儿童气道透X线异物吸入198例报告

目的：评价儿童气道透Ｘ线异物吸入的临床特征和Ｘ线检查的诊断价值及限度。材料与方法：回顾性分析１９８７￣１９９７年１９８例，８１．３％为３岁以下婴幼儿。全部病例经Ｘ线透视，１５２例摄有呼、吸二相胸片，均经内窥镜、气管切开或咯出异物证实。结果：（１）异物多数（８９．４％）为食物，半数以上（５７．６％）为花生。２１例（１０．６％）无机物中以笔帽为多（５７．１％）。（２）楔形和球形异物远较异形异物容易引起

Aspiration of Radiolucent Foreign Body into the Airway in Children: A Report of 198 Cases

Objective: To investigate the clinical characteristics of radiolucent foreign body aspiration in children and to study the diagnostic value and limit of radiologic examination. Materials and Methods: The clinical data and Xray findings were retrospectively analyzed in 198 patients encountered during the period of 19871997, proved by endoscopy, tracheotomy or spited foreign body. 81.3% of cases were under 3 years old. Fluoroscopy was performed in all cases, and inspiratory and expiratory chest films were taken in 152 cases. Results: (1) The foreign bodies were mainly food (89.4%), especially peanut (57.6%). Of 21 cases aspirated inorganic foreign body, 57.1% was pencil cap. (2) Wedgeshaped or spherical foreign body caused atelectasis much more easily than irregular one (P<0.001). The longer the foreign body stayed in the airway, the more the atelectasis, mediastinal shift, pendular movement of mediastinum and/or pneumonia occurred. (3) The accuracy of diagnosis was 95.9% with fluoroscopy, and the accuracy of localization was 70.0%91.4% according to different lobes or segments. (4) Mediastinal shift or pendular movement was the commonest radiologic finding (69.1%), predominantly seen in the cases with unilateral bronchial foreign body (91.4%). Cardiac broadening during inspiration was seen in 70.5% cases with laryngotracheal foreign body and in 40.0% cases with foreign bodies lodging in multiple regions. Conclusion: (1) The radiological manifestation is decided by the shape, size of the foreign body and its match extent with the lumen of airway, and also by the airflow effect produced by the foreign body. (2) Xray exam is necessary for discovering and localizing the foreign body, though fluoroscopy is superior to radiography in observing mediastinal abnormality. (3) Endoscopy is imperative for doubtful cases who complains a history of foreign body aspiration but has no abnormal Xray findings.