气管异物患者特殊情况的处理

目的通过气管异物特殊病例的分析,总结气管异物诊治过程中的经验教训,以便更好地处理气管异物,减少死亡率和并发症.方法收集1980年以来该科经治的153例特珠病人,其中有在入院时已窒息或近窒息的紧急情况72例,嵌顿性异物52例,特殊形状的异物14例,也包含一些特殊的误诊病例8例等.131例经喉镜下或气管镜下取出异物,占85.6%,7例经气管切开取出异物,占4.6%,3例开胸取出异物,其他12例.结果153例经治患者中治愈144例,植物人1例,死亡2例,其它转归6例.术中术后气管切开23例,胸腔穿刺或胸腔闭式引流19例,经适当的处理后均未留后遗症.结论气管异物是耳鼻咽喉科常见的急症,若能熟练掌握其诊治技能,不但能减少死亡率,而且能减少术后并发症,提高生存质量.

Management of special cases of tracheobronchial foreign bodies

Objective: To summarize the experience and lessons in the diagnosis and management by analyzing the special cases of tracheobronchial foreign bodies (TFBs). Methods: 153 special cases of TFBs hospitalized from January 1980 through December 2002 were reviewed. These special cases include: 76 cases in critical condition of asphyxia when hospitalized, 52 cases of incarcerated foreign bodies, 14 cases of special shaped foreign bodies, and 8 misdiagnosed cases etc. Results: Extractions of TFBs were successfully accomplished in 131 cases (85.6%) with laryngoscope or tracheoscope, 7 cases of (4.6%) with tracheotomy, 3 cases with thoracotomy (2.0%), 12 cases with the other managements. Of all the 153 patients, 144 patients were cured, 1 patient was in persistent vegetative state, 2 patients died and the others 6 cases. The overall mortality rate was 1.3%. Conclusions: TFBs is a common emergency encountered by otolaryngologist. It can be treated successfully with decreased mortality rate and post-operative complications if the problem is coped skillfully, therefore the quality of life of the patients can be improved.