应用纤维喉镜诊治喉咽异物

目的探讨喉咽部隐匿性、细小异物的治疗方法.方法对21例异物史明确,常规方法无法窥及或取出困难的患者行纤维喉镜检查.结果21例均一次发现异物并钳取成功.结论纤维喉镜诊治喉咽部隐匿性及可疑异物创伤小,成功率高.     

喉内窥镜在喉咽部异物诊治中的应用

目的探讨90°喉内窥镜在喉咽部异物诊治中的应用。方法对102例有喉咽部异物史行常规间接喉镜检查未发现异物的患者,采用外径8?mm 90°喉内窥镜连接影像显示系统进行检查和治疗。结果102例中98例喉咽有异物,均在喉内窥镜下用异物钳成功取出。4例未发现异物,经X线诊断为食管异物,行食管异物取出术时发现异物位于食管入口。结论喉内窥镜光线充足、视野清晰、操作方便,可有效地减少隐蔽性喉咽异物的漏诊,是一种安全、有效、患者易接受的诊疗方法。     

气管支气管异物527例诊治分析

气管支气管异物是耳鼻咽喉科常见危重急诊之一,我院近15年共有527例收入住院,在无麻或全麻下行直接喉镜、支气管镜异物取出术,取得满意疗效.现报道如下.     

成人气管支气管异物43例临床分析

摘要：目的探讨成人气管支气管异物的临床特点及合适的手术方法。方法回顾性分析２０10年１月~２０１5年12月福建医科大学附属龙岩第一医院耳鼻咽喉科收治的成人气管支气管异物43例的诊治过程。根据异物特点,采取合适的手术方式取出气管支气管异物,手术中经麻醉直接喉镜下取出2例、电子支气管镜下取出13例、硬质支气管镜下取出22例、经气管切开处联合硬质支气管镜取出6例。结果43例均成功取出异物,无失败病例,成功率100％,无死亡病例。结论快速有效诊断,术前评估,实施合适的手术方法对成人气管支气管异物的治疗至关重要。     

下咽黏膜下异物3例临床分析

目的探讨包埋型下咽黏膜下异物的诊治方式,以期减少漏诊、选取合适手术方式取出异物。方法3例包埋型下咽黏膜下异物患者通过询问病史、影像学检查、电子鼻咽喉镜检查而确诊,在支撑喉镜下使用显微喉镜钳、CO2激光辅助治疗等方式切开黏膜组织取出异物,并观察预后情况。结果3例患者均成功取出异物,术中出血少、创伤小,术后给予禁食水、补液、抗感染等治疗,患者恢复快,均治愈出院。结论包埋型异物较为少见,详细了解异物进入病史及依据CT影像学等辅助检查准确定位制定手术方案,咽后间隙、黏膜下及其间隙的异物可考虑行支撑喉镜下异物取出术,异物在颈动脉间隙、甲状腺等处或毗邻重要血管、器官时可考虑行颈部开放手术。通过准确定位增加该病治疗成功率。     

误诊为肺炎的小儿气管支气管异物的诊治

目的：分析小儿气管、支气管异物误诊为肺炎的原因，提高诊治水平，降低误诊率。方法：对67例误诊为肺部感染的气管、支气管异物患儿的临床资料进行回顾性分析；67例均在全身麻醉下行气管或支气管异物取出术。结果：63例（94％）均1次取出异物，4例（6％）经2次取出；无一例行气管切开及病例死亡。结论：提高对气管、支气管异物的认识及诊断水平是降低误诊率的关键，全身麻醉下硬管支气管镜检是取出气管、支气管异物的主要方法。     

可视喉镜在喉咽异物取出术中的应用

目的探讨可视喉镜下取出难治性喉咽异物的可行性。方法回顾性分析我科2016年1月~2019年1月经电子喉镜或喉X线正侧位片诊断为喉咽异物的住院患者27例,所有患者在全麻可视喉镜下经喉显微钳顺利取出异物,其中异物位于梨状窝者12例,其中9例为鱼刺,3例为鸭骨头;位于环后区者15例,均为1元或5角硬币。结果所有患者术中暴露良好,经喉显微钳顺利取出异物,麻醉过程中无心血管事件发生,无喉咽黏膜损伤、门齿松动、伤口感染等并发症。结论可视喉镜能很好地暴露喉咽,配合合适的喉显微器械能够顺利取出喉咽异物,安全可行,具有一定的创新性和独特的优势。     

下咽埋藏性异物的临床处理策略

目的总结下咽埋藏性异物的诊治经验及探讨手术径路的选择。方法回顾武汉市第一医院耳鼻咽喉科近6年就诊的12例下咽埋藏性异物患者的临床资料,对患者临床表现、异物种类、异物埋藏部位、取出或手术方式、病情转归等进行总结分析,所有患者随访半年以上。结果12例患者中,6例经口内镜下直接切开取出,或在等离子刀或CO2激光辅助下切开取出;3例行颈侧入路取出;1例电子喉镜下成功取出;1例自行消失;1例未做处理、异物在观察期内包埋机化。结论下咽埋藏性异物的诊断及定位依赖于影像学检查,取出方式取决于异物埋藏的部位,首选经口内镜下取出,必要时行颈侧切开径路。     

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。     

An autogenous foreign body in tracheobronchial tree

Foreign body in the trachea is not uncommon but foreign body of autogeneous origin is rare with stray dog bite.     

颈部外伤的诊治体会

目的回顾性分析颈部外伤患者的临床资料,对其发病原因、诊断及治疗过程进行分析,总结经验与体会。方法收集南京市第一医院耳鼻咽喉科2008年9月～2017年9月收治的颈部外伤患者19例,其中男15例,女4例;年龄18～87岁,平均年龄46.4岁,病程0.5 h至2个月。１９例患者中颈部异物9例（6例金属异物、3例玻璃异物）、开放性颈部外伤8例、闭合性颈部外伤2例。根据患者不同的发病原因及病情,选择不同的麻醉方式及治疗方法。结果19例患者伤口均愈合良好,随访6个月,无死亡病例,无气管及食管瘘,仅1例并发一定程度的声音嘶哑。结论在颈部外伤的诊治中,保持呼吸道通畅、止血、纠正失血性休克是关键,其次进行异物清除、喉气管功能重建及血管、神经吻合,减少术后功能损失。     

A long standing foreign body in the ethmoid-a case report

Headache is the most common complaint in present Jay ENT practice, it happens to be the most frequent and misunderstood wmptom. Foreign bodies in the paranasal sinuses invariably pose challenges to the surgeon due to the complex anatomy. Here, we present a case report of an unusual long standing foreign body of 40 years, in the ethmoid, presenting headache as a feature, after 37 years.     

An unusual case of impacted oesophageal foreign body

Impacted sharp foreign bodies in the oesophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as oesophageal perforation can occur. We hare reported a rare case of impacted denture in the oesophagus where endoscopic removal was not possible due to the perforation already caused by the denture, sinee this would have caused an oesophageal laceration, which could have proved fatal. Hence surgical removal had to be performed with repair of the oesophageal perforation.     

Asymptomatic impacted foreign body of larynx

A rare case of asymptomatic impacted foreign body coin of larynx is repearted.     

An unusual foreign body in the oesophagus. The body packer syndrome

We report a case of drug smuggling by internal concealment of heroin in the oesophagus. We review the literature and discuss presentation and management highlighting the need to maintain an awareness of body packer syndrome in the differential diagnosis of ingested foreign bodies.This work was presented as a poster at the Scottish Otolaryngological Society Summer Meeting, Perth, Scotland, UK, June 2002.     

Delayed diagnosis of laryngeal foreign body

Aspiration of a foreign body is a recognized cause of accidental death in children. Paediatricians are aware of the symptoms of inhaled foreign bodies in the lower respiratory tract. However, symptoms which suggest impaction in the larynx do not appear to raise the same index of suspicion of a foreign body. One case of laryngeal foreign body is described with a delay in diagnosis of five days. The clinical presentation, investigations and management are discussed.