儿童不典型支气管异物临床特征分析

Clinical Features of Atypical Foreign Body in Bronchus in Children

目的研究儿童不典型气道异物的发病原因、临床特点和诊治线索。方法选取2018年12月至2020年1月成都市妇女儿童中心医院呼吸科收治的44例不典型外源性支气管异物患儿为研究对象,采用Microsoft Word 2010版制作统计图饼图,评价各样本之间的构成比。结果患儿以1~3岁幼儿为主,41例(93.2%)无明确异物吸入史,3例有可疑异物吸入史。临床主要表现为咳嗽、喘息,肺部听诊以喘鸣音或双侧呼吸音不对称为主。患儿入院后均行多层螺旋CT及三维重建,显示支气管异物影及支气管不通畅者39例(88.6%),有5例CT气道无明显异物征象。44例患儿均在支气管镜下证实为支气管异物,其中右侧支气管嵌顿25例,左侧支气管17例,声门下气管异物2例。植物类异物37例(以坚果仁为主),化学性异物4例,动物骨头类3例。32例经支气管镜下异物网篮套取出,11例经异物钳抓取出,1例采用硬质支气管镜取出。并发炎性肉芽肿11例,4例肉芽增生明显患儿给予冷冻冻融治疗。结论儿童不典型支气管异物缺乏明确异物吸入史,临床表现多样化,诊断困难。对于有反复肺炎、喘息久治不愈的儿童应高度警惕支气管异物可能。早期行多层螺旋CT扫描、三维重建技术和支气管镜检查术有助于提高诊断正确率。

Objective To investigate the etiology,clinical characteristics,diagnosis and treatment of atypical foreign bodies in the airway of children.Methods A total of 44 children with atypical exogenous bronchial foreign bodies admitted to the respiratory department of Chengdu Women′s and Children′s Central Hospital from December 2018 to January 2020 were enrolled.Statistical pie chart was made by Microsoft Word 2010 to evaluate the constituent ratio of each sample.Results The 44 children with bronchial foreign body were mainly 1 to 3 years old,among which,41 cases(93.2%)had no definite history of foreign body inhalation,and 3 cases had a history of suspicious foreign body inhalation.The main clinical manifestations were cough and wheezing.Pulmonary auscultation results mainly revealed wheezing sound or bilateral respiratory sound asymmetry.Multi-slice spiral CT scanning and three-dimensional reconstruction were performed after admission,and 39 cases(88.6%)showed bronchial foreign body shadow and bronchial obstruction,5 cases showed no obvious foreign body sign in the airway.Bronchoscopy confirmed that all 44 children were with bronchial foreign bodies,including 25 cases of right bronchial incarceration,17 cases of left bronchial incarceration and 2 cases of subglottic tracheal foreign bodies;and including 37 cases of plant foreign bodies(mainly nuts),4 cases of chemical foreign bodies and 3 cases of animal bones.Thirty-two cases were removed by bronchoscopy foreign body basket,11 cases by forceps,and 1 case by rigid bronchoscopy.There were 11 cases of inflammatory granuloma,of which 4 cases of obvious granulation hyperplasia underwent cryoablation treatment.Conclusion Atypical bronchial foreign bodies in children is difficult to be diagnosed with no clear history of foreign body inhalation and diversified clinical manifestations.Children with recurrent pneumonia and prolonged wheezing should be highly vigilant against the possibility of bronchial foreign bodies.Early multi-slice spiral CT scanning and three-dimensional reconstruction,and bronchoscopy can help improve the accuracy of diagnosis.