肺切除术治疗延迟性吸入性支气管异物17例分析

目的 总结接受肺切除术治疗的延迟性吸入性支气管异物患者的临床病理资料,对该疾病的临床特点和治疗选择进行探讨.方法 1980年1月至2010年6月,利用肺切除术治疗延迟性吸入性支气管异物患者17例,其中男性12例,女性5例,年龄10～66岁,平均年龄36岁.症状包括咳嗽、咯血、发热、咳脓痰、气急等,发病时间间隔为3个月～8年,平均2年.术前确诊8例,9例误诊为其他疾病.行右肺下叶切除术4例,右中叶切除术3例,右中下叶切除术1例,右下叶切除术+肋床引流术1例,右下叶切除+胸膜剥脱术1例,胸腔镜下右肺下叶部分切除术1例,左全肺切除术4例,左下叶切除术1例,左上叶切除术1例.结果 术后死于肺部感染1例,并发支气管胸膜瘘2例.异物位于右侧11例,左侧6例,异物种类最多为骨片(8例),其次为辣椒尖(3例)和笔套管(2例).伴随肺内病理改变包括慢性支气管肺炎8例,支气管扩张7例,肺实变4例,慢性肺脓疡伴毁损肺3例,机化性肺炎2例,肺发育不全1例.结论 应重视延迟性支气管异物的诊断,降低误诊率,尽可能避免行肺切除术.对于肺内感染病变明显的病例,应及时行肺切除术,以免肺部病变发展为肺化脓症和脓胸等严重感染.

Treatment of delayed inhaled bronchial foreign bodies by pulmonary resection: 17 cases reports

Objective To investigate and analyze the clinicopathological features and choice of treatment for delayed inhaled bronchial foreign bodies. Methods A retrospective review is presented of patients with delayed inhaled bronchial foreign bodies treated by pulmonary resection between January 1980 and June 2010. There were 17 patients ( 12 male and 5 female). Mean age was 36 years (ranging 10 to 66 years). The mean interval of onset was 2 years ( rangeing 3 months to 8 years ). Confirmed diagnosis before surgery in 8 cases and 9 cases were misdiagnosed as other diseases. Surgical procedures included right lower lobectomy in 4 cases, right middle lobectomy in 3 cases, right lower and middle lobectomy in 1 case, right lobe lobectomy and rid resection drainage in 1 case, right lobe lobectomy and pleurectomy in 1 case, videoassisted right lobe partial resection in 1 case, left pneumonectomy in 4 cases, left lower lobectomy in 1 cases and left upper lobectomy in 1 cases. Results One case died of pulmonary infection and 2 cases complicated of BPF after operation. Foreign bodies were localized in the right bronchial tree in 11 cases, the left in 6 cases. The majority of the foreign bodies were vegetable origin. Conclusions The diagnosis rate of delayed inhaled bronchial foreign bodies should be improved in order avoiding of pulmonary resection. It is necessary to perform pulmonary resection timely if the pulmonary infection is evident for fear that the infection progress into severe infection.