10年气管、支气管异物诊治回顾性分析

Retrospective analysis on treatment of tracheal or bronchial foreign bodies in recent 10 years

目的探讨气管、支气管异物发生的人群特征、临床特点及支气管镜诊治经验。方法以"异物"一词对唐都医院支气管镜报告系统中的镜下描述及结论部分进行检索,起止时间:2008年9月至2018年8月,对检索出的有效病例的一般资料、异物种类、诊疗方法、异物存在部位、病变特点进行回顾性分析。结果共检索出有效病例171例;其中男性117例,女性55例,平均年龄50.8岁(7~84岁);病史最短1 h,最长18年;仅35例有明确异物吸入病史,占20.47%;58.48%的异物发生在41~70岁人群;食物是最常见的气管、支气管异物种类,占本组病例的70.17%,包括干辣椒皮、骨头、坚果等,其次为各种工业制品及牙齿(主要为假牙);84.21%的异物在局麻下使用支气管镜经口或经鼻腔取出;右肺下叶是异物最常发生的部位,占39.18%(67/171),65.38%(34/52)的辣椒皮位于右肺下叶;常用的异物钳取工具为异物钳、活检钳和冷冻方式,分别占45.78%、25.9%和24.7%,仅17例患者使用2种或2种以上工具取出异物;本组60.82%的患者异物局部伴有明显的肉芽组织增生。结论异物的发生与性别和年龄有关,且具有地域特色,症状往往不典型,易误诊;异物最易发生在右肺下叶,大多数异物可使用异物钳、活检钳或冷冻等单一工具取出,对复杂性异物需要联合支气管镜下其他治疗手段,肉芽组织增生是最常见的并发症;支气管镜检查是确诊和治疗气管及支气管异物最直接而有效的办法。

Objective To summarize the characteristics of population and clinical features of foreign bodies in the trachea or bronchus and the experiences of diagnosis and treatment by bronchoscopy. Methods Using "foreign body" as a key word, we searched the microscopic description and conclusion of the bronchoscopic reporting system of Tangdu Hospital in Xi'an from September 2008 to August 2017. We analyzed the general data of the patients, the catagories of the foreign bodies, the treatment methods, the sites of the foreign bodies and other characteristics. Results A total of 171 valid cases (54 females and 117 males, with an average age of 50.8 years) were searched out. The shortest medical history was only one hour while the longest medical history was 18 years. Only 35 patients had the clear history of foreign body aspiration, accounting for 20.47%. And 58.48% of foreign bodies occurred in the people aged 41-70 years. Foods were the most common categories of foreign bodies in the trachea or bronchus, accounting for 70.17%, including chilies, bones and nuts, etc., followed by various industrial products or dentures. And 84.21% of the foreign bodies were removed under local anesthesia by bronchoscopy via the oral or nasal passage. Foreign bodies were usually found in the inferior lobe of the right lung, accounting for 39.18%, and 65.38% of chilies were found in this site. The common tools for removing the foreign bodies included the foreign body forceps, biopsy forceps and cryotherapy, accounting for 45.78%, 25.9% and 24.7%, respectively. Only 17 foreign bodies were removed by two tools or more. And 60.82% of the patients were accompanied by obvious granulation tissue proliferation around the foreign bodies. Conclusion The occurrence of foreign bodies is correlated with gender and age, with evident regional characteristics. The symptoms of the patients are often atypical and easy to be misdiagnosed. The inferior lobe of the right lung is a prime site for foreign bodies, most of which are easy to be removed by one tool. As for complicated foreign bodies, other treatment methods are needed. Granulation tissue hyperplasia around the foreign bodies is the most common complication. Bronchoscopy is an effective method for diagnosing and treating tracheal and bronchial foreign bodies.