儿童呼吸道异物的影像学检查及诊断

Imaging examination and diagnosis of airway foreign body in children

目的评价各种影像学检查方法在诊断儿童呼吸道异物方面的临床应用价值。方法回顾性分析经支气管镜检查确诊为呼吸道异物的218例儿童患者的临床及影像学检查资料。结果确诊呼吸道异物218例,其中男140例,女78例。年龄6个月~12岁,平均19.2个月。全部病例均行常规胸部正位、喉气道侧位照片和透视检查。34例行64排螺旋CT检查。异物位于喉、声门下29例,气管55例,支气管134例(右侧79例,左侧55例)。按照异物的性质分类:金属异物5例,骨块29例,花生93例,瓜子59例,果蔬类22例,其他10例。34例显示异物的直接征象,177例仅显示间接征象。34例CT诊断可以直接显示支气管异物,诊断符合率100%。结论 X线照片及透视是儿童呼吸道异物的首选检查方法,CT检查为常规检查阴性儿童的重要补充手段。

Objective To evaluate the value of imaging examination and diagnosis of airway foreign body in children. Methods 218 of airway foreign bodies confirmed by bronehoscopy were retrospectively analyzed in terms of clinical and imaging data. Results 218 patients included 140 males and 78 females. Their ages ranged 6 months to 12 years （mean, 19.2 months）. All patients had conventional radiographs on frontal chest films, neck lateral films and fluoroscopy. 34 cases underwent 64-slice spiral chest CT examination. According to the location of the foreign bodies, 29 cases were in throat and subglottic, 55 cases in trachea and 134 cases in bronchus （79 cases in the right, 55 cases in the left）. According to the character of the foreign bodies, 5 cases were metal, 29 cases in bone, 93 cases in peanuts, 59 cases in seeds, 22 cases in fruits and vegetables and 10 cases in others respectively. Thirty-fourcases showed a direct sign of the foreign body and 177 cases showed the indirect signs. 34 cases on CT examination directly were showed foreign body in the tracheal bronchi. The diagnostic accuracy of CT examination was 100%. Conclusions X-ray photograph and fluoroscopy were the first choice for aspiratory foreign bodies in children. CT examination is an important supplementary method when conventional X-ray examination is negative.