Fraga José C, Pires Alexandra F, Komlos Marcia, Takamatu Eliziane E, Camargo Luciano G, Contelli Fábio H A
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
J Pediatr (Rio J). 2003 Jul-Aug;79(4):369-72.
Most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening.
Retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal.
Most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.
大多数气道异物通过呼吸内镜取出。很少情况下，异物取出必须通过气管切开术或气管造口术在内镜控制下进行。本文报告3例通过气管切开术为儿童取出异物的病例。
回顾性分析3例儿童气道吸入异物的病例记录。第一例中，气管造口管破裂，其远端被吸入。通过气管造口术进行内镜下取出。第二个孩子吸入了一个笔帽。由于笔帽无法通过声门下区域，所以无法通过内镜取出。于是进行了颈部气管切开术，并在内镜控制下取出异物。在最后一例中，异物位于左主支气管。通过气管造口开口进行支气管镜检查取出异物。所有儿童在内镜手术后均预后良好。气管切开术患者在取出异物后缝合气管。无需进行气管造口术。对于之前进行过气管造口术的儿童，异物取出后将气管造口管放回。
大多数儿童气道异物可通过内镜取出。当异物太大无法通过声门下区域，或太尖锐可能损伤气道时，应进行气管切开术或气管造口术。
