成人支气管异物27例分析

发布时间：2018-05-11 18:58

本文选题：支气管异物 + 成人　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：探讨成人支气管异物吸入的临床特点，提高其诊断及治疗水平。方法：回顾性分析2003年1月至2014年1月在广西医科大学第一附属医院住院的27例成人支气管异物患者的临床资料，包括患者的性别、年龄、异物在支气管内的位置、治疗史、异物吸入史、异物类型、内镜治疗情况、异物镜下表现及术前影像学表现。结果：1.本研究中，男19例，女8例，年龄25.5-82岁。平均年龄为57.7岁。其中60岁以上者占51.8%。病史4天-50年。病史大于1月占77.8%。有明确误吸病史11例。 2.常见症状有咳嗽27例，咳痰26例，发热6例、气促6例、喘息4例，咯血或血丝痰5例，胸痛5例。有2例有脑血管意外病史。4例有明确的肺部疾病。17人病程中曾误诊,包括肺炎、肺癌、支气管扩张症等。 3.绝大多数异物为有机类异物，，占80.7%。动物骨头最为常见，占55.6%。余下均为植物性异物。非有机类异物包括金属环、金属义齿、“纽扣样”塑料玩具各1例。18例异物位于右侧支气管内，其中右中间干及右下叶共15例。 4.共有9例行胸片检查，胸片均未能发现异物。20例行CT检查，仅10例确诊或疑诊支气管异物（5例确诊，5例疑诊）。常见的影像学表现有肺炎或阻塞性肺炎、肺不张等。 5.26例FB下可见异物。异物存留时间大于10天者（22例）均有不同程度的肉芽增生，骨类异物所致肉芽增生显著多于植物类异物和非有机类异物。均行FB尝试取异物，取出异物25例，成功率达92.6%。6例应用高频电烧灼术，其中1例联合应用球囊扩张术。结论：1.成人异物吸入老年男性多见，症状主要为咳嗽、咳痰，延误诊治或误诊不少见。 2.有机类异物多见，异物多位于右中干及右下叶支气管。肉芽增生明显多见于骨性异物吸入者。 3.经纤支镜取异物方法简单、并发症少、安全有效。 4.对于病史长、一般情况良好者，影像学提示同一部位反复阻塞性肺炎，应考虑异物吸入可能。应尽早行纤支镜检查。
[Abstract]:Objective: to explore the clinical features of inhalation of foreign body in adult bronchus and to improve its diagnosis and treatment. Methods: the clinical data of 27 adult bronchial foreign bodies hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2003 to January 2014 were retrospectively analyzed, including gender, age, location of foreign bodies in the bronchus, and history of treatment. History of foreign body inhalation, types of foreign bodies, endoscopic treatment, foreign body findings and preoperative imaging findings. The result is 1: 1. In this study, there were 19 males and 8 females aged 25.5-82 years. The average age was 57.7 years. 51.8% of them were over 60 years old. History 4 days-50 years. The history of the disease was greater than that of 1 month (77.8%). There were 11 cases with clear history of aspiration by mistake. 2. The common symptoms included cough in 27 cases, expectoration in 26 cases, fever in 6 cases, shortness of breath in 6 cases, wheezing in 4 cases, hemoptysis or blood sputum in 5 cases, chest pain in 5 cases. There were 2 cases with cerebrovascular accident history. 4 cases with definite pulmonary disease. 17 cases were misdiagnosed, including pneumonia, lung cancer, bronchiectasis and so on. 3. The vast majority of foreign bodies are organic foreign bodies, accounting for 80.7. Animal bones were the most common, accounting for 55. 6%. The rest were plant foreign bodies. Non-organic foreign bodies included metal ring, denture and "button like" plastic toys. 18 cases of foreign bodies were located in the right bronchus, including 15 cases of right middle trunk and right lower lobe. 4. There were 9 cases of chest X-ray examination, none of which could find foreign body. 20 cases had CT examination, only 10 cases diagnosed or suspected bronchus foreign body in 5 cases, 5 cases suspected diagnosis. Common imaging findings include pneumonia or obstructive pneumonia, atelectasis, and so on. Foreign bodies were found in 5.26 cases under FB. The granulation hyperplasia was more than 10 days in 22 cases. The granulation hyperplasia caused by bone foreign body was significantly more than that of plant foreign body and non-organic foreign body. 25 cases of foreign bodies were removed by FB. The success rate was 92.6.6 cases with high frequency electric cauterization, and one case with balloon dilatation. Conclusion 1. Adult foreign body inhalation is more common in elderly men with symptoms of cough, expectoration, delayed diagnosis and treatment or misdiagnosis. 2. Most of the organic foreign bodies were located in the right middle trunk and the right lower lobe bronchus. Granulation hyperplasia is more common in bone foreign bodies inhaled. 3. The method of foreign body extraction by fiberoptic bronchoscope is simple, less complication and safe and effective. 4. For those with long history and good condition, the imaging suggests repeated obstructive pneumonia at the same site, and the possibility of foreign body inhalation should be considered. Fiber bronchoscopy should be performed as soon as possible.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R768

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