病史隐匿的成人支气管异物15例分析

Bronchial Foreign Bodies in Adult Patients with Untraceable Disease History (a Report of 15 cases)

目的 :探讨病史隐匿的成人支气管异物的临床特点 ,以及处理经验与教训。方法 :总结分析自 1992年 11月～ 2 0 0 1年11月间收治的 15例此类病例。其中男 9例、女 6例 ;年龄 34～ 6 6岁 ;左侧 4例 ,右 11例。 5例经纤支镜检查明确为支气管内异物 ,3例因活检钳触及硬物始疑及异物可能 ,余 7例经开胸手术明确。除金属异物病例外 ,其余病例均有首诊误诊情况。结果 :经第 1次纤支镜检查取出异物 2例 ,抗感染 2周后第 2次纤支镜检查取物成功 4例 ,开胸手术治疗 9例。作肺叶切除者 3例 ;支气管剖开、异物取出术者 4例 ,一侧全肺切除术 2例。结论 :应重视病史不确切的成人气管异物的诊断 ,尽量作纤支镜不导物取 。

Objective: To investigate the clinical characteristic manifestation, and therapy strategies of bronchial foreign bodies in adult patients but without tractable disease history. Methods: 15 cases admitted between December 1992 and December 2001 were included. There were 9 males and 6 females in this group, aging from 34 to 66 years old. 4 were located to the left side, the other 11 at right side. Diagnosis of bronchial foreign bodies was ensured in 5 cases by bronchoscopy, uncertain in 3 cases, and in the other 7 cases it was made by exploratory thoracotomy. All the cases but with metal foreign bodies were misdiagnosed. Results: In 2 cases the foreign body was taken out during the first time bronchoscopy, succeeded in another 4 cases after 2 week anti infection therapy, and the other 9 cases underwent surgery, with 3 of lobectomy, 4 of bronchotomy, 2 of pneumonectomy. Conclusion: The author discussed experiences on reducing the incidence of misdiagnosing, and therapeutic strategies via bronchoscopy and surgery.