喉镜下取咽部隐匿性异物的临床特点和治疗效果分析（附74例报告）

Analysis of clinical characteristics and therapeutic effects of pharyngeal occult foreign body under laryngoscope (74 cases)

摘要:

目的 探讨喉镜下治疗咽部隐匿性异物的规范诊疗路径。方法 回顾性分析2021年5月－2022年5月该院异物内镜中心诊治的74例咽部隐匿性异物患者的临床资料，分析诊疗路径和治疗效果。结果 74例患者均得到了较好的治疗效果。其中，36例经喉内镜仔细检查后取出；32例使用颈部薄层CT准确定位后，26例在喉镜辅助下顺利取出，5例在全身麻醉喉镜辅助下小切口取出，1例在全身麻醉下颈侧切开取出；6例颈部薄层CT未能发现明显高密度异物影，CT检查后，根据患者疼痛位置反复喉镜检查发现，经咽局部表面麻醉后顺利取出。结论 颈部CT检查有助于发现并定位咽部隐匿性异物，但较小且密度低的异物容易漏诊。因此，应根据患者疼痛部位和疼痛程度再次判断，反复多次镜检，并重点检查咽部隐匿部位，是咽部隐匿性异物的常规诊疗路径。

Abstract:

Objective To explore the standardized diagnosis and treatment for pharyngeal occult foreign body under laryngoscope.Methods Analyze and summarize the clinical data, diagnosis and treatment path and treatment effects of 74 cases of pharyngeal occult foreign body diagnosed and treated by the endoscopy center of foreign body from May 2021 to May 2022.Results 74 cases of occult pharyngeal foreign body were treated well. Among them, 36 cases were removed after careful laryngeal endoscopy. 32 cases of pharyngeal foreign body could be accurately located by thin-slice CT of the neck, of which 26 cases were then successfully removed with the assistance of laryngoscopy, 5 cases were successfully removed through small incisions with the assistance of general anesthesia laryngoscope, and 1 case was removed through cervical incision under general anesthesia. Another 6 cases of neck thin-slice CT failed to find obvious high-density foreign body shadows. After CT examination, repeated laryngoscopy was performed according to the patient's pain location. Finally, foreign body was successfully removed after local anesthesia through the pharynx.Conclusion CT examination of the neck is helpful for the detection and localization of occult foreign bodies in the pharynx, but small and low-density foreign bodies are easily missed. Therefore, according to the patient's pain location and degree of pain, repeated microscopic examinations with a focus on examining the occult area of the pharynx is the routine diagnosis and treatment path for pharyngeal occult foreign body.