CAJ | 학술논문

目的探讨高难高危气管和支气管异物取出的最佳治疗方法和技巧.方法武汉儿童医院1995年8月至2012年8月收治4217例气管和支气管异物患儿,根据术前评估选择个性化治疗方案,回顾性分析其中272例(6.5％)高难高危患儿的临床资料.结果 271例患儿采用支气管镜直接法手术成功取出异物,手术成功率为99.6％;1例病史191 d的左下叶支气管笔帽异物患儿转入胸外科开胸取出异物.85例Ⅱ度及Ⅱ度以上喉梗阻气管异物(其中82例为1岁以下儿童)经紧急手术取出异物后解除喉梗阻.26例合并肺不张、肺实变、肺实变加胸腔积液患儿及27例第二次手术的患儿,均经抗感染治疗1周后再行支气管镜检异物取出术.一次支气管镜取出的17例笔帽异物中,病史两周以内的12例直接取出,4例用0.1％肾上腺素盐水冲洗,1例用自制支气管异物钩取出.26例口哨和32例外形尖锐异物均随支气管镜通过声门取出.42例多发性异物或易碎、易分散支气管异物使用小抱钳取出或经灌洗冲出.16例亚段支气管异物潜窥镜直视下采用麦粒钳取出.129例患儿术中行支气管灌洗,127例灌洗后1周X线胸片恢复正常;2例病史超过1个月合并肺实变的患儿灌洗后发生气胸及皮下气肿,治疗后痊愈.无声门水肿、窒息等其他手术并发症,并发症发生率为0.7％.结论高难高危气管和支气管异物治疗前需行全面评估,选用适宜的治疗方法和手术器械,才能最大限度地提高手术成功率,防止术中术后并发症.
목적 탐토고난고위기관화지기관이물취출적최가치료방법화기교.방법 무한인동의원1995년8월지2012년8월수치4217례기관화지기관이물환인,근거술전평고선택개성화치료방안,회고성분석기중272례(6.5％)고난고위환인적림상자료.결과 271례환인채용지기관경직접법수술성공취출이물,수술성공솔위99.6％;1례병사191 d적좌하협지기관필모이물환인전입흉외과개흉취출이물.85례Ⅱ도급Ⅱ도이상후경조기관이물(기중82례위1세이하인동)경긴급수술취출이물후해제후경조.26례합병폐불장、폐실변、폐실변가흉강적액환인급27례제이차수술적환인,균경항감염치료1주후재행지기관경검이물취출술.일차지기관경취출적17례필모이물중,병사량주이내적12례직접취출,4례용0.1％신상선소염수충세,1례용자제지기관이물구취출.26례구초화32예외형첨예이물균수지기관경통과성문취출.42례다발성이물혹역쇄、역분산지기관이물사용소포겸취출혹경관세충출.16례아단지기관이물잠규경직시하채용맥립겸취출.129례환인술중행지기관관세,127례관세후1주X선흉편회복정상;2례병사초과1개월합병폐실변적환인관세후발생기흉급피하기종,치료후전유.무성문수종、질식등기타수술병발증,병발증발생솔위0.7％.결론 고난고위기관화지기관이물치료전수행전면평고,선용괄의적치료방법화수술기계,재능최대한도지제고수술성공솔,방지술중술후병발증.
Objective To explore the best methods and skill for the removal of difficult and high risk tracheobronchial foreign body under bronchoscope.Methods A retrospective review was performed between August 1995 to August 2012.There were 4217 children with tracheobronchial foreign body,among them,272 were diagnosed as high-risk,highly difficult tracheobronchial foreign bodies confirmed by clinical manifestations,foreign body type and bronchoscopy.Results In 271 children,the tracheobronchial foreign body was removed under bronchoscope,the success rate was 99.6％ ; only one child with a pen cap blocking the left lower lobe bronchus was transferred to the department of thoracic surgery,and the foreign body was finally removed by thoracotomy.Eighty-five children (among them,82 children were under 1 year of age)had Ⅱ-Ⅱ degree laryngeal obstruction,the emergency surgery was performed to remove the foreign body and to relieve the laryngeal obstruction.Twenty-six children had lung infection and 27 children had failed foreign body removal surgery before,in all these children,the foreign body was removed after infection control.There were 17 children with the pen cap as the tracheobronchial foreign body,direct removal was successful in 12 children with the history less than two weeks; in 4 children,the foreign body was removed after 0.1％ epinephrine saline flush,and 1 case with the homemade bronchial foreign body hook remove.There were 26 children with the whistle as the foreign body,and 32 children had large and sharp foreign bodies.In these cases,the foreign bodies were removed together with the bronchoscope.Forty-two children had multiple or fragile foreign bodies,and 16 children had subsegmental bronchial foreign bodies.In these cases,the foreign bodies were removed with forceps under direct vision and intraoperative bronchial lavage.In This series,129 children received intraoperative bronchial lavage,among them,127 children showed normal X-ray changes one week after operation.Two children with a history of more than 1 month complicated with pulmonary consolidation.After bronchial lavage,pneumothorax and subcutaneous emphysema occured,which recovered after treatment.No glottic edema,asphyxia,and other complications were found,the complication rate of surgery was 0.7％.Conclusion For the removal of highly difficult and high risk tracheobronchial foreign bodies,preoperative analysis and discussion shoule be sufficient,appropriate surgical skill and surgical instruments may improve the success rate of the surgery and prevent the operation complications.