Lower Complication Rates Associated with Bronchial Foreign Bodies over the Last 20 Years
Lower Complication Rates Associated with Bronchial Foreign Bodies over the Last 20 Years
复制标题
过去 20 年来与支气管异物相关的并发症发生率较低
DOI：
10.1177/000348949210100115
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发表时间：
1992
期刊：
影响因子：
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通讯作者：
David Wagner
中科院分区：
文献类型：
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作者：
A. Inglis;David Wagner
回顾性比较了在华盛顿西雅图儿童医院和医疗中心两个独立的5年期间进行的所有内镜下支气管异物（BFB）取出术。1964年7月1日至1969年6月30日期间有54例患者，1984年7月1日至1989年6月30日期间有119例患者。晚期队列中的支气管镜异物取出几乎完全使用霍普金斯内镜引导异物抓钳，而不是第一组中通过肉眼引导的传统镊子。队列之间的平均年龄、异物类型、麻醉技术、手术时间或解剖分布无差异。晚期队列的并发症明显少于早期队列。并发症发生率随着原位BFB的持续时间而增加。晚期队列（4）中初次支气管镜检查时漏诊的BFB显著少于早期队列（10）。早期队列中3例患者和晚期队列中1例患者因无法通过内镜取出BFB而需行开胸术。有一例在诊断和手术之间的延迟期间发生异物从右主干迁移到左主干，导致患者在极端情况下需要紧急支气管镜检查。在疑似BFB患者中使用霍普金斯杆式支气管镜系统及时进行内窥镜检查将减少并发症和异物遗漏。
A retrospective comparison of all endoscopic bronchial foreign body (BFB) removals performed at Children's Hospital and Medical Center, Seattle, Washington, during two separate 5-year periods is reported. There were 54 patients between July 1, 1964, and June 30, 1969, and 119 patients between July 1, 1984, and June 30, 1989. Bronchoscopic removal of foreign bodies in the late cohort was performed almost exclusively with Hopkins telescope—guided foreign body graspers as opposed to traditional forceps guided by the naked eye in the first group. There were no differences in the average age, foreign body type, anesthetic technique, operative length, or anatomic distribution between cohorts. There were significantly fewer complications in the late cohort than the early. Complication rates increased with the duration of the BFB in situ. There were significantly fewer missed BFBs at initial bronchoscopy in the late cohort (4) than the early (10). Inability to endoscopically remove the BFB resulted in thoracotomy in 3 patients in the early cohort and 1 patient in the late cohort. There was one instance in which foreign body migration from right to left main stem occurred during the delay between diagnosis and operation, resulting in the necessity for emergent bronchoscopy with the patient in extremis. Prompt endoscopy in patients with suspected BFBs using the Hopkins rod bronchoscopic system will result in fewer complications and fewer missed foreign bodies.