硬性支气管镜联合纤维支气管镜在治疗小儿肺段支气管异物的应用

doi:10.6040/j.issn.1673-3770.0.2021.406

摘要/Abstract

摘要： 目的探讨硬性支气管镜联合纤维支气管镜在小儿肺段(及其亚段)支气管异物治疗中的应用价值。方法回顾性分析42例肺段(Ⅲ级及其亚段)支气管异物患者的临床资料,应用硬性支气管镜联合纤维支气管镜治疗,总结临床转归。结果 42例患者均成功取出异物,术中无窒息、大出血及气胸等并发症,手术时间平均为(15±3)min,术后顺利复苏转普通病房,5例术后出现轻度声嘶,无呼吸困难。结论硬性支气管镜联合纤维支气管镜是治疗肺段(及其亚段)支气管异物有效安全的手段之一,缩短了手术时间,减少并发症发生率,改善手术预后。

关键词: 硬质支气管镜, 纤维支气管镜, 异物

Abstract: Objective To investigate the application value of rigid bronchoscope combined with fiberoptic bronchoscope in the treatment of a bronchial foreign body in the infantile lung segment(and its subsegment). Methods Clinical data of 42 patients with a bronchial foreign body in the lung segment(grade III and sub-segment)were analyzed retrospectively. Results Foreign bodies in all 42 cases were successfully removed simultaneously, without any intraoperative complications such as asphyxia, bleeding, and pneumothorax. The average operation time was 15±3 min, postoperative recovery was smooth transferred to the general ward, with five cases of mild hoarseness and no dyspnea. Conclusion Rigid bronchoscope combined with a fiberoptic bronchoscope is an effective and safe alternative for the treatment of the bronchial foreign body in the pulmonary segment(and its sub-segment), which can shorten the operation time, reduce the incidence of complications, and improve the prognosis of the operation.

Key words: Rigid bronchoscopy, Fiberoptic bronchoscope, Foreign body

中图分类号:

R768

黄桂亮,孙昌志,罗仁忠,谢志伟,童志杰,刘少锋. 硬性支气管镜联合纤维支气管镜在治疗小儿肺段支气管异物的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 91-95.

HUANG Guiliang, SUN Changzhi, RUO Renzhong, XIE Zhiwei, TOHG Zhijie, LIU Shaofeng. Application of rigid bronchoscope combined with fiberoptic bronchoscope in the treatment of a bronchial foreign body in the infantile lung segment[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 91-95.

参考文献

[1] 刘光亮, 彭湘粤, 赵斯君, 等. 232例儿童呼吸道异物发生相关因素分析[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(4): 397-401. doi:10.11798/j.issn.1007-1520.201904013. LIU Guangliang, PENG Xiangyue, ZHAO Sijun, et al. Analysis of related factors of respiratory tract foreign bodies in 232 children[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(4): 397-401. doi:10.11798/j.issn.1007-1520.201904013.
[2] 吴欢欢, 仇君, 贺园珍, 等. 儿童呼吸道异物1085例流行病学特征分析[J]. 中国眼耳鼻喉科杂志, 2016, 16(1): 23-25. doi:10.14166/j.issn.1671-2420.2016.01.007. WU Huanhuan, QIU Jun, HE Yuanzhen, et al. Epidemiological features of 1 085 foreign bodies aspiration cases in children[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2016, 16(1): 23-25. doi:10.14166/j.issn.1671-2420.2016.01.007.
[3] Strychowsky JE, Roberson DW, Martin T, et al. Proximal bronchial balloon dilation for embedded distal airway foreign bodies[J]. Laryngoscope, 2016, 126(7): 1693-1695. doi:10.1002/lary.25680.
[4] 高滢, 王正辉, 常会敏, 等. 小儿气管支气管异物2 000例[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 39-42. doi:10.6040/j.issn.1673-3770.0.2015.303. GAO Ying, WANG Zhenghui, CHANG Huimin, et al. Foreign bodies in children';s Bronchus: ananalysis of 2 000 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015, 29(6): 39-42. doi:10.6040/j.issn.1673-3770.0.2015.303.
[5] 郝丽丽, 夏忠芳, 王智楠, 等. 小儿双侧支气管异物40例临床特点及治疗分析[J]. 中国眼耳鼻喉科杂志, 2017, 17(2): 119-122. doi:10.14166/j.issn.1671-2420.2017.02.012. HAO Lili, XIA Zhongfang, WANG Zhinan, et al. Clinical manifestation and management of bilateral bronchial foreign body aspiration in children[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2017, 17(2): 119-122. doi:10.14166/j.issn.1671-2420.2017.02.012.
[6] Aggarwal SK, Sinha SK, Ratan SK, et al. Complications of long-standing foreign body in the airway and their outcomes after endoscopic management: an experience of 20 cases[J]. J Laparoendosc Adv Surg Tech A, 2015, 25(1): 81-87. doi:10.1089/lap.2014.0354.
[7] Halwai O, Bihani A, Sharma A, et al. A study of clinical presentations and complications of foreign body in the Bronchus-own experience[J]. Otolaryngol Pol, 2015, 69(1): 22-28. doi:10.5604/00306657.1131145.
[8] 熊春华, 沈学锋. 452例儿童气管支气管异物临床分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(1): 47-48. doi:10.16066/j.1672-7002.2020.01.013.
[9] 潘宏光, 李兰, 梁振江, 等. 小儿气管支气管异物368例临床诊治分析[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(12): 544-546. doi:10.3969/j.issn.1001-1781.2010.12.006. PAN Hongguang, LI Lan, LIANG Zhenjiang, et al. Clinical analysis on 368 children cases with tracheobronchial foreign body[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2010, 24(12): 544-546. doi:10.3969/j.issn.1001-1781.2010.12.006.
[10] 陈蔚华, 张凯扬, 郑晓彬. 小儿喉、气管、支气管异物221例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 111-115. doi:10.6040/j.issn.1673-3770.0.2018.355. CHEN Weihua, ZHANG Kaiyang, ZHENG Xiaobin. Foreign bodies in the throat and bronchi of children: a report of 221 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 111-115.doi:10.6040/j.issn.1673-3770.0.2018.355.
[11] Golan-Tripto I, Mezan DW, Tsaregorodtsev S, et al. From rigid to flexible bronchoscopy: a tertiary center experience in removal of inhaled foreign bodies in children[J]. Eur J Pediatr, 2021, 180(5): 1443-1450. doi:10.1007/s00431-020-03914-y.
[12] Batra H, Yarmus L. Indications and complications of rigid bronchoscopy[J]. Expert Rev Respir Med, 2018, 12(6): 509-520. doi:10.1080/17476348.2018.1473037.
[13] Gendeh BS, Gendeh HS, Purnima S, et al. Inhaled foreign body impaction: a review of literature in Malaysian children[J]. Indian J Pediatr, 2019, 86(Suppl 1): 20-24. doi:10.1007/s12098-018-2824-8.
[14] 周宜龙, 石孟志, 胡青, 等. 呼吸道异物患儿出现Ⅳ度呼吸困难的救治体会[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(4): 377-378. doi:10.11798/j.issn.1007-1520.201704020.
[15] 索朗杰布, 黄冬雁, 白宗禧, 等. 西藏高海拔地区儿童气管支气管异物治疗经验[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(5): 453-457. doi:10.11798/j.issn.1007-1520.201705013. SUO Langjiebu, HUANG Dongyan, BAI Zongxi, et al. Treatment of tracheobronchial foreign body in children at high altitude areas as Tibet[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2017, 23(5): 453-457. doi:10.11798/j.issn.1007-1520.201705013.
[16] Idris S, Murphy RA, Witmans M, et al. A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children[J]. J Otolaryngol Head Neck Surg, 2018, 47(1): 26. doi:10.1186/s40463-018-0272-0.
[17] 洪育明, 林荣志, 梁振源, 等. 气管、支气管异物取出术中潜窥镜与普通支气管镜的应用[J]. 山东大学耳鼻喉眼学报, 2010, 24(2): 59-61. HONG Yuming, LIN Rongzhi, LIANG Zhenyuan, et al. Application of rod-lens and conventional bronchoscopy in tracheobronchial foreign body extraction[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2010, 24(2): 59-61.
[18] Divarci E, Toker B, Dokumcu Z, et al. The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration[J]. Int J Pediatr Otorhinolaryngol, 2017, 100: 232-237. doi:10.1016/j.ijporl.2017.07.012.
[19] Matsushita K, Uchida K, Otake K, et al. The “multiport airway adapter”in flexible bronchoscopy for peripheral bronchial foreign bodies in children[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(12): 2470-2472. doi:10.1016/j.ijporl.2015.10.050.
[20] Jayaraj AK, Jayaraj PK, Murugesh M, et al. Tracheal foreign body removal using flexible bronchoscope in a pediatric patient. A novel approach[J]. Am J Respir Crit Care Med, 2017, 196(8): 1071-1072. doi:10.1164/rccm.201703-0518IM.
[21] Schramm D, Ling K, Schuster A, et al. Foreign body removal in children: recommendations versus real life-A survey of current clinical management in Germany[J]. Pediatr Pulmonol, 2017, 52(5): 656-661. doi:10.1002/ppul.23609.
[22] 李秀国. 气管CT三维重建联合Hopkins内镜在特殊气管支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 71-73. doi:10.6040/j.issn.1673-3770.0.2014.046. LI Xiuguo. Tracheal CT reconstruction and Hopkins endoscopy in diagnosis and treatment of special tracheobronchial foreign body[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(4): 71-73. doi:10.6040/j.issn.1673-3770.0.2014.046.
[23] 贺定华, 赵斯君, 李赟, 等. 带钳Hopkins潜窥镜在小儿肺段支气管异物中的应用[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(3): 239-240, 243. doi:10.11798/j.issn.1007-1520.201603016. HE Dinghua, ZHAO Sijun, LI Yun, et al. Application of Hopkins endoscope with a forceps in the removal of bronchial foreign body in children[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2016, 22(3): 239-240, 243. doi:10.11798/j.issn.1007-1520.201603016.
[24] 左冬至, 耿宛平, 何晓松, 等. 配有高频呼吸机和潜望镜支气管镜在小儿气管支气管异物取出术中的应用[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(4): 379-381. doi:10.11798/j.issn.1007-1520.201704021.
[25] Heinz GJ 3rd, Richardson RH, Zavala DC. Endobronchial foreign body removal using the bronchofiberscope[J]. Ann Otol Rhinol Laryngol, 1978, 87(1 Pt 1): 50-52. doi:10.1177/000348947808700110.
[26] 仇书要, 刘大波, 黄振云, 等. 硬质支气管镜联合纤维支气管镜探查在176例气道梗阻患儿中的应用[J]. 中国耳鼻咽喉头颈外科, 2017, 24(3): 132-135. doi:10.16066/j.1672-7002.2017.03.006. QIU Shuyao, LIU Dabo, HUANG Zhenyun, et al. Rigid bronchoscope combined with fiber bronchoscope application in 176 children with airway obstruction[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(3): 132-135. doi:10.16066/j.1672-7002.2017.03.006.
[27] 王亚芳, 宋英鸾, 赵海涛, 等. 纤维支气管镜在儿童支气管异物残留病例诊治中的作用[J]. 中国耳鼻咽喉头颈外科, 2017, 24(9): 491-492. doi:10.16066/j.1672-7002.2017.09.015. WANG Yafang, SONG Yingluan, ZHAO Haitao, et al. Application of fiberoptic bronchoscopy in the treatment of residual foreign bodies in children[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(9): 491-492. doi:10.16066/j.1672-7002.2017.09.015.

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