NON-ASPHYXIATING TRACHEOBRONCHIAL FOREIGN-BODIES IN ADULTS
NON-ASPHYXIATING TRACHEOBRONCHIAL FOREIGN-BODIES IN ADULTS
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DOI：
10.1183/09031936.94.07030510
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发表时间：
1994-03-01
影响因子：
24.3
通讯作者：
LAN, RS
中科院分区：
文献类型：
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作者：
LAN, RS
本文报告47例成人非窒息性气管支气管异物的临床表现。异物滞留时间为1周或更短的有9例（“急性组”）; 1个月或更长的有29例（“慢性组”），不确定的有4例（“不确定组”）;异物为支气管结石的有5例（“支气管结石组”）。在慢性和不确定组中，未发现促发因素，骨是最常见的异物。慢性组中，仅有15例患者在支气管镜检查前有窒息史，除急性组外，大多数病例的临床表现和X线表现无特异性。在慢性组中，异物平均停留时间为25.8个月。12例因无窒息史和胸片上异物不可见而延误诊断，14例因患者不知情而延误诊断，1例因医生不知情而延误诊断，2例因既往取物失败而延误诊断。在慢性组中，窒息史或导致“怀疑支气管内病变”的情况是主要指征。90%以上的患者用纤维支气管镜取出异物。它的结论是，最重要的诊断因素是一个高的临床怀疑指数和灵活的纤维支气管镜检查提供了一个有价值的治疗选择，在选定的条件。
The presentations of 47 adult patients with a non-asphyxiating tracheohronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine (''acute group''); 1 month or more in 29 (''chronic group''), uncertain in four (''uncertain group''); and the foreign body was a broncholith in five patients (''broncholith group''). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient.Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients.The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to ''suspicion of an endobronchial lesion'' were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.