小儿气管支气管异物临床分析  

Clinical study of tracheobronchial foreign bodies in children

作　　者：刘广平[1] 郝欣平[2] 曹波[1] 沈蓓[1] 刘跃[1] 

机构地区：[1]天津儿童医院耳鼻咽喉科,天津300074 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2009年第6期337-339,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨儿童气管支气管异物术前诊断依据,提高术前明确诊断率,减少不必要的手术创伤。方法回顾分析1260例小儿气管支气管异物,按照病史、症状和检查结果分组,统计每组的术前诊断与手术明确异物存在的符合率,统计异物存在的侧别差别。结果异物史明确,有咳喘症状并且听诊一侧肺呼吸音减低或消失以及胸透可见一侧肺不张或肺气肿时,异物存在率97.6%;异物史明确并且有咳喘,而听诊无呼吸音减低,胸透心肺膈无改变,异物存在率90.1%;无明确异物史,但患儿有咳喘等症状并且听诊一侧肺呼吸音减低,胸透有纵隔摆动、一侧肺不张或肺气肿,异物存在率34.1%。异物于左侧支气管发病率略高于右侧。结论对于儿童气管支气管异物的病例需要详细追问病史,观察患儿症状,仔细分析术前患儿检查结果,不同情况具体分析,尽量减少不必要的支气管镜检查。注意异物存在左侧支气管的几率稍高于右侧,尽量降低手术的盲目性。OBJECTIVE To discuss the pre- operative diagnosis of tracheobronchial foreign bodies in children. To improve presurgical diagnosis and reduce surgical trauma by comparing the diagnosis pre- surgically and the findings in surgery. METHODS A retrospective study of 1260 cases of tracheobronchial foreign bodies in children was performed. Subjects are divided into different groups according to history, symptoms and results of examinations. The coincidence rate between pre-operative diagnosis and the results of the surgery was analyzed. The side of the foreign body was also analyzed. RESULTS If there was a clear history of foreign body ingestion combined with cough, unilateral diminution of respiration and unilateral pulmonary atelectasis or pulmonary emphysema in X-ray, the accuracy of tracheobronchial foreign bodies was 97.6%. If there was a clear history of foreign body ingestion combined with the sign of cough, whereas without abnormal respiration or X-ray, the accuracy of tracheobronchial foreign bodies was 90.1%. There was no clear history, but cough, unilateral diminution of respiration, mediastinum pendular movement, and unilateral pulmonary atelectasis or pulmonary emphysema in X-ray could be confirmed, the accuracy was 34.1%. The foreign bodies are more frequently to be found in the left trachea and bronchi. CONCLUSION In order to make a correct diagnosis, doctors need to know the history better, observe the signs of the children, and analyze the results of examinations carefully before surgery, thus the use of bronchoscopy could be reduced. Knowing the foreign bodies occure more frequently in the left trachea and bronchi, doctors could reduce the trauma of surgery.

关 键 词：异物 气管 儿童 支气管镜检查 早期诊断 

分 类 号：R768.1[医药卫生—耳鼻咽喉科]