1.安徽省儿童医院;2.安徽省儿童医院耳鼻咽喉科 安徽合肥;3.上海交通大学附属新华医院耳鼻咽喉头颈外科 上海;4.安徽省儿童医院麻醉科 安徽合肥
目的：研究小儿双侧支气管异物的临床特点、诊断要点、围手术期处理技巧,减少漏诊、误诊,提高救治率,减少并发症的发生。方法：回顾性分析我院25例双侧支气管异物患儿的临床资料,对其临床特点、手术技巧及诊治原则进行总结。结果：25例中22例有明确异物吸入史,3例异物史不明确。主诉均有阵发性咳嗽伴喘息症状,就诊时呼吸困难、口唇青紫2例,伴呕吐4例。肺部听诊：16例不同程度的单侧肺呼吸音减低,9例双肺呼吸音对称减低。影像学检查：22例术前行胸部64排螺旋CT三维成像(multidetector CT, MDCT)检查,其中10例显示双侧支气管异物,12例显示单侧支气管异物。3例术前无影像学资料。手术均在全身麻醉下由经验丰富的医生实施硬质支气管镜取出,异物均取出顺利,无并发症发生。结论：根据患儿有异物呛入后短时间内出现咳喘、呼吸困难进行性加重、听诊时双肺呼吸音相同程度或不同程度的减低及配合影像学检查可初步诊断是否为双侧支气管异物,一经诊断应尽快实施气管镜取出异物,减少死亡及并发症发生率。
Objective: To explore the clinical characteristics, diagnosis and perioperative management of bilateral bronchial foreign bodies in children, Reduce the missed diagnosis, misdiagnosis, increase the curative rate and reduce the complications. Method:The clinical data of 25 cases with bilateral bronchial foreign bodies were retrospectively analyzed, and The clinical features, surgical techniques and principles of diagnosis and treatment were summarized.Results: There was a definite history of foreign body aspiration in 22 of 25 cases , The history of foreign bodies in 3 cases was not clear.All 25 cases had paroxysmal cough and wheezing symptoms, There were 2 cases of dyspnea and purple lips,4 cases of vomiting.Signs included unilateral decreased breath sound(16cases).bilateral symmetry decreased Breath sound (9cases).Twenty-two cases had MDCT (multidetector CT) in which 10 were found to have bilateral bronchi abnormalities,and 12 were found to have unilateral bronchi abnormalities.3 cases had no pre-operative imageology. All operations were performed under general anesthesia by experienced doctors with rigid bronchoscopy, The foreign bodies were well removed and without complications. Conclusion:According to the child foreign body choking in a short period of time after the emergence of cough and asthma, dyspnea progressive aggravation,At auscultation, the decrease of respiratory sound in both lungs to the same degree or different degree and the preliminary diagnosis of bilateral bronchial foreign bodies with imaging examination can be made. Foreign bodies should be removed by bronchoscopy as soon as possible to reduce the incidence of death and complications.