Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2021 Aug 13;100(32):e26908. doi: 10.1097/MD.0000000000026908.
Successful removal of an airway foreign body (FB) in some intractable cases can be very challenging, because of tracheal anomalies, unstable respiratory status of the patients, and the location of FB. The use of cardiopulmonary bypass (CPB) support for the treatment of a FB is extremely rare.
We present a case of a 39-month-old previously healthy girl who was admitted to our hospital for suspected FB aspiration (FBA). Initially, the attempt for removal of the FB by conventional bronchoscopy failed because of hypoxic intolerance.
Bronchoscopy revealed tracheal anomalies and subsequent computed tomography angiography demonstrated the presence of a pulmonary artery sling (PAS), which confirmed the diagnosis of PAS accompanied with FBA.
With the assistance of CPB, multidisciplinary treatment involving the respiratory, cardiothoracic and anesthetic teams were involved and the bronchial FB was removed by flexible bronchoscopy successfully and then PAS was corrected by surgical intervention.
The patient remained asymptomatic, without shortness of breath or wheezing during the 15 months follow-up.
This case highlights that in a complicated case of FBA, bronchoscopy and computed tomography imaging are of great importance to achieve an accurate diagnosis, and a multidisciplinary treatment approach is essential for a satisfactory outcome. If the patient is unstable for bronchoscopy, CPB can be temporarily used in the stabilization of the patient to allow safe removal of the FB.
在某些棘手的情况下，成功移除气道异物（FB）非常具有挑战性，这是由于气管异常、患者呼吸状态不稳定以及 FB 的位置所致。使用体外循环（CPB）支持来治疗 FB 极其罕见。
我们报告了 1 例 39 月龄的既往健康女孩，因疑似 FB 吸入（FBA）而入院。最初，由于缺氧不耐受，常规支气管镜检查未能成功取出 FB。
支气管镜检查显示气管异常，随后的 CT 血管造影显示存在肺动脉吊带（PAS），这证实了 PAS 合并 FBA 的诊断。
在 CPB 的协助下，涉及呼吸、心胸和麻醉团队的多学科治疗介入，通过柔性支气管镜成功取出支气管 FB，然后通过手术干预纠正 PAS。
患者在 15 个月的随访中无症状，无呼吸急促或喘息。
该病例强调，在复杂的 FBA 病例中，支气管镜和 CT 成像对于准确诊断非常重要，多学科治疗方法对于获得满意的结果至关重要。如果患者因支气管镜检查不稳定，可以暂时使用 CPB 来稳定患者，以便安全取出 FB。
