成人特殊类型支气管异物患者23例治疗体会

目的提高成人特殊类型支气管异物的诊断及治疗水平。方法回顾性分析2003年1月至2014年1月在广西医科大学第一附属医院呼吸内科住院治疗的成人特殊类型支气管异物患者的临床资料。结果共收治特殊类型支气管异物患者23例,其中男15例,女8例;年龄25.5~74岁,中位年龄55.3岁;病史10至50年。23例患者中能提供明确异物误吸病史者11例;患者均有不同程度的异物周围气道炎症、肉芽组织增生及异物嵌顿;经纤维支气管镜取出异物21例(91.3%),因高度疑癌转外科手术治疗1例,因反复取异物失败最终放弃治疗1例。结论纤维支气管镜下取成人支气管异物简单安全、异物取出率高;对于特殊类型支气管异物,术前、术中做好充分准备可提高手术安全性及取出成功率。     

经纤维支气管镜取出成人气道异物56例

目的报道一组成人气道异物病例的临床特点和纤维支气管镜下取出异物的安全性及有效性。方法对我科2008年1月至2014年12月收治的56例成人气道异物患者的临床资料进行回顾性分析。结果成人气道异物56例,其中男性36例,女性20例,年龄平均(50.18±12.32)岁。31例患者(55.36%)否认异物吸人史。20例(35.71%)病程≤3天,22例(39.29%)3~7天,14例7~30天(25%)。以咳嗽为主要症状34例(60.71%)。50例接受局部麻下纤维支气管镜镜下治疗,成功取出气道异物;6例患者喉罩全麻下成功取出异物。异物来源为动物骨骼23例(41.07%),鱼骨7例(12.50%),坚果壳7例(12.50%),坚果肉6例(10.71%)、牙齿、义齿6例(10.71%),金属7例(12.50%)。异物相关并发症主要有气道肉芽增生42例(75.00%),阻塞性肺炎23例(41.07%),肺不张16例(28.57%)。操作过程中及治疗完成后气道出血40例(71.43%),无因异物和治疗导致死亡的病例。结论成人气道异物较儿童有不同临床特点,误吸史比率小,症状不典型,个别病例确诊时间长,容易误诊、漏诊。经纤维支气管镜取出成人气道异物安全、可行。     

成人气管支气管异物2222例临床Meta分析

目的探讨我国成人气管支气管异物患者的临床特点和支气管镜下治疗的有效性和安全性。方法将1986年6月至2016年6月治疗的2 222例成人气管支气管异物患者的临床资料进行回顾性分析。结果成人气管支气管异物2 222例,男性1 520例,女性702例。1 318例患者否认异物坠积。1 950例患者无基础疾病。1 952例(87.84%)患者接受局部麻醉下支气管镜镜下治疗,成功取出气道异物。主要的临床症状为咳嗽1 625例(73.1%)。异物来源为动物骨骼1 036例(46.6%),果肉、果核类358例(16.1%),金属异物122例(5.49%),义齿和破损牙齿136例(6.12%)。异物引发的并发症有阻塞性肺炎740例(33.3%),肺不张340例(15.3%)。操作过程中及治疗完成后气道内出血143例(6.43%)。3例患者死于窒息。结论成人的气管支气管异物没有典型的临床症状;在表面麻醉下经支气管镜取出成人气管支气管异物是有效的、安全的。     

成人气道吸入辣椒皮的支气管镜治疗方式及文献复习

正临床上常见成人气道内吸入辣椒皮,因其不同于骨头、金属异物等不可透X线异物,吸入辣椒皮后无法在X线片上显示,容易造成误诊,患者往往因慢性咳嗽或CT片上出现了阻塞性肺炎等而就诊,在行支气管镜时发现气道内有辣椒皮而确诊~([1-2])。目前公认支气管镜钳取法为气道异物治疗的最方便、有效的治疗方法。近年来在外院以钳取方式未能完全取出辣椒皮或出血而转诊到我院呼吸内镜中心者不少,因此有必要总结治疗成人气道吸入辣椒皮的经验,并进行成人     

经可弯曲支气管镜应用冷冻方法摘除难取性气道异物

气道异物是临床上常见的问题,经可弯曲支气管镜摘除是首选方法,具体摘取的方法很多,近2年来我们应用冷冻的方法摘取难取性气道异物,取得了良好效果,现报道如下。对象与方法 2003年12月至2005年12月期间气道异物患者8例,男5例,女3例,年龄14～78岁,平均(57.6±22.6)岁。均在外院或本院经可弯曲支气管镜应用常规方法如异物钳、异物篮、Fogarty 球囊等尝试30 min 以上未取出。患者的基本情况见表1。冷冻仪为 ERBE Erbokyo CA(德国 ERBE 公司),可弯曲支气管镜为 Olympus 1T40(日本 Olympus 公司)。按局麻下可弯曲支气管镜检查常规准备,经口进镜,到达异物处后,冷     

气道内异物误诊并气胸1例及文献复习

目的：提高气道内异物诊断治疗的水平,并对误治后造成气胸的处理进行探讨。方法回顾我院收治的1例气道内异物误诊为气胸患者病历资料,并复习相关文献,探讨成人气道内异物的诊断,及误治引起气胸后的诊断、处理。结果中年男性、脑外伤术后昏迷、气管切开患者,突发呼吸困难,外院误诊为气胸,治疗无效。入我院确诊为气道内异物,异物取出后好转。结论成人气道内异物易出现误诊,支气管镜检查对诊治有重要价值。阻塞性肺不张与气胸同时存在时诊断难度增加,其处理宜及时采取措施改善通气。     

纤维支气管镜诊治成人支气管异物28例临床分析

目的 探讨纤维支气管镜在成人支气管异物诊治中的作用.方法 对经纤维支气管镜诊治的28例成人支气管异物患者进行回顾性分析.结果 一次性成功取出者25例,3例因异物周围炎症肉芽组织粘连严重,分两次成功取出.治愈率100%,无并发症.结论 纤维支气管镜对减少支气管异物的误诊及治疗具有重要价值.     

经支气管镜诊治长期误诊的成人支气管异物分析

目的探讨支气管镜对成人支气管异物的诊治价值。方法回顾性分析37例长期误诊的成人支气管异物的临床表现、支气管镜下特征及钳取异物技巧。主要临床表现为咳嗽、咳脓痰、发热、局限性呼吸音减弱、吸气时干啰音。仅6例胸片或CT可见异物的直接表现。误诊为肺炎、肺癌、支气管炎、支气管扩张、支气管哮喘、肺结核等疾病,误诊时间1个半月~25年。结果37例均经支气管镜成功钳出异物。钳取异物用时最长4 h,最短约15 m in。24例镜下直接见到异物,8例吸净脓性分泌物后见到异物,5例异物被肉芽组织包埋。异物为动物骨头31例,虾、螃蟹脚、金属异物、中药丸、瓜子壳、杨梅核各1例。结论成人支气管异物的误诊应予重视,支气管镜检查是诊治成人支气管异物的最主要手段。     

电子支气管镜取成人支气管异物20例临床分析

目的探讨电子支气管镜在支气管异物取出术中的临床应用价值。方法 2%利多卡因注射液咽、喉、气道表面麻醉后,使用电子支气管镜配合活检钳取20例成人支气管异物。结果 17例获成功,一次成功取出异物为14例占70%,2次成功取出异物为3例占15%,改用纤维支气镜配合异物钳取出3例,占15%。未出现严重操作并发症。结论电子支气管镜在显示屏直视下钳夹并取出异物,具有视野清晰、易发现异物、分离出异物,患者痛苦较小,可保留操作过程资料、便于教学等优点。     

电子支气管镜诊治成人气管及支气管异物135例临床回顾性分析

目的探讨气管及支气管异物(TFBs)发生的临床特点及应用支气管镜取异物的经验。方法选择2007年5月至2014年10月在我院经支气管镜诊治的135例成人气管及支气管异物患者,对其年龄、危险因素、临床表现、影像学特点、异物种类、发病部位等特点进行回顾性分析。结果 135例患者中40~70岁108例占80.0%,其中男性69例(63.9%)女性39例占(36.1%);有96例无明确异物吸入史(71.1%);异物以动物骨类居多,占90例(66.7%);异物最常见的部位是右侧支气管,占113例(83.7%);1例金属义齿经支气管镜移至气管上段时,由于其金属分支刺入气管壁,行气管切开取出,其余134例均成功经支气管镜取出异物。结论成人气管及支气管异物患者因无特异性临床表现,且大多无明确异物吸入史时,容易误诊。支气管镜检查是确诊和治疗成人气管及支气管异物的最有效方法。     

Adult airway foreign body removal. What's new?

Signs and symptoms of adult FB aspiration are most often nonspecific. Misdiagnosis and delay in diagnosis frequently occur. Radiographic evaluation is helpful, but flexible bronchoscopy is the gold standard in the identification and localization of an airway foreign body. With increasing experience and development of better accessories, removal using a flexible bronchoscope under local anesthesia can be performed safely and successfully. Review of large series of FB removal indicates a success rate of 86% in more than 400 procedures with flexible bronchoscopy.     

多层螺旋CT检查对气道异物的诊断价值

目的：探讨多层螺旋CT对气道异物的诊断价值。方法对门诊收治疑似气管异物患者56例,给予多层螺旋CT检查,并与支气管镜检查作对照。结果多层螺旋CT检查共检出气道异物患者52例,1例误诊为肺炎,后经气管镜检查并取出异物,漏诊2例,假阳性1例。多层螺旋CT检查及气管镜对气道异物检出率差异无统计学意义（χ2＝0.61, P ＞0.05）。以支气管镜检查结果为金标准,螺旋 CT 灵敏度为96.23％,特异度为66.67％,诊断符合率为94.64％。结论多层螺旋CT检查气道异物,具有灵敏度高、符合率高特点,诊断时应结合病史、临床体征,以降低误诊率、漏诊率。儿童检查应以最低剂量扫描,避免辐射损伤。     

Airway foreign bodies: what's new?

Tracheobronchial foreign body (FB) aspiration is a common problem in children and adults. The medical history is the single most predictive factor in the clinical suspicion of FB aspiration. The "penetration syndrome" defined by the sudden onset of choking and coughing with or without vomiting should prompt concerns for FB aspiration. Findings on radiographic imaging include visualization of a radiopaque FB, atelectasis, postobstructive changes, mediastinal shift, and pneumomediastinum. In the presence of a high clinical suspicion even with normal imaging studies, bronchoscopy should be performed for a thorough evaluation of the airways. Bronchoscopic extraction of airway FBs can be safely accomplished with both the rigid as well as the flexible bronchoscope in adults and children. Rigid bronchoscopy allows for control of the airway and provides excellent visualization with a variety of ancillary instruments available. Increasingly, both the adult and pediatric flexible bronchoscopes have been used successfully in the extraction of airway FBs utilizing urologic or bronchoscopic instruments. Airway control can be achieved with an endotracheal tube or a laryngeal mask airway. A delay in diagnosis increases morbidity including cough, wheeze, edema, and granulation tissue formation. Bronchoscopic evaluation and removal should be performed as soon as the diagnosis is suspected.     

Inadvertent removal of foreign body via a flexible fiberoptic bronchoscope in a 4-year-old boy

We report the case of a 4-year-old child with an atypical presentation of an aspirated unwitnessed foreign body in the airway. During an attempt to obtain a biopsy of what appeared to be a mucosal growth, the foreign body was removed. This may be the first report of foreign body removal in a child this young, using a flexible fiberoptic bronchoscope. Pediatr Pulmonol. 1994; 18:51–52. © 1994 Wiley-Liss. Inc.     

Use of fiberoptic bronchoscopy to retrieve bronchial foreign bodies in adults

The flexible fiberoptic bronchoscope was used to treat bronchial foreign bodies in 33 adults. The length of time that the foreign body was in the lung was less than 1 wk in six (acute group), more than 1 month in 21 (chronic group), and uncertain in two (uncertain group), and the foreign body was an endogenous broncholith in four patients (broncholith group). The foreign bodies were nonfragile, solid matter in most cases and they frequently had sharp projections on them. Granulations around the foreign body were common in the chronic group, but there was no correlation between the length of time the foreign body was in the lung and the amount of granulation or the number of the bronchoscopies needed for diagnosis or management. The granulations did not bleed easily on biopsy or during removal of the foreign body. In fact, they receded if several pieces were removed, making the foreign body much easier to recognize and to retrieve in the next bronchoscopy (about 1 wk later). After removal of the foreign body, the residual granulations regressed, and the bronchial lumen became more patent. The mortality, morbidity, and complication rates were very low, whereas the success rate was high. We conclude that flexible fiberoptic bronchoscopy is practical and safe in retrieving bronchial foreign bodies in adult patients.     

Foreign body in the airway: unusual cause of acute dyspnoe after cardiac surgery

We report on a 68-year-old male who presented with acute onset of dyspnoe and cough. After coronary artery bypass grafting and mitral valve repair with an annuloplasty ring, postoperative recovery was initially uneventful. On the 6th postoperative day, he came back to intensive care unit due to acute dyspnoe. Fig. 1 demonstrates chest x-ray. We identified the foreign body as a dental prosthesis (Fig. 2).Removal from the right bronchial tree was successful using a flexible bronchoscope under local anesthesia; intubation was not required. This procedure was safe and well tolerated by the patient.Clinical presentation of adult foreign body aspiration are often nonspecific. Chest x-ray is very helpful for identification and localization of foreign bodies in the airway. Extraction can be performed with flexible or rigid bronchoscopy. For the removal, biopsy forceps, Fogarty balloon catheter, alligator forceps or wire baskets are effective.

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Fremdkörper in den Atemwegen: seltene Ursache akuter Dyspnoe nach einer Herzoperation

     

The tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration

The typical chest computed tomography (CT) finding of the arc welders is ill‐defined micronodules diffusely distributed in the lung. We report a rare case of tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration. We used the CT and mineralogical analysis in diagnosis and the flexible fiberoptic bronchoscope in therapy. The CT showed bronchiectasis with pulmonary infiltration of the right lower lobe and high‐density shadow in the basal bronchus of the right lower lobe. The foreign bodies were removed by a fibreoptic bronchoscope. Semiquantitative chemical analyses showed that the constituent of foreign body was similar to the dregs which were collected in the same garage. This is an unusual case of the welding‐related respiratory diseases, which is different from Welder's siderosis and broncholith.     

Inadvertent loss of bronchoscopy instruments in the tracheobronchial tree.

Equipment malfunction is a rare complication of flexible fiberoptic bronchoscopy. We report an unusual example of equipment failure resulting in the inadvertent introduction of a foreign body (the tip of a cleaning brush) into the bronchial tree of a patient during FFB. In addition, we review several other cases in which problems have been caused by malfunction of accessory equipment. Careful inspection of all cleaning and biopsy utensils should reduce the chance of iatrogenically introducing a foreign body from the bronchoscope channel into the patient's airway. We suggest that biopsy forceps are the best retrieval instrument to use when the foreign body involved is a brush or a piece of wire.     

Anesthesia and airway managements for emergency removal of esophageal foreign body in a trisomy 21 patient with mental retardation and predicted difficult airway: A case report

Introduction:The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery.Patient concerns:A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck.Diagnoses:Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways.Interventions:Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction.Outcomes:Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication.Lessons subsections as per style:When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.