CAJ | 학술논문

目的总结接受肺切除术治疗的延迟性吸入性支气管异物患者的临床病理资料,对该疾病的临床特点和治疗选择进行探讨.方法 1980年1月至2010年6月,利用肺切除术治疗延迟性吸入性支气管异物患者17例,其中男性12例,女性5例,年龄10～66岁,平均年龄36岁.症状包括咳嗽、咯血、发热、咳脓痰、气急等,发病时间间隔为3个月～8年,平均2年.术前确诊8例,9例误诊为其他疾病.行右肺下叶切除术4例,右中叶切除术3例,右中下叶切除术1例,右下叶切除术+肋床引流术1例,右下叶切除+胸膜剥脱术1例,胸腔镜下右肺下叶部分切除术1例,左全肺切除术4例,左下叶切除术1例,左上叶切除术1例.结果术后死于肺部感染1例,并发支气管胸膜瘘2例.异物位于右侧11例,左侧6例,异物种类最多为骨片(8例),其次为辣椒尖(3例)和笔套管(2例).伴随肺内病理改变包括慢性支气管肺炎8例,支气管扩张7例,肺实变4例,慢性肺脓疡伴毁损肺3例,机化性肺炎2例,肺发育不全1例.结论应重视延迟性支气管异物的诊断,降低误诊率,尽可能避免行肺切除术.对于肺内感染病变明显的病例,应及时行肺切除术,以免肺部病变发展为肺化脓症和脓胸等严重感染.
목적 총결접수폐절제술치료적연지성흡입성지기관이물환자적림상병리자료,대해질병적림상특점화치료선택진행탐토.방법 1980년1월지2010년6월,이용폐절제술치료연지성흡입성지기관이물환자17례,기중남성12례,녀성5례,년령10～66세,평균년령36세.증상포괄해수、각혈、발열、해농담、기급등,발병시간간격위3개월～8년,평균2년.술전학진8례,9례오진위기타질병.행우폐하협절제술4례,우중협절제술3례,우중하협절제술1례,우하협절제술+륵상인류술1례,우하협절제+흉막박탈술1례,흉강경하우폐하협부분절제술1례,좌전폐절제술4례,좌하협절제술1례,좌상협절제술1례.결과 술후사우폐부감염1례,병발지기관흉막루2례.이물위우우측11례,좌측6례,이물충류최다위골편(8례),기차위랄초첨(3례)화필투관(2례).반수폐내병리개변포괄만성지기관폐염8례,지기관확장7례,폐실변4례,만성폐농양반훼손폐3례,궤화성폐염2례,폐발육불전1례.결론 응중시연지성지기관이물적진단,강저오진솔,진가능피면행폐절제술.대우폐내감염병변명현적병례,응급시행폐절제술,이면폐부병변발전위폐화농증화농흉등엄중감염.
Objective To investigate and analyze the clinicopathological features and choice of treatment for delayed inhaled bronchial foreign bodies. Methods A retrospective review is presented of patients with delayed inhaled bronchial foreign bodies treated by pulmonary resection between January 1980 and June 2010. There were 17 patients ( 12 male and 5 female). Mean age was 36 years (ranging 10 to 66 years). The mean interval of onset was 2 years ( rangeing 3 months to 8 years ). Confirmed diagnosis before surgery in 8 cases and 9 cases were misdiagnosed as other diseases. Surgical procedures included right lower lobectomy in 4 cases, right middle lobectomy in 3 cases, right lower and middle lobectomy in 1 case, right lobe lobectomy and rid resection drainage in 1 case, right lobe lobectomy and pleurectomy in 1 case, videoassisted right lobe partial resection in 1 case, left pneumonectomy in 4 cases, left lower lobectomy in 1 cases and left upper lobectomy in 1 cases. Results One case died of pulmonary infection and 2 cases complicated of BPF after operation. Foreign bodies were localized in the right bronchial tree in 11 cases, the left in 6 cases. The majority of the foreign bodies were vegetable origin. Conclusions The diagnosis rate of delayed inhaled bronchial foreign bodies should be improved in order avoiding of pulmonary resection. It is necessary to perform pulmonary resection timely if the pulmonary infection is evident for fear that the infection progress into severe infection.