儿童气管支气管异物临床诊治体会（附32例报告）

Experience in clinical diagnosis and treatment of children with foreign bodies in trachea and bronchus (32 cases)

摘要:

目的 总结儿童气管支气管异物的临床特点，为儿童异物吸入的预防提供依据，并探讨静脉-吸入复合麻醉喉罩通气下经可弯曲支气管镜（FB）在儿童气管支气管异物取出中的有效性和安全性。方法 回顾性分析2018年1月－2020年5月该院经FB确诊和治疗的32例支气管异物患儿的临床资料。结果 该组患儿男女比例为2.2∶1.0，好发年龄1～3岁，农村儿童发病率最高。支气管异物种类以食源性异物为主，多嵌顿于右侧支气管。常见的并发症为支气管黏膜充血水肿、肺气肿、肺炎、肉芽组织增生、黏膜糜烂和纵隔气肿，最常见症状为咳嗽和喘息。支气管异物胸部CT阳性率为78.12%。全部病例均在全身麻醉喉罩下经FB取出异物，成功率为100.00%，术中术后并发症少。主要手术方式为异物网篮套取、异物钳钳取和球囊拖拉。结论 气管支气管异物以3岁以下的农村男童较多见，应加强宣教、科普和监管。有明确或可疑异物吸入史的患儿应及早行胸部CT协助诊断，无明确异物吸入史或影像学无阳性提示的隐匿性支气管异物，易出现误诊和漏诊。因此，对于有反复咳嗽和喘息病史、经临床常规治疗效果不佳者，应及早行FB检查以明确诊断，尽早治疗。静脉-吸入复合麻醉喉罩通气下经FB在儿童气管支气管异物取出中是有效、安全的，可常规应用于临床治疗。

Abstract:

Objective To summarize the clinical characteristics of children’s tracheobronchial foreign bodies, and provide evidence for the prevention of children’s foreign bodies inhalation, and explore the efficacy and safety of flexible bronchoscope (FB) in the removal of children’s tracheobronchial foreign bodies with combined intravenous and inhalation anesthesia under laryngeal mask ventilation.Methods Clinical data of 32 children with bronchial foreign bodies who were diagnosed and treated with FB from January 2018 to May 2020 were retrospectively analyzed.Results The male to female ratio of the children in this group was 2.2 ∶1.0, and the prevalence age was 1 to 3 years old. The incidence of rural children was the highest. The main types of foreign bodies are food-borne foreign bodies, mostly incarcerated in the right bronchus. Common complications are bronchial mucosal congestion and edema, emphysema, pneumonia, granulation tissue hyperplasia, mucosal erosion, and mediastinal emphysema. The most common symptoms are cough and wheezing. The positive rate of chest CT for bronchial foreign bodies was 78.12%. In all the cases, the foreign bodies were removed through FB under general anesthesia laryngeal mask, the success rate was 100.00%, and the intraoperative and postoperative complications were few. The main surgical methods were foreign body net basket collection, foreign body forceps removal and balloon dragging.Conclusion Foreign bodies in the trachea and bronchus are more common in rural boys under 3 years old. Publicity, education and science popularization should be strengthened, and supervision should be strengthened. If there is a clear or suspicious history of foreign body inhalation, chest CT should be performed as soon as possible to assist in the diagnosis. Occult bronchial foreign bodies without clear history of foreign body inhalation or no positive imaging suggestion are easy to be misdiagnosed and missed in clinical practice, so there is a history of repeated coughing and wheezing. If the treatment effect is not good, FB examination should be performed as soon as possible to further confirm the diagnosis and treatment. It is effective and safe to take children's tracheobronchial foreign bodies through FB with combined intravenous and inhalation anesthesia under laryngeal mask ventilation, and It can be used routinely in clinical treatment.