reports of all bronchoscopies performed from 1994-2003 at a tertiary-level pediatric hospital in Mexico City were reviewed. Those with a final diagnosis of foreign body aspiration were analyzed. Of 2,376 bronchoscopies performed during the study period, 59 (2.5%) yielded a final diagnosis of foreign body aspiration: 28 lodged in the right bronchi, 15 in the left bronchi, and those remaining, in the larynx or trachea. Foreign bodies were organic in nature in 38 (64.4%), mainly peanuts, pumpkin seeds, and beans, while 21 (35.6%) were inorganic, mainly pen caps and pins. In 23 cases, flexible bronchoscopy was attempted as the initial therapeutic procedure. Among these latter patients, the procedure was successful in 21 (91.3%). Ages of these 21 patients ranged from 9 months to 16 years (median, 5 years). The only two patients in whom foreign bodies could not be removed through flexible bronchoscopy were males, 2 years of age, both with a peanut lodged in right main bronchus. In conclusion, flexible bronchoscopy must be taken into account as initial therapeutic method for foreign body removal in infants and children.     

无痛支气管镜取婴幼儿支气管异物的应用价值

目的探讨无痛支气管镜取婴幼儿支气管异物的应用价值。方法回顾性分析2013年4—7月我院收治的有支气管异物的患儿4例的临床资料,均采用无痛支气管镜进行手术治疗。结果 2例外形不规则异物以异物钳随支气管镜通过声门取出,2例外形圆钝异物以套圈取出,随后均行支气管灌洗,无声门水肿、出血、窒息等并发症,术后均经抗感染治疗1周痊愈。结论无痛纤维支气管镜能较安全地取出婴幼儿支气管异物,且可以减少或避免因患儿不合作造成的气道远端损伤的风险。     

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。     

Foreign body aspiration diagnosed by microscopy

We report a rare case of foreign body aspiration diagnosed by microscopic analysis of a sample of the foreign body. A 50-year-old man presented with a 5-month history of 40 pound weight loss and a nonresolving right lower lobe pneumonia. Medical history, radiographic studies, direct visualization of the foreign body by flexible fiberoptic bronchoscopy, and gross examination of a sample of the foreign body retrieved by a forceps biopsy catheter failed to yield the diagnosis. Moderate bleeding associated with the bronchoscopic "biopsy" procedure contributed to a preliminary misdiagnosis of endobronchial tumor. Microscopic analysis of the "biopsy" specimen demonstrated vegetable matter. The patient underwent rigid bronchoscopy and a peanut was retrieved from the bronchus intermedius. He was maintained on antibiotics for an additional 8 weeks and had complete clinical and radiographic recovery. The epidemiology, presentation, and management strategies of foreign body aspiration in the adult are briefly reviewed.     

Bronchoendoscopic involvement in patients with carcinoma of middle third of esophagus in absence of respiratory symptoms

BACKGROUND: Bronchoscopic examination has been advocated as an essential part of evaluation of patients with newly diagnosed esophageal malignancy. The present study describes the role of routine preoperative fibreoptic bronchoscopy in staging disease and assessing resectibility in patients with malignancy involving the middle third of esophagus. METHODS: Preoperative fibreoptic bronchoscopy was performed in 125 patients with carcinoma of the middle third of esophagus. None of the patients had clinical or chest radiographic evidence of extension of disease outside the esophagus. RESULTS: Abnormalities were detected in 33 patients (25.6%), the commonest being external compression over the posterior wall of trachea in 17 (13.6%). Other abnormalities noted were left vocal cord paresis in seven (5.6%); compression over one or both major bronchi in seven (5.6%) and over the left lower lobe bronchus in one (0.8%); infiltration of the left main bronchus in two (1.6%); and growth in trachea in four (3.2%), in left main bronchus in two (1.6%) and over cricoarytenoid area in one (0.8%) patient. CONCLUSIONS: Tracheobronchial involvement, even in the absence of clinical or radiological features, is not uncommon in esophageal cancer. Preoperative bronchoscopy is useful to assess the extent of disease and resectibility in these patients.     

An adult case of bilateral true tracheal bronchi associated with hemoptysis

The term tracheal bronchus encompasses a variety of bronchial anomalies originating from the trachea or main bronchus and directed to the upper lobe, and a true tracheal bronchus is any bronchus originating from the trachea. In most cases, it is found incidentally during bronchoscopy or tomography. It is often unilateral, and bilateral true tracheal bronchi are very rare. We report a case of a 54-year-old woman who had bilateral true tracheal bronchi associated with hemoptysis.     

Severe respiratory distress caused by dental foreign object]

A 77-year-old man hospitalized in a bedridden state for cerebral infarction and left hemiparesis experienced the sudden onset of dyspnea and cyanosis. Chest X-ray films detected a foreign object in the hilum of the left lung. Emergency bronchoscopy revealed a dental crown lodged in the second carina. It was not possible to remove the crown with bronchoscopy forceps. The patient suffered severe respiratory failure the following day. Bronchoscopy again was performed, and the foreign object was removed with basket-type forceps. It was the patient's first molar, covered with a crown. The patient's respiratory failure was caused by atelectasis of the left lower lobe and overinflation, of the right lung, both of which resulted from postoperative edema of bronchial mucous membrane. Dental foreign objects do not cause pulmonary atelectasis or pneumonia as easily as other types of bronchial foreign objects. Therefore, there is usually enough time for thorough examination prior to removal procedures. It is important to accurately identify the shape of the foreign object, choose appropriate forceps, and successfully remove the object in the first operation. Moreover, adequate dental treatment of caries and loose teeth is important as a means of preventing dental foreign objects, especially in elderly people and bedridden patients.