儿童特殊类型伴肉芽肿喉异物的诊治分析  

Diagnosis and treatment of special type of laryngeal foreign body with granuloma in children

作　　者：屠德桢 林宗通 沈翎 陈德平 杨中婕 廖桥淯 TU Dezhen;LIN Zongtong;SHEN Ling;CHEN Deping;YANG Zhongjie;LIAO Qiaoyu(Department of Otolaryngology,Fuzhou First General Hospital,Fuzhou Children's Hospital of Fujian Province,Fuzhou,350005,China)

机构地区：[1]福州市第一总医院(福建省福州儿童医院)耳鼻咽喉科,福州350005

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第2期163-167,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：福州市“十四五”临床专科培强培优培育建设项目(No:20220304)。

摘　　要：目的:探讨儿童特殊类型伴肉芽肿喉异物的诊断和治疗,为该病的规范化诊治提供临床参考。方法:对我科收治的1例,以及结合相关文献报道的5例儿童特殊类型喉异物伴肉芽肿的临床资料进行回顾性分析,总结该病的临床特征,并探讨其诊断和治疗方案。结果:(1)初诊时6例患儿均被误诊,病程较长,其中5例无明确异物史,1例有异物史但未发现异物。(2)临床症状多样化,可表现为声嘶、咳嗽、喘鸣、呼吸困难,也可无明显症状。(3)3例采用喉镜检查确诊,3例采用喉镜结合影像学检查确诊。(4)未被肉芽肿包裹的异物,先取出异物再治疗肉芽肿;肉芽肿包裹的异物,先切除肉芽肿,再取出异物。结论:特殊类型伴肉芽肿的喉异物可由于缺乏异物史等原因,致异物长期滞留,导致肉芽肿形成,引起误诊。电子喉镜结合喉部CT检查可早期明确诊断。可视喉镜结合喉内镜使用方便,等离子刀有利于精准切除肉芽肿,并在一定程度上避免气管切开。Objective This article explores the diagnosis and treatment of a special type of laryngeal foreign body with granuloma in children,providing a clinical reference for standardized diagnosis and treatment.Methods This article retrospectively analyzes one case admitted to our department and five other cases reported in relevant literature involving a special type of laryngeal foreign body with granuloma in children.It summarizes the clinical characteristics of this disease and explores its diagnosis and treatment.Results①A total of 6 cases were misdiagnosed and had a long course of illness.Five cases had no clear history of foreign body at the first visit.One case had foreign body history but no foreign body was found.②The clinical symptoms were diverse,which could be hoarseness,cough,wheezing,dyspnea,or no symptoms.③A total of 3 cases were diagnosed by laryngoscopy,and 3 cases were diagnosed by laryngoscopy and imaging examination.④Foreign bodies that were not wrapped in granulomas,were removed first and then the granulomas were treated;foreign bodies wrapped in granulomas were removed after the removal of granulomas.Conclusion A special type of laryngeal foreign body with granuloma may lack of accurate foreign body history,resulting in long-term retention of foreign bodies,leading to granuloma formation and misdiagnosis.Electronic laryngoscopy combined with CT examination contribute to early diagnosis.Low temperature plasma under endoscope and anesthetic laryngoscope is conducive to the exposure and precise removal of foreign bodies and avoids tracheotomy to a certain extent.

关 键 词：儿童 喉异物 肉芽肿 诊断 治疗 

分 类 号：R767.1[医药卫生—耳鼻咽喉科]