Xu En-ming, Xu Zhong-qiang, Wang Zhi-nan, Wang Yan, Chen Ping, Zhang Ya-min, Xia Fei, Zhang Yan
Department of Otorhinolaryngology, Wuhan Children's Hospital, Wuhan 430030, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Dec;47(12):982-6.
To explore the best methods and skill for the removal of difficult and high risk tracheobronchial foreign body under bronchoscope.
A retrospective review was performed between August 1995 to August 2012. There were 4217 children with tracheobronchial foreign body, among them, 272 were diagnosed as high-risk, highly difficult tracheobronchial foreign bodies confirmed by clinical manifestations, foreign body type and bronchoscopy.
In 271 children, the tracheobronchial foreign body was removed under bronchoscope, the success rate was 99.6%; only one child with a pen cap blocking the left lower lobe bronchus was transferred to the department of thoracic surgery, and the foreign body was finally removed by thoracotomy. Eighty-five children (among them, 82 children were under 1 year of age) had II-II degree laryngeal obstruction, the emergency surgery was performed to remove the foreign body and to relieve the laryngeal obstruction. Twenty-six children had lung infection and 27 children had failed foreign body removal surgery before, in all these children, the foreign body was removed after infection control. There were 17 children with the pen cap as the tracheobronchial foreign body, direct removal was successful in 12 children with the history less than two weeks; in 4 children, the foreign body was removed after 0.1% epinephrine saline flush, and 1 case with the homemade bronchial foreign body hook remove. There were 26 children with the whistle as the foreign body, and 32 children had large and sharp foreign bodies. In these cases, the foreign bodies were removed together with the bronchoscope. Forty-two children had multiple or fragile foreign bodies, and 16 children had subsegmental bronchial foreign bodies. In these cases, the foreign bodies were removed with forceps under direct vision and intraoperative bronchial lavage.In This series, 129 children received intraoperative bronchial lavage, among them, 127 children showed normal X-ray changes one week after operation. Two children with a history of more than 1 month complicated with pulmonary consolidation. After bronchial lavage, pneumothorax and subcutaneous emphysema occurred, which recovered after treatment. No glottic edema, asphyxia, and other complications were found, the complication rate of surgery was 0.7%.
For the removal of highly difficult and high risk tracheobronchial foreign bodies, preoperative analysis and discussion should be sufficient, appropriate surgical skill and surgical instruments may improve the success rate of the surgery and prevent the operation complications.
探讨支气管镜下取出困难及高危气管支气管异物的最佳方法和技巧。
对1995年8月至2012年8月间的病例进行回顾性分析。4217例气管支气管异物患儿中，272例经临床表现、异物类型及支气管镜检查确诊为高危、高难度气管支气管异物。
271例患儿在支气管镜下取出气管支气管异物，成功率为99.6%；仅1例笔帽阻塞左肺下叶支气管患儿转胸外科，最终经开胸手术取出异物。85例患儿（其中82例年龄小于1岁）出现Ⅱ-Ⅱ度喉梗阻，急诊手术取出异物并解除喉梗阻。26例患儿合并肺部感染，27例患儿既往异物取出手术失败，均在控制感染后取出异物。17例笔帽气管支气管异物患儿中，病程小于2周的12例直接取出成功；4例经0.1%肾上腺素盐水冲洗后取出异物，1例用自制支气管异物钩取出。26例口哨异物患儿，32例大而尖锐异物患儿，均随支气管镜一并取出异物。42例多发或易碎异物患儿，16例亚段支气管异物患儿，直视下用钳取出异物并术中支气管灌洗。本系列中，129例患儿术中进行支气管灌洗，其中127例术后1周X线表现正常。2例病程超过1个月合并肺实变患儿，支气管灌洗后出现气胸及皮下气肿，经治疗后恢复。未发现声门水肿、窒息等并发症，手术并发症发生率为0.7%。
对于取出高难度及高危气管支气管异物，术前应充分分析讨论，采用合适的手术技巧及手术器械可提高手术成功率并预防手术并发症。
