Hamouri Shadi, Swesi Faisal, Novotny Nathan Michael
1 Department of General Surgery and Urology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology , Irbid, Jordan .
2 Department of Surgery, Beaumont Health, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
J Laparoendosc Adv Surg Tech A. 2018 Oct;28(10):1243-1247. doi: 10.1089/lap.2018.0101. Epub 2018 Jun 6.
Headscarf use is becoming more common throughout the world. Many articles describe the problem of aspirated headscarf pins but few if any give technical details for retrieval or innovative methods of removal if traditional bronchoscopy fails particularly in the pediatric population. Herein, we describe our method of deep sedation with laryngeal mask airway (LMA) and flexible bronchoscopy (FB) and retrieval with a stepwise algorithm if traditional FB fails.
A retrospective review of pediatric patients with aspirated headscarf pins was performed. Patient demographics, symptomatology, procedure specifics, and outcomes were recorded.
Fifty-six patients had pins removed at our institution between January 2010 and May 2017. Ninety-one percent were female. Each had a history of aspiration of a needle confirmed by a chest X-ray. The most common presenting symptom was cough in 48%. Only a small minority had physical exam findings (9% either wheezing or decreased air entry). FB via LMA under deep sedation was used as a primary intervention and was successful in 52 of 56 cases (93%). Fluoroscopy was added to aid the FB in 3 cases and was successful in 2 of the 3 patients. Two patients underwent mini-thoracotomy for removal. All pins were removed successfully and none of the patients had any postprocedural complications.
Surgeons caring for pediatric patients throughout the world should be knowledgeable in a common problem often facing girls wearing headscarves. Given the majority of the needles are in segmental bronchi in teenage girls, we recommend FB as the primary modality with the addition of fluoroscopy to guide if needed and video-assisted thoracoscopy or mini thoracotomy if less invasive methods fail.
在全球范围内，佩戴头巾的现象越来越普遍。许多文章描述了头巾别针误吸的问题，但如果传统支气管镜检查失败，特别是在儿科患者中，很少有文章给出取出别针的技术细节或创新的取出方法。在此，我们描述了使用喉罩气道（LMA）进行深度镇静和柔性支气管镜检查（FB）的方法，以及在传统FB失败时采用逐步算法进行取出的方法。
对误吸头巾别针的儿科患者进行回顾性研究。记录患者的人口统计学信息、症状、手术细节和结果。
2010年1月至2017年5月期间，我院有56例患者的别针被取出。91%为女性。每位患者均有经胸部X线证实的针头误吸史。最常见的症状是咳嗽，占48%。只有一小部分患者有体格检查发现（9%有喘息或呼吸音减弱）。在深度镇静下通过LMA进行FB作为主要干预措施，56例中有52例成功（93%）。3例患者在FB时加用了荧光透视，其中2例成功。2例患者接受了胸腔镜下取出术。所有别针均成功取出，且无患者出现任何术后并发症。
全球范围内治疗儿科患者的外科医生应了解佩戴头巾的女孩经常面临的一个常见问题。鉴于大多数针头位于青少年女孩的段支气管内，我们建议将FB作为主要方式，必要时加用荧光透视引导，若侵入性较小的方法失败，则采用电视辅助胸腔镜或胸腔镜下取出术。
