气管支气管异物15年病例回顾

Tracheobronchial foreign bodies:A 15-years’review

目的回顾性分析广西医科大学第一附属医院近15年来不同科室收治的气管支气管异物病例的临床特点,为气管支气管异物的诊治提供临床经验与参考。方法收集并整理2005年1月—2019年12月就诊于耳鼻咽喉头颈外科、儿科、呼吸内科及其他科室诊断为气管支气管异物的病例资料。本研究每5年作为1个阶段,将所收集病例分为2005—2009年、2010—2014年、2015—2019年3个阶段,总结比较不同阶段、不同科室气管支气管异物病例的诊断治疗特点。结果①本研究共收集了699例气管支气管异物病例,其中耳鼻咽喉头颈外科549例(78.5%),儿科70例(10%),呼吸内科65例(9.3%),其他科15例(2.1%)。在第1个5年阶段中,患者以耳鼻咽喉头颈外科收治为主(90.1%);至2019年,儿科和呼吸内科收治患者比例增至56.1%,纤维支气管镜的应用比例由2012年的6.3%增至2019年的61%;②影像检查方式包括胸部X线253例(36.2%),胸部CT 404例(57.8%);胸部X线检出率为71.1%,胸部CT检出率为91.3%;③各科室15年总的平均住院日比较,其中耳鼻咽喉头颈外科3.68 d、儿科6.89 d、呼吸内科及其他科11.00 d;④手术相关并发症发生率为3.4%(24/699),其中耳鼻咽喉头颈外科为1.8%(10/549)、儿科8.6%(6/70)、呼吸内科10.8%(7/65)、其他科为6.7%(1/15);硬质支气管镜为2.0%(12/591)、纤维支气管镜为11.1%(12/108)。结论①气管异物影像检查以胸部X片、CT为主,检出阳性率较高;②气管支气管异物主要收治科室为耳鼻咽喉头颈外科,儿科、呼吸内科近年来收治病例数增加。气管异物取出方式逐渐由硬性支气管镜转向纤维支气管软镜;③随着诊治经验增加,病种平均住院日有缩短趋势;④并发症发生率或与不同科室及手术操作经验有关。

Objective To summarize the characteristics of tracheobronchial foreign bodies(TFBs)managed in the First Affiliated Hospital of Guangxi Medical University,so as to provide clinical experience and reference for the diagnosis and treatment.Methods Clinical data of 699 TFBs patients who were treated in otolaryngology head and neck surgery,pediatrics,respiratory medicine departments and other departments in our hospital between Jan 2005 and Dec 2019 were collected.Five years as a stage,TFBs features of different stages and departments were analyzed retrospectively.Results①A total of 699 cases were collected in this study,including 549 cases(78.5%)in otolaryngology head and neck surgery department,70(10%)in pediatrics department,65(9.3%)in respiratory department and 15(2.1%)in other departments.During the first five years,the patients were mainly admitted to the otolaryngology head and neck surgery department(90.1%).By 2019,the proportion of pediatric and respiratory cases increased to 56.10%.The proportion of bronchofibroscope application increased from 6.30%in 2012 to 61.00%in 2019.②The imaging examinations adopted for diagnosis included chest X-ray in 253 cases(36.2%)and chest computerized tomography(CT)in 404(57.8%).And the detection rates of Chest X-ray and chest CT were 71.1%and 91.3%respectively.③The average lengths of stay in otolaryngology department,pediatrics department and in respiratory and other departments were 3.68 days,6.89 days and 11.00 days respectively.④The total complication rate was 3.4%(24/699),and those in the otolaryngology department,pediatrics department and respiratory medicine department and other departments were 1.8%(10/549),8.6%(6/70),10.8%(7/65)and 6.7%(1/15),respectively.The complication rates of rigid and fiber bronchoscopy were 2.0%(12/591)and 11.1%(12/108).Conclusion The imaging examinations for the diagnosis of TFBs include chest X-ray and CT.The main admission department of TFBs is the otolaryngology department with increased number of admitted cases in pediatrics department and respiratory medicine department.The mode of TFBs removal is gradually shifted from rigid bronchoscopy to fiber bronchoscopy with a shortened trend of average inpatient day due to increased clinical experience.The complication incidence of TFBs removal may be related to surgical experience.