Dubey Neeraj Kumar, Upadhyay Aparaajita, Raghuwanshi Neha, Godha Surbhi, Mundra Rajkumar
Department Of E.N.T., M.G.M. Medical College, Indore, India.
M.G.M. Medical College, Indore, 452001 India.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):5354-5360. doi: 10.1007/s12070-021-02596-8. Epub 2021 May 4.
Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16 year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1-5 year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic insertion and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.
在缺乏最合适器械的情况下，儿童误吸异物的处理极具挑战性。硬质支气管镜检查在漫长的历史进程中不断发展。霍普金斯杆状望远镜和光学镊子的出现提高了取出气管支气管异物的效果和安全性。本研究纳入了36名年龄小于16岁、确诊气道异物的儿童。使用了两种类型的镊子：（1）与霍普金斯杆状透镜望远镜联合使用的光学镊子[n = 25]（2）标准镊子[n = 11]。最常见的年龄组是1 - 5岁[n = 26]，男性占优势[n = 20]。最常见的部位是右支气管13例（右主支气管11例、右中间支气管1例、右下叶支气管1例），其次是左主支气管11例、气管10例、双侧支气管和声门下各1例。大多数病例（n = 26）发现为植物性异物。与标准镊子相比，光学镊子的平均抓取尝试次数、平均支气管镜插入次数以及从插入镊子到取出异物的平均时间均较少，p值具有显著性差异。光学镊子具有气道高分辨率和放大视野、手柄弹簧作用以及更好触感的优势。这些有助于正确识别气管支气管异物的类型、大小和部位。使用光学镊子进行精确抓取尝试可减少并发症的发生几率。光学镊子为硬质支气管镜检查带来了新的维度，被证明对外科医生、住院医生以及有误吸异物的患者来说是真正的福音。
