Foley catheter removal of blunt oesophageal foreign bodies in children

In a two year period between 1985 and 1986, eight children presented with impacted blunt foreign bodies in the oesophagus were successfully treated by removal using a Foley catheter without anaesthesia. There were no complications. All patients were discharged well after one or two days in hospital. The technique is safe, rapid and easy to perform.     

经气管内插管静脉全身麻醉儿童支气管异物取出

 【目的】 评估气管内插管静脉全身麻醉下经支气管镜或支撑喉镜联合Hopkins内镜取儿童支气管异物的安全性及效果,以提高儿童支气管异物处理的水平。【方法】 回顾性分析45例我院收治的支气管异物待查患儿,于气管内插管静脉全身麻醉下行支气管镜检查或支撑喉镜联合Hopkins内镜检查,取出异物。术中密切监测生命体征并记录手术时间。【结果】 行支气管镜检查术15例,支撑喉镜联合Hopkins内镜检查术30例,术中全部病例均经历临时拔出气管插管,共43例发现并成功取出异物,2例未发现异物,全部病例的平均手术时间（8.46±5.96）min,支气管镜组（12.87±6.44）min,支撑喉镜联合Hopkins内(5.82±3.78)min,15例术中曾出现短暂SpO2低于85%,全部病例PETCO2及心率等生命体征平稳。未出现任何并发症。【结论】气管内插管静脉全身麻醉下经支气管镜或支撑喉镜联合Hopkins内镜取出患儿气管支气管异物,手术操作简便,快速,麻醉简单、安全、疗效显著,值得推广。     

Hypopharyngeal and oesophageal foreign bodies

Foreign bodies in the food passages are quite common in Jos Community. Majority of 119 cases seen over a period of four years were children 92.4% and a coin was the commonest foreign body (86.5%). The site of lodgement of the foreign body was hypopharynx and abdomen in 11 cases each while 97 were held in oesophagus, mainly in its upper part. Removal of the foreign body by oesophagoscopy was difficult in patients who presented late. The coins formed a pouch in posterior oesophageal wall in six cases while their anterior surfaces got discoloured in 14 cases causing difficulty in their identification. Besides coins in children and dentures in adults, nine patients accidently swallowed a wide variety of foreign objects of different shapes and sizes. Management of such cases has been discussed.     

Double coins at the oesophageal inlet

Multiple foreign bodies lodged in the oesophagus are extremely rare. Here an unusual case of two coins accidentally lodged at the oesophageal inlet of a six-year-old girl is reported. The coins were successfully removed by oesophagoscopy. It is to be noted that apart from the straight x-ray (PA view) of the neck and chest, a lateral view is essential for proper characterisation and identification of the type and number of foreign bodies prior to surgical removal.     

非洲儿童气管支气管异物的临床特点分析

目的探讨对非洲儿童气管、支气管异物的诊断和治疗方法。方法回顾性分析笔者在非洲尼日尔共和国尼亚美国家医院工作期间收治的儿童气管、支气管异物90例的临床资料及其诊治经过。结果 81例患儿在全麻下行硬支气管镜检查并将异物成功取出,痊愈出院;1例在就诊时因窒息而死亡;两例手提脚头朝下拍打背部,咳出异物;两例麻醉后因无手术器械而放弃手术;两例插管麻醉意外死亡;两例转外科开胸手术治疗。结论非洲儿童气管、支气管异物的诊治因地域、国情具有特殊性,异物多为中空型玩具,呼吸困难的情况少,且症状轻,诊断主要依靠病史,应用硬气管镜诊治,可代替气管导管,既可手术也可麻醉和通气、缩短手术时间、提高手术安全性,是诊治非洲(包括我国贫困地区)儿童气管、支气管异物的首选方法。     

X线电视监视下行眼眶小金属异物旁注气取出术探讨

目的探讨摘取眼眶细小金属异物的有效方法及手术技巧。方法对17例眼眶金属异物行C臂机电视定位,引导注射针头进入并与异物接触,注入适量气体使金属异物与周围软组织分离,于眼睑部或结膜部作切口,用蚊式血管钳进入,夹持金属异物并缓慢取出。结果17例眼眶细小金属异物均顺利取出,术后未对视力造成不良影响。结论X线电视监视下异物旁注气协助眼眶细小金属异物取出是一种简便、实用、有效且创伤小的眼眶细小金属异物取出的方法。     

特殊类型呼吸道异物的处理

目的 探讨气管、支气管特殊类型异物的有效处理方法。方法 回顾分析24例气管、支气管特殊异物的处理方法。结果 15例特殊异物经气管镜取出，6例从气管切开口处取出，使用纤维支气管镜取出2例，1例异物开胸取出。结论 根据气管、支气管特殊异物类型、病程和是否伴发合并症，制定合理的手术计划，充分做好围手术期的处理和术中的应变处理，可以减少并发症的发生，取得良好的治疗效果。     

肌松药应用于小儿气管异物取出术中的临床疗效探讨

目的：研究肌松药在小儿气管异物取出术中的临床疗效。方法方便选取80例2012年10月—2015年11月在该院接受气管异物取出术的小儿,随机分为观察组和对照组,每组40例,观察组术中采用顺式阿曲库铵进行手术,对照组保留自主呼吸,统计分析两组患儿手术持续时间、苏醒时间及不良反应。结果两组患者均顺利完成手术,无死亡病例;观察组手术时间(12.5±3.5)分显著优于对照组的(25.8±12.1)(t=5.78,P﹤0.05);观察组术后苏醒时间(30.1±13.5)分显著优于对照组的(45.1±18.2)(t=3.62,P﹤0.05)。结论在小儿气管异物取出术中合理运用肌松药可显著缩短手术时间、降低不良反应。     

七氟烷诱导喉罩置入麻醉在小儿气道异物取出术中的应用

目的研究七氟烷诱导喉罩置入麻醉在小儿气道异物取出术中的应用。方法对2008年7月至2010年1月81例实施气道异物取出患儿采用七氟烷吸入喉罩置入全身麻醉方式,观察在行气道异物取出时患儿的无创血压、心率、脉搏氧饱和度以及呼气末二氧化碳的变化。结果与麻醉前基础值比较,围麻醉期HR、SBP、SpO2、PETCO2差异无统计学意义（P﹥0.05）,81例行气道气道异物的小儿均安全顺利地完成了操作,而且术后苏醒迅速。结论七氟烷吸入喉罩置入全麻在小儿气道异物取出术中是一种安全可靠的麻醉方法。     

X线透视引导下眶内异物取出联合玻璃体手术对眼球穿通伤合并眶内异物的治疗

目的：介绍C臂X线透视引导下眶内异物取出联合玻璃体手术对眼球贯通伤合并后眶内异物的治疗。 方法：对7例(7眼)眼球贯通伤合并眶内异物,行玻璃体切除术联合C臂透视引导下眶内异物取出术,根据术中具体情况同时行眼内光凝、硅油或全氟化碳(C3F8)填充。分析手术时机、异物位置及取出情况、 术前和末次随访时视力、眼球运动和眼内、眶内炎性情况。 结果　7例异物全部一次手术摘出成功。透视照射时间均少于2.5分钟。随访8～24月。术后患眼最佳视力等同或高于术前, 所有患者均无术中及术后并发症发生。 结论　玻璃体切除术联合C臂X线透视引导下眶内异物取出术是治疗眼球贯通伤合并后眶内异物的一种安全可靠方法。     

Foreign body aspiration in adults

Foreign body aspiration is not an uncommon problem, particularly in children, the elderly, and those with predisposing factors like neurological impairment. In adults, regional differences exist in the type of foreign body aspirated. We report four cases of foreign body aspiration in South Asian adults, three of which were related to the widespread habit of chewing stimulant seeds such as betel nuts (two) and tamarind seed (one). It is important for clinicians to maintain a high index of suspicion for the diagnosis of foreign body inhalation in the appropriate clinical setting. Bronchoscopy is necessary not only for the diagnosis but also for the removal of foreign body from the bronchial tree. Once the foreign body is removed, the improvement in symptoms is usually dramatic, making it rewarding for any physician to manage.     

医麻密切配合在小儿气道异物取出中的关键作用

目的回顾14年小儿气道异物取出术105例的点滴经验,手术医师和麻醉师完美配合是手术成功的关键。准确诊断异物部位,麻醉及用药选择、手术步骤、手术时机等均应仔细研讨。方法小儿气道异物取出中,气管支气管异物大多用全麻：1）眯达唑仑异丙酚复合麻醉。2）异丙酚瑞芬太尼复合麻醉。3）氯胺酮γ-羟基丁酸钠复合麻醉;鼻道异物和咽、喉部异物用无麻或表麻。结果105例小儿气道异物中,气管支气管异物28例,咽、喉及声门区异物24例,鼻道异物53例,一次性取出96例,再次取出9例。无一例术中死亡。结论小儿气道异物应尽快取出,麻醉是关键,深度要足,若全麻深度不足比无麻更危险。要诊断准确,作好术前各项准备,手术时机正确把握。手术医师和麻醉师密切配合,共同预防术中并发症,正确选好异物钳,术者精心操作。预防呼吸和心跳骤停的并发症,及时发现异常征兆和正确处理,就能保证手术的成功。广泛宣传、普及卫生知识、改掉不良习惯,预防误吸异物,减少小儿气道异物的发生率。     

The management of ingested foreign bodies in the upper digestive tract: a retrospective study of 49 cases.

Forty-nine cases of accidental foreign body ingestion treated in our unit were reviewed. Fish bones were the commonest foreign body ingested by adults while coins and pins accounted for most cases in the paediatric age group. All except one patient had endoscopy performed, majority with flexible endoscope. Foreign bodies were detected and successfully removed endoscopically in 23 patients except one. In another 12 patients, foreign bodies were demonstrated by chest X-ray or Barium meal but at the time of endoscopy, they had passed beyond the reach of the endoscope. For the remaining 13 patients, despite having a history of foreign body ingestion and retrosternal pain, subsequent investigation failed to demonstrate the foreign bodies. Barium contrast studies were performed in 31 cases, with 5 false negative and 2 possible false positive findings. There were 2 serious complications related to foreign body ingestion, one had empyema thoracis and another died of massive bleeding due to esophageal carotid fistula.     

电子喉镜在困难咽喉异物取出术中的临床体会

目的探讨电子喉镜在困难咽喉异物取出术中的临床运用。方法2008年3月=2012年3月的4年间，我科在电子喉镜介入下共处理困难异物97例。结果96例困难咽喉异物一次性经电子喉镜下成功取出。1例患者为假牙牙套且已部分进入食道，最终食道镜下取出。结论电子喉镜具有视野广而清晰无盲点，分辨率高的优点，特别适用于困难咽喉异物的取出，更为准确、方便。     

内镜治疗儿童上消化道异物30例临床分析

目的: 探讨内镜治疗儿童上消化道异物的方法、经验及技巧。方法: 对30例儿童(<12岁)上消化道异物行急诊内镜检查和治疗,咽喉部局麻下用成人细径胃镜进行操作,运用各种异物器械取异物。结果: 30例儿童32件异物,非全麻下取异物28例,全麻下取异物2例;食管异物19例,胃内异物9例,十二指肠异物2例。29例31件异物经内镜成功取出,仅1例1件异物进入小肠未能取出,成功率96.7%。除1例在操作过程中出现一过性呼吸抑制,余无其它并发症。结论: 内镜治疗儿童上消化道异物简便、安全、有效,可作为首选治疗方法。     

全身麻醉用于小儿特殊类型气管异物探取术

目的探讨一种使患儿舒适、安全,术者乐意采用、认可的取异物全身麻醉方法。方法采用表面麻醉与利多卡因、γ-羟丁酸钠、芬太尼、丙泊酚等药物静脉复合,使患儿术程中保留自主呼吸。在严密的生命指征监测指导下控制麻醉深度。结果51例手术圆满完成操作,49例异物一次性取出。平均手术时间20分钟。围手术期:患儿安静、无痛,探取顺利,术者满意。患儿全部在术后40±12分钟内清醒,无术中不良记忆和术后并发症。结论合理的药物组合、全身麻醉下探取小儿特殊类型气管异物是安全可行的方法,易于推广使用。     

气囊导尿管在子宫切口妊娠中的运用

目的:探讨双腔气囊导尿管气囊内注水压迫子宫切口治疗剖宫产术后子宫切口妊娠(Caesarean scar pregnancy,CSP)清宫时出血的疗效及可行性。方法:诊断明确的CSP经药物保守治疗后清宫时出血,用双腔气囊导尿管放置宫腔,气囊内注入无菌0.9%NaC l溶液20～40 m l压迫子宫切口12例,术后24～48 h取出。根据术后取出导尿管1 h内阴道出血量的多少,分为满意或不满意。结果:用双腔气囊导尿管气囊内注水压迫子宫切口止血,满意度91.7%,而且无1例并发症发生。结论:在迫切需要保全子宫且无条件行子宫动脉栓塞术的基层医院,使用双腔气囊导尿管气囊内注水压迫子宫切口治疗CSP清宫时出血是安全、易接受、可行的,为进一步后续治疗争取了时间。     

硬支气管镜下小儿肺不张的诊疗分析

目的通过硬支气管镜检术明确小儿肺不张的病因,评价支气管灌洗术及异物取出术治疗肺不张的疗效。方法回顾性分析我院呼吸科和耳鼻喉科通过胸部X线片及肺CT等影像学检查诊断为肺不张并行硬支气管镜检术的120例患儿临床资料,分析小儿肺不张的病因,评价支气管灌洗术及异物取出术治疗肺不张的疗效。结果气道阻塞性肺不张共117例,其中气管外源性异物87例(72.5%),内源性异物30例(25.0%),肺先天性发育不良3例(2.5%);经支气管灌洗术及异物取出术治疗,外源性异物造成的肺不张1周内复张总有效率97.7%,内源性异物造成的肺不张1周内复张总有效率63.3%,先天性肺发育不良3例均无效。结论小儿肺不张的病因主要为支气管阻塞;硬支气管灌洗术及异物取出术是治疗小儿肺不张的有效方法。     

Inhalation of foreign bodies by children: a continuing challege in management.

In a review of 19 years' experience with inhalation of foreign bodies by children the 33 patients (mean age 28 months) were found to have presented most frequently with wheezing or coughing, or both, of recent onset, and to have decreased air entry, rhonchi or respiratory stridor, or a combination of these signs. Eighteen children had inhaled a nut, a pea or a bean. The other 15 had inhaled various organic and inorganic objects. All the children underwent bronchoscopy, and the foreign body was completely removed in 19 during the first procedure; the remainder required repeated bronchoscopy or direct surgical removal of the foreign body, or both. Permanent disability or death was not encountered. The findingsof the study indicate that early bronchoscopic removal is the preferred treatment when a child inhales a foreign body.     

双腔导尿管取儿童食管硬币状异物疗效观察

目的探讨双腔导尿管取食管异物的方法和优点。方法采用双腔导尿管治疗24例儿童食管扁平光滑的异物。结果24例中1次成功取出21例,2例2次取出,1例异物进入胃内。结论双腔导尿管取儿童食管内扁平光滑异物是一种有效的方法。