儿童气管支气管异物临床诊治探讨

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1、·734·中国实用儿科杂志2004年12月第19卷第12期论著文章编号:1005-2224(2004)12-0734-04儿童气管支气管异物临床诊治探讨江沁波刘玺诚江载芳【摘要】目的探讨儿童气道不同部位异物的临床特征、诊治方法及应用硬气管镜、纤维支气管镜或开胸等治疗方法的最佳时机。方法回顾性总结首都医科大学附属儿童医院纤维支气管镜(纤支镜)室1990年12月至2003年12月间诊治的下气道异物临床资料;应用纤支镜对硬气管镜难以取出、又无开胸指征的气道异物进行治疗;追踪临床转归。结果经纤支镜诊断下

2、气道异物192例,位于Ⅱ级以下支气管159例;年龄12d至14岁;病程4h至8年,3d内仅24例。食物性异物146例,小塑料制品异物22例,仅18例可通过X线检查确诊异物。临床特点:45例无确切异物史,41例有反复呼吸道感染,5例因植物性及硬果壳类异物致咯血,滞留达7个月至3年。X线表现:肺炎113例(58.9%),肺不张50例(26.0%),肺透光增强及支气管阻塞征各37例(19.3%),纵隔摆动或心影反常大小28例(14.6%),胸膜炎或胸腔积液12例(6.3%),异物远端支气管扩张7例(3

3、.6%),25例(13.0%)X线正常。转归:取出异物175例:开胸14例(其中6例病肺叶、段切除);硬气管镜取异物47例56次(3例未取出);纤支镜取118例并灌洗吸入性肺炎14例,共380次。治愈149例,好转41例,2例未愈。结论支气管异物临床过程不同于气管异物,是慢性肺疾患的病因之一;纤支镜检查直观、操作灵巧,可以发现硬气管镜和X线检查所不能发现的支气管异物,在治疗上弥补硬气管镜和单纯药物治疗的不足,避免慢性肺疾患的发生和发展。【关键词】气管支气管异物纤维支气管镜儿童中图分类号:R72文

4、献标识码:AStudyontheclinicaldiagnosisandtreatmentfortracheobronchusforeignbodiesinchildren.JiangQinbo,LiuXi-cheng,JiangZaifang.BeijingChildren'sHospitalAffiliatedtoCapitalUniversityofMedicalSciences,Beijing100045,ChinaAbstractObjectiveToexploretheclinica

5、lcharacteristics,diagnosisandtreatmentforairwayforeignbodiesinchildren.Toexplorethebesttimeforinterventiontreatment.MethodsWeretrospectivelysummarizedthedataaboutairwayforeignbodiesthatdiagnosedbyfiber-bronchoscopyinBeijingChildren'sHospitalbetween19

6、90.12～2003.12.Fibrobronchoscopywasap-pliedtotheairwayforeignbodiesunabletoberemovedwithrigidtracheoscope,fiberbronchoscopeorbythoracotomy.ResultsTherewere192airwayforeignbodiesdiagnosedbyfiber-bronchoscopy.Ages:12days-14years;course:4hours-8years.159

7、(morethan80%)airwayforeignbodieswerelocatedunderⅡorⅢgradebronchus.Alimentaryforeignbodieswere146cases(nearly80%),plasticforeignbodieswere22cases(11.5%)andonly18cases(3.6%)metalforeignbodiesweredis-coverdbyX-ray.BronchusforeignbodysinX-raypresenttedas

8、pneumonia(113cases;58.9%),atelectatic(50cases;26.0%),blocksignalinbronchus(37cases;19.3%)andpleuralthickeningwere12cases(6.3%),bronchiectasisafterbronchusforeignbodieswere7cases(3.6%)andhoneycomblungwere2cases.Theforeignbodieswereenucleatedin175(14we