颈部迁移性异物误诊分析及文献复习  

Misdiagnosis of Migratory Foreign Body in the Neck and Literature Review

作　　者：仇佳泰 和晓坡 QIU Jiatai;HE Xiaopo(School of Stomatology,Shandong Second Medical University,Weifang,Shandong 261053,China;Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Shandong Second Medical University,Weifang,Shandong 261000,China;Department of Oral and Maxillofacial Surgery,Weifang People's Hospital,Weifang,Shandong 261000,China)

机构地区：[1]山东第二医科大学口腔医学院,山东潍坊261053 [2]山东第二医科大学第一附属医院口腔颌面外科,山东潍坊261000 [3]潍坊市人民医院口腔颌面外科,山东潍坊261000

出　　处：《临床误诊误治》2024年第21期15-18,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨颈部迁移性异物的误诊原因、治疗方法及防范措施。方法回顾性分析2023年收治的1例误诊的颈部迁移性异物并感染患者的临床资料。结果患者10 d前误咽鱼骨后出现持续颈部肿痛,首次于外院就诊未明确诊断,第2次于外院就诊考虑感染,并给予抗感染治疗后效果不佳。入院后经相关检查后行颈部探查+异物取出术明确诊断为颈部迁移性异物并感染。误诊时间8 d。确诊后给予颈外入路取出异物、脓肿引流、抗感染及鼻饲饮食等处理后患者痊愈。结论临床医生应提高对颈部迁移性异物的认识。对于有误咽异物史,内镜检查阴性,但有持续颈部症状者,应高度怀疑异物迁移,及时行CT扫描或超声检查可以防止误诊及严重并发症发生。Objective To investigate the causes of misdiagnosis,treatment methods and preventive measures of migratory foreign body in the neck.Methods The clinical data of a patient with misdiagnosed migratory foreign body and infection in the neck in 2023 were retrospectively analyzed.Results The patient developed persistent neck swelling and pain after swallowing fish bone 10 d before.The diagnosis was not clear at the first visit to another hospital,and infection was considered at the second visit to another hospital;however,the effect was not good after anti-infection treatment.After admission,cervical exploration and foreign body removal were performed to confirm the diagnosis of migratory foreign body and infection in the neck.The misdiagnosis lasted 8 d.After diagnosis,the patient recovered following treatment via external cervical approach to remove the foreign body,abscess drainage,anti-infection treatment and nasal feeding diet.Conclusion Clinicians should improve the awareness of migratory foreign bodies in the neck.For patients with a history of swallowing foreign bodies and negative endoscopy findings,but persistent neck symptoms,foreign body migration should be highly suspected.Timely CT scan or ultrasound can prevent misdiagnosis and the incidence of serious complications.

关 键 词：异物游走 感染 误诊 咽后脓肿 引流术 超声检查 颈部损伤 

分 类 号：R649.4[医药卫生—外科学]