球囊导管经可弯曲支气管镜在儿童气道异物中应用的回顾性分析

Use of balloon catheter via flexible bronchoscopy for removal of airway foreign bodies in children:A retrospective analysis

目的研究球囊导管经可弯曲支气管镜治疗儿童气道异物的有效性、安全性。方法回顾性分析2011年至2019年在广州医科大学附属第一医院儿科住院的60例球囊导管经可弯曲支气管镜治疗儿童气道异物的病例资料。结果60例患儿中,男40例,3岁以下58例(96.7%)。主要临床表现有咳嗽(98.3%)、气喘(56.7%)、发热(46.7%)。85%患儿有明确异物吸入史。异物以植物类食物为主(91.6%),以花生等果仁类食物最为常见。异物嵌顿部位主要为左主支气管(33.3%)和右主支气管(26.7%)。40例(66.7%)气道异物伴肉芽组织增生,其中少量肉芽13例(21.7%)、肉芽部分包裹26例(43.3%),完全包裹1例(1.7%)。60例患儿气道异物均1次性成功取出,其中单一球囊导管异物取出31例(51.7%),从打开球囊到异物被拖出声门一般耗时约15~20秒。无术中严重出血、气胸、声带或气道壁损伤等并发症发生。结论对于儿童常见的花生等果仁类气道异物,尤其并发肉芽组织增生者,应用球囊导管经可弯曲支气管镜行异物取出是安全、有效、快速的,具有比较明显的优势。

Objective To investigate the efficacy and safety of balloon catheter via flexible bronchoscopy for removal of airway foreign bodies in children.Methods A retrospective analysis was performed on clinical data of 60 children with airway foreign bodies,who were hospitalized and treated with balloon catheter via flexible bronchoscopy in Department of Pediatrics,First Affiliated Hospital of Guangzhou Medical University between 2011 and 2019.Results Of the 60 children,40 were male;58(96.7%)were below 3 years old.The clinical manifestations were chiefly cough(98.3%),asthma(56.7%),and fever(46.7%).85%of the children had a definite history of foreign body aspiration.The foreign bodies were predominated by plant foods(91.6%),most frequently the nut foods such as peanuts.The sites of foreign body entrapment were the left(33.3%)and the right main bronchus(26.7%)in most of times.In 40 cases(66.7%)of airway foreign bodies with hyperplastic granulation tissue,13(21.7%)were with minimal granulation hyperplasis,26 cases(43.3%)with partial and one(1.7%)with complete granulation encapsulation of the foreign body.All airway foreign bodies in the 60 children were successfully removed at one attempt,and in 31 cases(51.7%),were removed by a single balloon catheter.In general,the duration between balloon deployment and foreign body retrieval out of the glottis was 15-20 seconds.There were no intraoperative complications,such as severe bleeding,pneumothorax,vocal cord or airway wall injury.Conclusion For children with usual airway foreign bodies such as peanuts,especially those with hyperplastic granulation tissue,balloon catheter removal via flexible bronchoscopy is a safe,effective,and rapid approach with significant advantages.