Nohara Jun, Lee Synnum, Noguchi Tetsuo, Sakaguchi Yasuto, Kono Tomoya, Terada Yasuji
Department of Respiratory Medicine, Nagahama City Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Dec;47(12):1098-102.
We describe the successful extraction from an airway of foreign bodies metal nails in three cases. They were all carpenters, and often held nails between their lips. Case 1: a 72-year-old man had aspirated a nail three months earlier, but did not seek medical assistance at the time. A chest X-ray film and CT examination revealed a nail in the peripheral S7 region of the right lower lobe. The nail could not be extracted with forceps via bronchoscopy, so video-assisted thoracic surgery was performed. During surgery, the nail moved to the truncus intermedius, then it was extracted using bronchoscopy forceps. The extracted nail was rust-proof, and no rust was observed. Case 2 : a 76-year-old man visited our hospital with a history bloody sputum with a slightly dry cough for two months. A chest X-ray film showed a nail in the right hilum. Bronchoscopy revealed the nail covered with mucinous secretion in the right B7, and it was extracted by forceps. It was a rust-proof type nail, and no granulation tissue was observed in the bronchus. Case 3: a 74-year-old man visited our hospital because of dry cough for two months. A chest X-ray revealed a nail in the right hilus and bronchoscopy showed the nail was buried in reactive granulation tissue in the right middle lobe bronchus and could not be observed from the surface. Tranilast (n-[3,4-dimethoxycinnamoyl] anthranilic acid) at 300 mg/day and Methylprednisolone at 250 mg/day were prescribed for 4 days, followed by a reduction of the corticosteroid to 40 mg/day for 3 days. Seven days later, the granulation tissue and mucosal edema had diminished, and the nail was successfully extracted. The extracted nail was not rust-proof and had swollen with rust. These nails were found a few months after aspiration. The reason why these were not defected was possibly that the long and narrow shape did not obstruct the segmental bronchus and the symptoms can be less severe compared with other foreign bodies. The rust-proof nails were covered with mucinous secretion, but the nail without coating had rusted and caused reactive granulation tissue and swelling observed. Corticosteroid and Tranilast are thought to be effective in reducing such granulation tissue in airways.
我们描述了3例成功从气道取出异物金属钉的病例。他们都是木匠，经常将钉子含在嘴唇间。病例1：一名72岁男性3个月前误吸了一枚钉子，但当时未寻求医疗帮助。胸部X线片和CT检查显示右肺下叶外周S7区域有一枚钉子。无法通过支气管镜用钳子取出钉子，因此进行了电视辅助胸腔镜手术。手术过程中，钉子移至中间段支气管，然后用支气管镜钳子将其取出。取出的钉子是防锈的，未观察到锈迹。病例2：一名76岁男性因两个月来有血痰伴轻度干咳病史前来我院就诊。胸部X线片显示右肺门有一枚钉子。支气管镜检查发现右B7处的钉子被黏液分泌物覆盖，并用钳子将其取出。这是一枚防锈型钉子，支气管内未观察到肉芽组织。病例3：一名74岁男性因干咳两个月前来我院就诊。胸部X线显示右肺门有一枚钉子，支气管镜检查显示钉子埋在右中叶支气管的反应性肉芽组织中，从表面无法观察到。给予曲尼司特（n-[3,4-二甲氧基肉桂酰]邻氨基苯甲酸）300mg/天和甲泼尼龙250mg/天，用药4天，随后将皮质类固醇减至40mg/天，用药3天。7天后，肉芽组织和黏膜水肿减轻，钉子成功取出。取出的钉子不是防锈的，已因生锈而肿胀。这些钉子是在误吸几个月后发现的。这些钉子未造成损害的原因可能是其长而窄的形状未阻塞段支气管，与其他异物相比症状可能较轻。防锈钉子被黏液分泌物覆盖，但未涂层的钉子生锈并导致观察到反应性肉芽组织和肿胀。皮质类固醇和曲尼司特被认为对减少气道内的此类肉芽组织有效。
