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儿童气管支气管异物的处理:我们的经验

Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience.

作者信息

Gayen Ganesh Chandra, Das Debabrata, Ray Ritam, Maitra Mainak

机构信息

Department of ENT and Head Neck Surgery, Malda Medical College and Hospital, Singatala, Uma Roy Sarani, Malda Town, West Bengal 732101 India.

Department of ENT and Head Neck Surgery, R G Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, West Bengal 700004 India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(4):536-539. doi: 10.1007/s12070-022-03098-x. Epub 2022 Apr 24.

Abstract

(1) To study the epidemiological profile of the patients. (2) To study the various modalities of investigations to arrive at confirmatory diagnosis. (3) To study the post-operative complications. It was a hospital based prospective study. A total of 36 paediatric patients were included in the study over a duration of 2 years (August 2017 to July 2019). Written informed consent was taken from the parent of each patient before performing bronchoscopy. All the patients were subjected to careful clinical examination and investigations required followed by emergency bronchoscopic removal of foreign body. The patients were followed up at 1 and 3 months after bronchoscopic removal. Amongst the 36 cases, 12 cases presented with airway emergency which addressed by bronchoscopic removal immediately. 10 cases presented with suggestive history of foreign body aspiration were subjected to clinical and radiological studies followed by bronchoscopic removal. 14 cases were referred from paediatric in-patient department who were being treated for unresolved LRTI. Early intervention is life saving if timely done. Unresolved LRTIs should be looked carefully to address missed foreign bodies. HRCT Thorax with 3-D reconstruction (Virtual Bronchoscopy) helps in exact localization of the foreign body. Experienced team of surgeons and anesthetist along with a ICU support is needed for efficient management.

摘要

(1) 研究患者的流行病学特征。(2) 研究用于确诊的各种检查方式。(3) 研究术后并发症。这是一项基于医院的前瞻性研究。在2年期间(2017年8月至2019年7月),共有36例儿科患者纳入研究。在进行支气管镜检查前,已获得每位患者家长的书面知情同意书。所有患者均接受了仔细的临床检查及所需的检查,随后通过急诊支气管镜取出异物。在支气管镜取出异物后,对患者进行了1个月和3个月的随访。在这36例病例中,12例表现为气道急症,通过支气管镜立即取出异物进行处理。10例有异物吸入可疑病史的患者接受了临床和放射学检查,随后进行支气管镜取出。14例是从儿科住院部转诊而来,他们因下呼吸道感染未愈正在接受治疗。如果及时进行,早期干预可挽救生命。对于未愈的下呼吸道感染,应仔细检查以发现漏诊的异物。胸部高分辨率CT三维重建(虚拟支气管镜)有助于异物的精确定位。高效管理需要经验丰富外科医生和麻醉师团队以及重症监护病房的支持。

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本文引用的文献

3
Tracheobronchial foreign bodies in children: imaging assessment.儿童气管支气管异物:影像学评估
Semin Ultrasound CT MR. 2015 Feb;36(1):8-20. doi: 10.1053/j.sult.2014.10.001. Epub 2014 Oct 18.
4
Inhalation of foreign bodies in children: experience of 22 years.儿童异物吸入:22 年经验。
J Trauma Acute Care Surg. 2013 Feb;74(2):658-63. doi: 10.1097/TA.0b013e3182789520.
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Inhaled foreign bodies in pediatric patients: review of personal experience.小儿患者吸入性异物:个人经验回顾
Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1897-903. doi: 10.1016/j.ijporl.2007.09.002. Epub 2007 Oct 23.
8
Foreign bodies aspirated in children: role of bronchoscopy.儿童误吸异物:支气管镜检查的作用
Thorac Cardiovasc Surg. 2007 Jun;55(4):249-52. doi: 10.1055/s-2006-924714.

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