Martin Andrew, van der Meer Graeme, Blair Dora, Mahadevan Murali, Neeff Michel, Barber Colin, Mills Nicola, Salkeld Lesley, Gruber Maayan
Starship Children's Hospital, Auckland, New Zealand.
Starship Children's Hospital, Auckland, New Zealand; Otolaryngology Department, Naharia West Galilee Medical Centre, Naharia, Israel.
Int J Pediatr Otorhinolaryngol. 2016 Nov;90:49-53. doi: 10.1016/j.ijporl.2016.08.018. Epub 2016 Aug 26.
Aspirated foreign bodies in children present a potentially life-threatening condition and can be challenging to diagnose. This study aims to elucidate the characteristics and outcome of children with long-standing aspirated foreign bodies.
Retrospective case series of all cases of confirmed long-standing aspirated foreign bodies (LSAFB) between January 2003 to December 2015 in a single paediatric tertiary-level institution, defined as more than two weeks from choking episode or beginning of symptoms.
Clinical files and operative records on 227 patients were screened and 35 children were confirmed to have been treated for LSAFB as per definition above. Median time to presentation was 4 weeks (mean 8.8 weeks). Eighty-six percent presented with cough and 51% with dyspnoea. Abnormal chest X-ray findings were found in 28 out 31 patients (90%). Organic foreign bodies (22) were more common than inorganic (14). Intraoperative granulation tissue was demonstrated in 89% of patients and in 46% of patients this was regarded as significant (defined as obstructing more than 50% of the involved airway lumen). Mean length of stay was 2.5 days. Nine patients (26%) had 11 respiratory complications; there were no mortalities.
Paediatric LSAFB poses an uncommon diagnostic dilemma as there is often no witnessed history of aspiration event; and signs, symptoms and chest X-Ray findings are often non-specific. Laryngobronchoscopy is made more difficult by the presence of granulation tissue and the sequelae of prolonged non-treatment is a higher rate of chronic respiratory disease.
儿童误吸异物是一种潜在的危及生命的情况，诊断可能具有挑战性。本研究旨在阐明长期误吸异物儿童的特征及转归。
对一所儿科三级医疗机构2003年1月至2015年12月期间所有确诊的长期误吸异物（LSAFB）病例进行回顾性病例系列研究，定义为自窒息发作或症状开始起超过两周。
筛查了227例患者的临床档案和手术记录，35名儿童根据上述定义确诊为接受了LSAFB治疗。就诊中位时间为4周（平均8.8周）。86%的患者表现为咳嗽，51%表现为呼吸困难。31例患者中有28例（90%）胸部X线检查有异常发现。有机异物（22例）比无机异物（14例）更常见。89%的患者术中可见肉芽组织，其中46%的患者肉芽组织被认为较为严重（定义为阻塞受累气道腔的50%以上）。平均住院时间为2.5天。9例患者（26%）出现11次呼吸并发症；无死亡病例。
儿科LSAFB造成了一种不常见的诊断困境，因为通常没有误吸事件的目击史；体征、症状和胸部X线检查结果往往不具有特异性。肉芽组织的存在使喉镜检查更加困难，长期不治疗的后遗症是慢性呼吸道疾病的发生率较高。
