气管切开后鼻内镜下取出气管支气管特殊异物6例

2001年3月至2008年7月,我们对6例支气管镜下不能取出的气管支气管特殊异物,采用经气管切开、内镜下取出异物,效果良好.     

纤维支气管镜取气管支气管异物3例

例 1 　 男 ,8岁。误吸塑料哨笛后咳嗽、呼吸不畅 3 d,于 1 997年 1 0月 3 0日入院。体检 :体温3 6 .4℃ ,呼吸 2 0次 /min,呼吸平稳 ,深呼吸时胸腔内发出哨鸣音 ,右肺呼吸音明显减弱。X线胸透 :深呼吸时见纵隔摆动 ,右下肺透光度增强。诊断 :右支气管异物。家属带来与吸入物相同的塑料哨笛一只 ,为白色圆管状 ,长 1 3 mm,一端外径 8mm,另一端略大 ,且有一环形外突的唇缘 ,外径 1 0 .5 mm,管内径 3 .5 mm,内卡有一片可取出的簧片。即取支气管镜及异物钳进行模拟试取 ,哨笛内孔可通过纤维支气管镜活检钳。于当日在全麻下行支气管异物取出术 …     

气管内镜在疑难气管异物取出术中的应用

目的 探讨气管内镜在疑难气管异物取出术中的应用价值.方法 对10例疑难气管异物患者实施气管镜检查,并辅助应用气管内镜,观测异物的形态、位置及其与气管壁的关系,并取出异物.结果 10例疑难气管异物中,9例一次性成功取出,术后无气胸、纵膈气肿等并发症;1例手术失败,转胸科实施开胸手术取出异物.结论 气管内镜的应用有助于查明疑难气管异物的形状、位置及其与气管壁的关系,利于该类异物的取出.     

全身麻醉气管插管下支气管镜处理医源性气管异物18例

由于气管插管经过喉腔时的相对盲目性或喉腔内新生物较大、带蒂、质脆等原因,可造成新生物完全或部分脱落,形成医源性气管异物,不及时取出可引起术后持续性呛咳甚至发生阻塞性肺炎等多种并发症.     

气管支气管异物21例

我科自 1 984～ 2 0 0 1年收治气管支气管异物5 0 2例 ,其中特殊类型的异物 2 1例 ,现报告如下。1　临床资料2 1例中 ,男 1 7例 ,女 4例 ;1～ 3岁 2例 ,4～ 1 2岁 1 3例 ,2 1～ 5 2岁 6例。就诊时间最短 2ｈ ,最长一年半。异物位于总气管 2例 ,右支气管 1 5例 ,左支气管 4例。异物种类 :塑料口哨 8例 ,金戒指 1例 ,摩托车反光灯塑料碎片 1例 ,义齿 1例 ,塑料棋子 1例 ,自动铅笔帽 1例 ,气管导管芯 1例 ,大头针1例 ,耳钉 1例 ,自行车钢珠 1例 ,螺丝钉 1例 ,注射针头 1例 ,图钉 2例。2 　 手术方法和术中情况1 4例儿童采用全麻 ,经喉镜导入气…     

气管打火机异物1例

患者,男,28岁,于2005年5月12日因自吞打火机6h入院。患者因与家人吵架后自吞打火机,当即出现剧烈咳嗽,数分钟后症状缓解,感呼吸稍费力,胸痛,于外院胃镜检查未发现异物。门诊食管钡餐造影检查示：胸段气管腔内可见巨大长条状异物影,无气胸及肺气肿征象。入院体检：吸气性呼吸困难Ⅰ度,双肺可闻及哮鸣音。     

支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用

目的探讨经支气管内镜视频监视下小儿气道异物取出术的优点和可行性。方法对3例11个月至6岁、气管支气管异物的患儿,实施气管内插管全麻下经支气管内镜视频监视下取出异物,异物嵌顿部位为支气管1例、气管2例;异物种类为花生2例、塑料笔帽1例。结果均完整取出异物,无出现手术并发症。结论采用支气管内镜视频监视系统是治疗小儿气道异物安全有效的方法,并可向其它气管疾病的诊疗延伸,值得推广应用。     

气管黏膜脱落致气管异物1例

患儿 ,女 ,2岁。因误服地芬诺酯 1 5片 ( 2 .5mg/片 ) ,5h后出现昏迷 ,就诊于我院急诊科。体检 :体温 37℃ ,脉搏 80次 /min ,无自主呼吸。昏迷 ,口唇紫绀。立即给予气管插管 ,上呼吸机 ,同时给予补液、利尿、抗感染等治疗。机械通气 4h后出现自主呼吸 ,停呼吸机。 2d后拔除气管插管 ,听诊双肺呼吸音粗糙 ,可闻及少量痰鸣音及湿音。血常规 :WBC 2 4 .2× 1 0 9/L。X线胸片示 :支气管肺炎。给予抗炎、保护脑细胞等对症治疗 7d ,患儿出现呼吸加快、声嘶 ,以“药物中毒、心肺复苏后、急性喉支气管肺炎”转入儿科。体检 :体温 37℃ ,脉搏1 1…     

气管套管蚀断致气管异物1例

患者 ,男 ,5 2岁 ,因声门上喉癌于 1 994年在我院行全喉切除术。因气管造瘘口狭窄而长期配戴气管套管 (1 2 mm) ,术后呼吸、饮食正常。1 999年 6月2日晨 ,清洗内管时出现呛咳、呼吸困难、喘鸣 ,于 2h后来诊。体检 :精神紧张 , 度吸气性呼吸困难 ,心率 96次 /min,气管瘘口粘膜充血 ,轻度水肿 ,并伴有肉芽生长。透视发现 :蚀断气管套管坠入主气管下端 ,相当于气管分叉水平。即用 1 %地卡因溶液表面麻醉气管内粘膜后 ,在 X线电视监视器下用喉1 黄河三门峡医院耳鼻咽喉科 (河南三门峡 ,472 0 0 0 )2 黄河三门峡医院放射科息肉钳自气管造瘘处进…     

气管异物误诊为食管异物1例

病人 ,男 ,5 0岁。因癫痫发作后 ,上排 4个连体假牙掉入喉部 ,胸痛不适来我院就诊。查体 :呼吸平稳 ,双肺呼吸音清 ,无发绀 ,咽无充血 ,间接喉镜检查未见异常。食道透视提示 :食道中段金属异物。于第 2天上午复查食道透视 ,异物位置无改变 ,遂于食道镜下行异物取出术 ,术中食道内未见异物 ,第 3次行食道钡透提示 :气管中段金属异物 ,同时做胸部CT扫描证实 :气管异物。用 4 0 0mm× 80mm规格气管镜观察 ,异物位于右支气管开口处 ,鳄鱼嘴钳钳紧后取出。次日复查胸片无异物发现 ,所见正常 ,病人痊愈出院。讨论 :食道异物的主要症状为吞咽疼痛 …     

Use of an endoscopic urology basket to remove bronchial foreign body in the pediatric population

Foreign body (FB) aspiration is a common problem in the pediatric population. Rigid bronchoscopy is considered the treatment of choice for removal of tracheobronchial FB. This is a report of two cases of tracheobronchial foreign body aspiration that were managed using an endoscopic urology basket through a flexible bronchoscope. This report's main purpose is to inform physicians on the benefit of flexible bronchoscopy and of the potential use of the endoscopic urology basket for tracheobronchial FB retrieval. We hope that the flexible bronchoscopy and the endoscopic basket will become a standard tool in FB retrieval kits for pediatric otolaryngologists who deal with this issue on a routine basis.     

特殊类型呼吸道异物的诊断与治疗

目的：探讨特殊类型呼吸道异物的诊断与治疗。方法：分析69例特殊类型呼吸道异物患者的临床资料,其中45例在全身麻醉下经支气管镜通过声门取除异物,24例经气管切开取除异物。结果：经支气管镜取除异物的45例患者中43例治愈,2例在异物通过声门时滑脱,发生异物变位,患者因呼吸衰竭死亡;经气管切开取除异物的24例患者全部治愈。8例术后血氧饱和度低于90％,送到ICU病房经正压通气等治疗后恢复正常,总治愈率为97．1％。结论：特殊类型呼吸道异物可在全身麻醉下经支气管镜通过声门取出;但对年龄较小,有肺不张,异物较大而且形状不规则的患者应通过气管切开取除异物更安全。     

带钳Hopkins潜窥镜在小儿肺段支气管异物中的应用

摘要：目的探讨带钳Hopkins潜窥镜在小儿肺段支气管异物取出中的临床应用。方法27例肺段支气管异物患者,其中5例为二次手术,以仿真支气管CT和纤维支气管镜诊断。全身麻醉下,从硬性支气管镜套入带钳Hopkins潜窥镜,Hopkins潜窥镜接电视监视系统,直视下将肺段支气管异物取出。结果27例患者均成功将异物取出,无开胸取异物、气管切开口取异物及死亡病例,5例二次手术患者中,1例患者术后出现气胸,行胸腔闭式引流,转ICU病房,其他患者无气胸、纵隔气肿等并发症发生。结论带钳Hopkins潜窥镜可在直视下钳夹并取出异物,提高小儿肺段支气管异物取出的精确性,避免了开胸取异物,减少了并发症及术后残留。     

A heuristic approach to foreign bodies in the paediatric airway

ObjectivesThis retrospective study reviews the clinical presentation and management of children with airway FBs in our centre. It suggests a safe and reliable guideline to help differentiate which patients should proceed to investigation with rigid laryngobronchoscopy.MethodsA retrospective review of all case notes of laryngobronchoscopies performed for suspected FB aspiration from January 2003 to August 2013 at a tertiary paediatric institution was undertaken. Patient characteristics, history, clinical examination, radiological findings and outcomes were analysed.Results158 patients underwent rigid laryngobronchoscopy for suspected FB aspiration between January 2003 and August 2013. The baseline population demographics, the location and type of FBs retrieved were comparable to other similar studies; however, there is a statistically significant higher proportion of Pacific, Maori and Middle Eastern/Latin American/African children compared with the baseline population. Two or more positive findings in the presence of an acute history, any examination or radiology findings is a good indicator to proceed to laryngobronchoscopy with over 99% sensitivity.ConclusionIn a hospital presentation population, this retrospective study suggests that a guideline to proceed to laryngobronchoscopy in a case of suspected FB aspiration is two out of the three positive findings in the presence of an acute history, any examination or radiology findings. Patients who are stable and who do not have two of the three broad category findings can be considered for conservative management and observed on the ward, however, this is a guideline and must be combined with the clinical expertise of the paediatric airway specialist. Further studies are recommended to investigate contributing factors for the disproportionately higher incidence amongst Pacific, Maori and Middle Eastern/Latin American/African children.     

Pulmonary recovery after rigid bronchoscopic retrieval of airway foreign body

OBJECTIVE: The aim of this study was to determine how long postoperative pulmonary care is needed in patients after rigid bronchoscopic retrieval of foreign body from the airway and to identify the factors affecting pulmonary recovery. MATERIALS AND METHOD: A retrospective review of 98 pediatric patients who had foreign body removed from the airway by rigid bronchoscopic procedure was conducted. After the removal of the foreign body, the time required for complete clinical and radiologic pulmonary recovery was reviewed for each subject. Factors examined included age, sex, preoperative symptoms, preoperative radiologic findings, duration between the aspiration event and treatment, the type of foreign body, the location of foreign body impaction, operation time, immediate postoperative radiologic changes, and treatment outcome. RESULTS: More than 1 week for the complete pulmonary recovery was required in 25 (25.5%) cases, whereas 74.5% of subjects fully recovered within 1 week after the removal of foreign body. In the univariate analysis, preoperative inflammatory symptoms, and radiologic findings, an operation time of over 50 minutes and the aggravation of immediate postoperative radiologic findings predicted a delayed pulmonary recovery (more than 1 week). In the multivariate analysis, three of four variables previously noted, except preoperative inflammatory symptoms, showed significant predictability for a delayed pulmonary recovery. CONCLUSION: The recovery time of more than 1 week after rigid bronchoscopic retrieval of airway foreign body was associated with preoperative inflammatory findings by radiologic study, a prolonged procedure over 50 minutes, and aggravation of the immediate postoperative radiologic findings. Therefore, long-term pulmonary care is required for this group of patients.     

儿童呼吸道异物的误诊误治

目的:分析儿童呼吸道异物误诊的原因及危害,探讨有效的防治措施。方法:分析452例儿童呼吸道异物误诊误治的临床资料。结果:重视病史的采集和体检是防止误诊误治的主要措施,X线检查及螺旋CT三维重建技术能够为儿童呼吸道异物的诊断提供帮助。结论:临床医师应意识到呼吸道异物的危害性,避免误诊误治的发生,合适的手术时机和手术方式能够有效降低并发症,提高治愈率。     

The complimentary role of diagnostic and therapeutic endoscopy in foreign body aspiration in children

Objective

To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting.

Methods

Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010.

Results

Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases.

Conclusions

Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.     

38例呼吸道异物并严重并发症的治疗探讨

目的探讨小儿气管、支气管异物并严重并发症的临床表现及治疗。方法回顾总结1990年6月-2007年12月湘雅二医院38例呼吸道异物伴严重并发症的患儿,其中伴气胸14例,纵膈气肿6例,肺脓疡7例,大出血、气管食管瘘、渗出性胸膜炎各3例,心衰2例。记录每例患儿症状及持续时间、体格检查、肺部影像学检查及异物性质和位置。结果38例呼吸道异物伴严重并发症的患儿,36例异物经支气管镜取出,2例开胸取出。除1例死亡外,37例患儿完全康复。结论对呼吸道异物伴严重并发症患儿取异物时需做好应变的准备,正确判断和处理并发症可以减少死亡率发生。     

The fork in the road: A laryngeal filter airway foreign body

Objective

Upper aero-digestive tract foreign body management can be complicated and life threatening in both adult and pediatric populations. The variation seen with foreign bodies including shape, material, and duration of ingestion can impact clinical decision making and management. The objective of this report is to demonstrate a complicated case of upper airway obstruction by a plastic fork.