儿童喉、气管异物的诊治分析

Analysis of diagnosis and management of children with foreign bodies in the larynx and trachea

目的探讨儿童喉、气管异物的临床特点及诊治手段。方法分析2001年1月到2005年6月间经硬质气管镜或纤维支气管镜确诊的87例喉、气管异物患儿的临床特点、影像学改变、并发症、异物取除方法。结果气管、喉异物占同期呼吸道异物的10.7%(87813),1～3岁组占73.6%。93.1%有异物吸入史,喘鸣占67.8%、吸气性凹陷40.2%、发绀27.6%、声音嘶哑19.5%、气管拍击音4.6%。6例(6.9%)患儿病情突变,表现发绀、呼吸困难,神志不清。胸片异常30.2%,胸透异常26.5%。硬质气管镜取异物63例并全部取出(100%),其中3例为纤支镜取异物未成功者;纤支镜取异物20例,取出17例(85.0%),两者成功率差异无显著性(P>0.5),但纤支镜取异物耗时不确定,并有5例异物通过鼻后孔时跌落入食道。结论儿童喉、气管异物典型症状不多见,异物吸入史为敏感指标;胸片、胸透异常率低,应及时作纤支镜检查,取除喉、气管异物首选硬质气管镜。

Objective To evaluate the clinical features and the diagnostic and therapeutic means of laryngeal and tracheal foreign bodies in children. Methods From January 2001 through June 2005, a total of 87 pediatric patients with foreign bodies in the larynx and trachea diagnosed by bronchoscopy were included in this study. The clinical characteristics, chest X-ray findings, complications and management of foreign bodies were analyzed. Results The location of the foreign bodies was shown to be 10.7% （87/813） in the larynx and trachea . Of these 87 cases, the patients aged 1 - 3 years represented 73.6% of the total. History of aspiration was present in 93.1% of children, asthmatic wheeze in 67.8%, retraction during inspiration in 40.2%, cyanosis in 27.6%, hoarseness in 19.5% and audible stridor in 4.6%. The plain chest radiography was abnormal in 30.2% of the patients and abnormal fluoroscopy in 26.5% . Choking episodes producing cyanosis, dyspnea and loss of consciousness were found in 6 （6.9%） patients . Rigid bronchoscopic removal of foreign bodies was succeded in 100% （63163） of children including 3 patients whose flexible bronchoscopic procedure failed, and flexible bronchoscopic removal was succedful in 85% （17/20）. The successful rats showed no statistical difference between the two methods （ P〉0.5 ）. However, when the flexible bronchoscope was used, foreign bodies dropped into the esophagus in 5 patients. Conclusion The characteristic manifestations was not frequent in the patients with larynx and trachea foreign bodies. History of aspiration was the most sensitive diagnostic tool. The plain chest radiography and fluoroscopy had low positive finding. Therefore, fiberoptic bronchoscopic examination should be performed timely. However, for extraction of foreign bodies, rigid bronchoscope would be the first choice.