食管异物并发食管穿孔及颈部脓肿临床分析

目的：探讨食管异物并发食管穿孑L及颈部脓肿的临床特点及治疗方法,以期提高对该病的诊治水平。方法：24例食管异物并发食管穿孔及颈部脓肿患者均在全身麻醉下行食管镜检查异物取出术,其中经食管镜取出异物14例,开胸后取出义齿3例,颈侧切开取出异物5例;余2例未见异物。结果：24例患者中并发脓肿16例,其中食管周围脓肿10例,颈部脓肿4例,纵隔脓肿2例;治愈21例,死亡1例,1例因血糖高转内分泌科,1例转胸外科继续治疗。结论：早期诊断、早期治疗是处理食管异物并发食管穿孔的关键。对于食管异物并发食管穿孔及颈部脓肿患者行薄层CT扫描具有极高的诊断及鉴别诊断价值。颈部脓肿一经确诊,应及时行脓肿切开引流术,合理应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗可提高治愈率。     

颈侧切开在颈段食管异物取出中的应用

目的 探讨颈侧切开术治疗颈段食管异物的适应证及诊治要点.方法 回顾性分析1999年1月至2009年1月治疗2189例食管异物患者中137例(6.25%)行颈侧切开术患者的临床资料,其中16岁以上成人组114例,16岁以下未年组23例.成人中食管穿孔67例(58.8%);食管未穿孔患者47例,其中7例合并有食管周围脓肿.未成年人中食管穿孔19例(19/23);食管末穿孔但合并食管周围脓肿3例,未形成脓肿的巨大异物1例.结果 137例异物患者经颈侧切开手术治疗后均痊愈出院.19例(13.9%)患者出现声嘶,3个月内均恢复.成人组5例(3.6%)患者术后出现轻度颈段食管瘢痕性狭窄,行扩张治疗3～11个月完全恢复;9例穿孔食管行二期缝合后穿孔愈合,其余食管穿孔均一期愈合;1例颈总动脉受损行结扎术后患者未出现偏瘫、失语等后遗症;9例气管切开患者中7例住院期间拔除气管套管,2例肥胖患者中1例出院后3个月拔管,1例带管至今.未成年组穿孔食管术中对位缝合后均一期愈合;5例气管切开患儿均拔管.结论 贯穿性食管异物及颈部脓肿是颈侧切开术的适应证,积极防治颈侧切开手术的并发症及合并症,可获得较好疗效.     

颈侧切开术治疗异物穿孔并纵隔脓肿6例

目的：探讨颈侧切开术治疗异物穿孔并纵隔脓肿患者的适应证及临床诊疗要点。方法i6例异物穿孔并纵隔脓肿患者均在入院后12h内行颈侧切开术。结果i6例患者中,4例取出异物;1例入院前已在当地医院取出异物;1例未找到异物。除1例声嘶、术后1年恢复外,余均无并发症。结论：异物穿孔并纵隔脓肿是颈侧切开术的适应证。     

多层螺旋CT三维重建对疑似支气管异物的诊断价值

目的评价多层螺旋CT（MSCT）三维重建在小儿气管支气管异物鉴别诊断中的应用价值。方法回顾性分析24例疑似气管支气管异物患者行多层螺旋CT及三维重建技术进行诊断,评价多层螺旋CT及三维重建技术对气管支气管异物的显示情况及诊断价值。结果 19例螺旋CT诊断为支气管异物者经支气管镜检确诊并取出异物;另5例疑似气管支气管异物患者经CT扫描未发现异物,经保守治疗痊愈。结论螺旋CT及图像后处理技术可提高小儿气管支气管异物的诊断准确性,减少误诊。     

异物致颈部脓肿三例并文献复习

目的 探讨异物所致颈部脓肿临床特点、诊断及治疗方式,提高对异物所致颈部脓肿的诊治水平。 方法 回顾性分析3例异物所致颈部脓肿患者并同期所有中、英文类似报道病历资料,共49例。 结果 49例中采用手术治疗48例,术中发现并取出异物46例;保守治疗1例;发生呼吸骤停等并发症17例,所有报道病例均治愈出院。 结论 异物所致颈部脓肿病情危重,并发症较多。结合病史及影像学检查,发现并取出异物,尽早颈部脓肿引流是治疗关键。     

Rational diagnosis of pediatric pharyngeal abscess]

BACKGROUND: Diagnostic procedures intend to differentiate superficial cervical abscesses from deep abscesses and uncomplicated lymphadenitis. They should provide identification of the causing agent, of the route of infection and of possible underlying diseases. Present techniques for examining pediatric cervical abscesses should be assessed. METHODS: Currently published data on diagnostic procedures in pediatric neck abscess from National Library of Medicine data files were evaluated. Moreover, clinical findings, diagnostic procedures, therapy and outcome of 47 children with cervical abscess treated from 1992-1996 were retrospectively evaluated. RESULTS: Studies providing appropriate evidence on the value of various diagnostic procedures in pediatric cervical abscesses were not found. In 47 patients with confirmed cervical abscess treated at our department, clinical examination, erythrocyte sedimentation rate and ultrasound examination of the neck were sufficient to establish the correct diagnosis. Additional investigations such as MRI or CT-scans, chest X-rays, Mendel-Mantoux test, various virus titres and other laboratory examinations were performed only in selected cases. The route of invasion (tonsil, dental or otogeneous) could be identified in 13 children. In 4 children an infected cervical cyst was found. CONCLUSIONS: Clinical examination, erythrocyte sedimentation rate and sonography are appropriate to establish the diagnosis of pediatric cervical abscess and in accordance with the principles of Managed Care.     

Computed tomography in penetrating wounds of the orbit with retained foreign bodies

Penetrating wounds of the orbit can have serious immediate and delayed effects on the eye and the CNS. Infection, vessel erosion, or interference with ocular function necessitates removal of the foreign object. Precise localization of the retained material and its relationship to the globe, extraocular muscles, optic nerve, and brain is essential, when surgery is contemplated. We describe two children with retained foreign bodies that required removal. Computed tomography (CT) was essential in one instance in planning the surgical approach. In the other patient, the retained foreign body and an associated brain abscess were recognized only by CT. The contribution of CT to the assessment of retained foreign bodies is discussed and its present limits are defined. Computed tomography is highly recommended as the single most informative diagnostic modality for this type of injury.     

Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes

Over a 6.5-year period, 5,848 patients who had ingested a foreign body were admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong. Potentially serious complications developed in 12 patients (0.21%). Eight patients had an esophageal perforation; three had clinical evidence that their injury had been caused by the foreign body itself and five were deemed to have been injured iatrogenically during esophagoscopy. One of the latter group eventually developed an abscess. Four patients originally presented with an abscess. Three of these patients and the patient who later developed an abscess were treated with neck exploration and surgical drainage. One of the patients who initially presented with an abscess refused surgical treatment and was treated conservatively. Conservative treatment was also initiated for all patients who had a perforation. Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal) related to an ingested foreign body should be explored and surgically drained.     

降低小儿气管支气管异物并发症及病死率的诊断和治疗方案分析

目的总结一套诊断和治疗方案，进一步降低小儿气管支气管异物的并发症率及病死率。方法分析北京儿童医院1987年1月～2003年8月7260例小儿气管支气管异物患儿疗效，总结采用快速诊断方案，应用术前评估体系，建立围手术期治疗方案的效果。结果应用快速诊断方案共实施气管镜检查术7618例，其中术后证实为气管异物的有7260例，诊断符合率达95．3％。7260例小儿气管支气管异物病例中，24h内做出诊断并实施气管镜检的为7007例，占96．4％。无麻醉或表面麻醉6933例，全身麻醉及表面麻醉复合327例，病史超过1个月或为特殊类型的气管异物采用全身麻醉及表面分段麻醉相复合的麻醉方法，无麻醉并发症出现。7165例一次手术成功，占总手术98．7％，95例实施二次或二次以上手术，16例转为纤维支气管镜取异物，12例由气管镜手术转至胸科开胸取出异物，其余67例于二次气管镜手术时顺利取出异物。术后出现并发症7例，发生率为0．1％，其中1996年以前6例，1996年后对所有病例进行术前评估后再处理，手术并发症仅1例。无死亡病例。结论快速诊断，术前评估，实施适时有效的手术和围手术期治疗，可以有效降低小儿气管支气管异物的并发症率，降低死亡率。     

复杂性食管异物的临床诊疗分析

目的 探讨复杂性食管异物伴发严重并发症的种类及特点,总结其临床诊断及治疗方法。 方法 对广东医科大学附属医院2015年1月至2018年1月住院治疗的244例食管异物中22例伴有严重并发症的患者资料进行回顾性分析,包括发患者群、就诊时间、异物类型及嵌顿位置、并发症类型及诊断治疗方式等。 结果 22例中除4例儿童外,其余患者均在发病后通过进食馒头、蔬菜、努力吞咽等方式,试图将异物强行推入胃中未果,从而出现严重并发症;从发病到就诊最长达32 d,平均5.9 d;误吞异物类型中17例(77.3%)为动物性骨头,以鱼骨和鸡骨为主;10例嵌顿于食管入口水平,5例嵌顿于T1-T2水平,3例嵌顿于T8-T9水平;严重并发症包括食管穿孔或合并食管局部炎症6例(27.3%),颈部及纵隔气肿、脓肿5例(22.7%),食管纵隔瘘4例(18.2%),游走于食管外异物3例(13.6%),咽后壁脓肿1例(4.5%),气胸1例(4.5%),气管食管瘘1例(4.5%),食管主动脉瘘1例(4.5%);14例于食管镜下取出异物,3例经颈侧切开探查取出异物,3例同时行颈部及纵隔脓肿切开引流术,1例行食管镜+胸腔镜探查,并行肺大泡切除术,1例行支气管镜异物取出术+气管食管瘘修补术;22例患者中治愈21例(95.5%),平均住院时间为6.2 d,死亡1例(4.5%)。 结论 复杂性食管异物多见于老年患者,多因发生异物嵌顿后患者错误的暴力吞咽方式、不及时就医等不恰当处理方法,导致了患者病情的延误。异物的类型、嵌顿位置及就医时间与并发症的产生及严重程度呈正相关,上消化道造影及CT检查是诊断食管异物及其并发症的最有效方法,能够清楚地显示出异物与周围重要组织器官的关系,多学科协助治疗是挽救严重并发症引起危重病情的重要方式。     

301例食管异物患者临床诊治分析

目的回顾性分析301例食管异物患者的临床资料,探讨食管异物的临床特征,以提高诊治率。方法收集2000年1月～2011年12月收治经x线食管吞钡棉等检查确诊的食管异物患者301例,其中288例患者有明确的异物史,患者均表现为吞咽困难和疼痛;术前均行X线食管吞钡棉明确异物部位,并根据异物所处部位采取不同的手术方式。结果281例患者通过硬质食管镜取出异物,10例患者通过电子胃镜取出异物,4例合并下咽后壁脓肿患者行颈侧切开取出异物,6例患者入院后自行呕出或进入胃内,1例患者术后失血过多而死亡。结论对于食管异物患者应早诊断、早治疗,同时应根据异物的性质及所处部位采用不同的手术方式,避免并发症的发生。     

Otogenic lateral sinus thrombosis in children.

INTRODUCTION: The clinical picture of lateral sinus thrombosis (LST) has changed with the advent of antibiotics, as have the utility of various diagnostic tests. LST may appear in children as a complication of acute otitis media, but nowadays it is more frequently encountered in adults with long-standing chronic ear disease. METHOD: A retrospective study of all the pediatric patients with LST between 1982 and 1997. RESULTS: Thirteen cases of LST were diagnosed and treated by our department. In six cases, LST was due to acute otitis media and in the remaining cases it was due to chronic otitis media. Headache, fever, aural discharge and mastoid tenderness were the most frequent findings in these patients and four patients were initially diagnosed with meningitis. In the majority of the patients, LST was accompanied with other intracranial complications, such as perisinus abscess, brain abscess and meningitis. One patient with multiple brain abscesses, unresponsive to several drainage procedures, died. The other patients recovered and have since been followed-up as out-patients. CONCLUSION: LST may be difficult to diagnose due to previous antibiotic treatment and to the overlap of clinical findings with other entities such as meningitis. Despite the value of modern imaging techniques in the investigation of the disease, a high index of suspicion based on the clinical picture is warranted. Our results are consistent with those of other recent studies, who found that mortality of LST has dropped below 10%.     

Otogenic brain abscess: the Syracuse experience.

A review is presented of five cases of otogenic brain abscesses (from among 34 cases of brain abscesses of all causes) treated during a 16-year period at a major university hospital in upstate New York. Although the morbidity and mortality rates are high for patients with brain abscess, advances in the microbial isolation methods, specificity of antimicrobial agents, and earlier diagnosis by CT scans have all contributed to an improved outcome for this dreaded disease.     

儿童食管异物的临床特征与治疗方式的选择

目的探讨儿童食管异物的临床特征及治疗方式的选择,提高对儿童食管异物的诊治水平。方法回顾性分析我院自2001年～2011年收治568例食管异物患儿的临床特征,针对异物的性质和特点采用硬质食管镜、Foley管、电子胃镜、硬质支气管镜和外科手术取出患儿食管异物。结果食管镜下异物取出438例,Foley管取出异物80例,异物经大便排出35例,电子胃镜取出6例,硬质支气管镜取出7例,外科手术取出2例,平均治愈时间为2.5 d。50例患儿出现食管炎,8例患儿出现较严重的并发症,其中食管穿孔2例、食管脓肿3例、咽后脓肿3例,无一例死亡患儿。结论跟据小儿食管异物的特点、性质、病程长短、异物周围黏膜炎症反应程度和停留的部位,选择合适的治疗方式,可获得较好的疗效,避免严重并发症的发生。     

Otogenic brain abscesses in a patient sample of the otolaryngology clinic of the Poznan Medical Academy 1953-1984

Between 1953-1984 we treated 64 otogenic brain abscesses (44 of the temporal lobe and 20 of the cerebellum). This material included 2 cerebral abscesses and 1 cerebellum abscess in children. In 3 cases the abscess was a complication of acute otitis media. 84% of patients with a temporal lobe abscess and 85% with a cerebellar abscess recovered. Treatment consisted of removal of the inflammatory process in the middle or inner ear with subsequent puncture of the abscess and replacement of the pus by antibiotic solution. Otologic, neurologic, ophthalmolgic, EEG and CT examinations were performed on 50 patients. Residual signs of epilepsy were found in 6 patients. Forty one patients resumed work or study. The merit of computer tomography (CT) in diagnosing brain abscesses is emphasized. Since CT has been used a successful outcome has been obtained in 8 cases and a fatal result in 1.     

Foreign bodies in upper digestive tract

Foreign body ingestion is a common problem frequently encountered in both children and adults. A total number of 152 patients (104 children and 48 adults) with ingested foreign body admitted in our hospital are reviewed. Location of foreign body was made out by radiological examination. History of having swallowed foreign body was the most common symptom in both blunt and sharp foreign bodies. Endoscopic removal of foreign body was done under general anaesthesia for all cases, except one in which foreign body was removed by open surgical method. Blunt, foreign bodies were common among children, where as meat with bone was common in adults (19/48). Most of blunt foreign bodies in children (83.5%) were impacted in post cricoid region. Where as in adutls, the foreign bodies (37.5%) were seen in upper oesophagus. Retropharyngeal abscess was seen in 2 cases, which was associated with sharp foreign bodies. In all but one, endoscopic removal was successful. In one case denture impacted in post cricoid region was removed by open surgical method. There was no mortality in our series.     

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.     

A prospective study of foreign-body ingestion in 311 children

OBJECTIVE: To determine the preferable management protocol of foreign body ingestion in pediatric patients. METHODS: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. RESULTS: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. CONCLUSIONS: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.     

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.     

Chronic esophageal foreign bodies in pediatric patients: a retrospective review

OBJECTIVE: Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. METHODS: We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week. RESULTS: Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series. CONCLUSIONS: Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.