成人支气管异物的支气管镜下表现和介入治疗方式探讨

Tracheoscopic manifestation and interventional therapy using bronchoscopy in adult patients of tracheobronchial foreign bodies

摘要:

目的 探讨成人支气管异物支气管镜下表现和介入治疗方式。方法 回顾性分析空军军医大学唐都医院呼吸与危重症医学科2014年1月－2019年4月129例经支气管镜检查确诊的成人支气管异物患者支气管镜下表现、介入治疗方式及预后等临床资料。结果 129例患者中，88例为局麻经鼻进镜，33例患者全麻完成检查治疗，8例患者局麻下发现异物后经全麻下取出异物。取出异物的128例患者中，29例直视下可见异物，未造成管壁管腔黏膜改变；65例直视下见部分异物伴周围肉芽组织增生；23例管壁肉芽组织生长致管腔堵塞，清除部分肉芽后异物暴露；6例患者气道分泌物致管腔堵塞，吸除分泌物后见异物；4例异物嵌顿；1例超细支气管镜下未见异常，后经支气管内超声导向鞘引导（EBUS-GS）探及明显边界回声灶，活检钳钳夹确定为异物。129例异物患者中取出128例，镜下吸引取出2例。使用一种介入手段取出95例，较为常用的手段包括冷冻（28例）、活检钳（27例）、异物钳（25例）、异物网篮（10例）；使用两种介入手段取出25例，最常用的手段包括活检钳+冷冻（11例）；使用三种及以上介入手段取出6例。所有患者术后无出血、气胸、穿孔及窒息等严重并发症发生。所有患者中124例痊愈，1例因本身合并气道狭窄，多次镜下治疗后病情好转，3例异物吸入时间过长导致原异物所在部位形成局部支气管扩张，1例患者因全麻支气管镜下采用多种方式仍无法取出异物，建议手术，患者家属放弃治疗。结论 支气管镜检查是诊断及治疗成人支气管异物安全有效的方法，值得推广。

Abstract:

Objective To investigate the bronchoscoic manifestations and interventional therapy in adult patients with tracheobronchial foreign bodies.Methods Retrospective analysis of the clinical data in tracheoscopic manifestations and interventional therapy of 129 adult patients with tracheobronchial foreign body from January 2014 to April 2019.Results Patients were diagnosed and treated using bronchoscopy by local anesthesia (88 patients), general anesthesia (33 patients) and 8 patients diagnosed with local anesthesia and removed the foreign body after general anesthesia. Foreign bodies of 29 cases is visible under direct vision and not cause changes in the mucosa of tracheal wall, some foreign bodies with surrounding granulation tissue were observed under direct vision in 65 cases, in 23 cases were lumen blockage caused by the growth of granulation tissue in tube wall and some foreign bodies were exposed after the removal of granulation, the lumen blocked in 6 patients caused by airway secretion and the foreign bodies were seen after the secretions were aspirated, foreign bodies were incarcerated of 4 cases, there was no abnormality in 1 case under the ultra-bronchiole bronchoscopy, the obvious boundary echo foci were detected by EBUS-GS and diagnosed by the biopsy forceps. Foreign bodies of 128 cases were taken out, among them, 2 cases were taken just by vacuum suction. 95 cases were removed by one interventional method and the more common methods included cryoablation (28 cases), grasping forceps (27 cases), biopsy forceps (25 cases), foreign body basket (10 cases); 25 cases were taken by two interventions, the most commonly used means was biopsy forceps combined with cryoablation (11 cases); 6 cases were taken using three or more interventions. All these patients had no serious complications such as hemorrhage, pneumothorax, perforation and asphyxia. 124 patients recovered, 1 patient was improved after multiple endoscopic treatment due to airway stenosis, inhalation of foreign bodies for too long in 3 cases cause resulted in the formation of local bronchiectasis at the site the original foregn body, one patient was unable to remove the foreign body under tracheoscopy due to general anesthesia, surgery was recommended and the patient's family member gave up the treatment.Conclusion Tracheoscopy is a safe and effective method for diagnosing and treating adult tracheobronchial foreign bodies.