气管、支气管异物患儿再手术46例临床分析

Clinical analysis of re-operation of 46 children with tracheo-bronchial foreign bodies

目的探讨气管、支气管异物再手术的原因、指征、方式,及避免再手术的措施。方法 46例患儿初次手术采取选用Negus硬支气管镜的方式。再手术时根据不同情况选用的仪器有Negus硬支气管镜35例、纤维支气管镜9例,另外还有开胸手术2例,再手术均在全麻下进行。结果 46例患儿初次就诊时间24 h时内16例(16/46),24 h～1周就诊9例(9/46),1周以上就诊21例(21/46);初次手术时机分别是立即急症手术12例(12/46),限期手术26例(26/46),择期手术8例(8/46)。初次异物取出手术结果,取出27例,发现异物但是未能取出6例,未发现10例,手术未能完成3例;所有患者术后观察,根据实际情况均需再次手术,再次手术发现并取出异物36例,未发现异物10例。结论初次手术无论是否取出异物,如果手术后仍然反复咳喘,胸部X线检查仍怀疑异物存在,抗炎消肿治疗1周以上症状、体征无好转,不能排除异物存在,应考虑再次手术;考虑到多种因素的充分的术前准备可有效地降低再次手术的可能性。

Objective To discuss the causes and ways of reoperation for foreign bodies in the trachea and bronchus, and to explore measures to avoid reoperation. Methods Data of 46 cases, who had been bronchoscopied 2 times for trache- a-bronchial foreign body, were reviewed. The causes and ways of reoperations were analyzed, and measures to avoid reoperation were explored. Results In 46 cases, 16 cases were diagnosed within 24 hours, 9 cases in 1 week, and 21 cases after one week. 12 cases were bonchoscopied immediately they visited doctors because of difficult respiration, while 26 cases were bronchoscopied within days, and the other 8 cases were bronchoscopied at a designated time. In 27 cases, foreign bodies were discovered in the trachea and/or bronchus, which were removed during the first operation. However, in 6 cases, foreign bodies failed to be retrieved. Operations were aborted in 3 patients because of the bleeding in the bronchus. There were 10 cases with no foreign body discovered during the first operation. AU the first operations were performed by doctors with a Negus bronchoscope. But for the second operations, three methods, including a Ne- gus bronchoscope, fibro-bronchoscope and thoracotomies, were applied. During the second operations, foreign bodies were rediscovered in 36 cases, but not in the other 10 cases. Conclusions For the cases with foreign body in trachea and/or bronchus, whether the foreign body had been found or not during the first operation, reoperation should be rec- omrnended if the foreign body remains suspected. Sufficient preparations can reduce the possibility of reoperation.