目的 总结束胸后16排螺旋CT扫描在诊断危重小儿气管及支气管异物中的作用。 方法 对2011年9月－2012年2月4例气管支气管异物危重患儿用自制束缚带束胸后行CT扫描，扫描后所得图像与2009年5月－2011年8月8例既往工作中未行束胸CT扫描危重患儿气管支气管异物图像进行比较（其中1例为同一患儿行常规及束胸后CT检查），并进行图像后处理，包括多平面重建、气管支气管树重建、CT仿真内窥镜；并观察束胸检查前后患儿血氧饱和度（SpO2）变化情况；其中1例进行束胸前后胸廓最大径线比较。 结果 束胸后CT扫描能明显降低呼吸运动伪影，对气管支气管异物的发现率有明显提高；检查前后患儿SpO2未见明显变化；1例束胸后胸廓最大径线缩小0.8 cm。 结论 束胸后16层螺旋CT扫描能最大限度的避免呼吸运动伪影，使得气管支气管异物能够快速准确诊断，为后期实施适时治疗提供有效影像资料，进而降低该病的并发症及病死率，并且在束胸检查前后患儿SpO2无明显变化。
ObjectiveTracheobronchial foreign bodies (TFBs) aspiration is rare in adults,although it can occur at any age. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in adult patients of central south China. MethodsA total of 244 patients with TFBs over the age of 14 years were reviewed retrospectively from January 1997 to February 2012. The incidence,risk factors,clinical manifestations,radiological findings,types and locations of TFBs were analyzed. ResultsAmong the 27719 patients,TFBs were found only in 0.88%(244) cases. The prevalence of TFB aspiration increased steadily with age beginning in the fifth decade. The incidence of TFBs was 0.62% among people aged 70 to 80 years. Risk factors such as cerebrovascular diseases and neural degenerative disease were found among 32 (6.6%) patients. Among 153 patients with clear history of foreign body aspiration,135 patients (88.2%) were addicted to the hot pepper. Paroxysmal cough (81.1%) was the most common clinical manifestations of TFBs. Only 12 cases (4.9%) were found with non-opaque foreign bodies by chest X-ray but 106 cases (43.4%) were found with opaque foreign bodies by chest CT. The most common indirect chest imaging findings were recurrent infections and consolidation of the same area.Bone fragments of animals was the most common type in foreign bodies (47.2%). The most common position of foreign bodies was the right bronchial (65.6%). Total foreign bodies of 234 patients (95.9%) had been successfully removed by flexible bronchoscopy. ConclusionAlthough TFBs is rare in adults in south China,but yield by flexible bronchoscopy (0.88%) is much higher than that is reported in western countries (0.32%-0.33%). Addiction to the hot pepper and speaking loudly when having dinner may be the major risk factor for high incidence in central south China.
The specificity of the clinical characteristics and examination results of adult tracheobronchial foreign bodies may not be obvious, which may lead to delay in diagnosis, thereby reducing patients’ quality of life and even life-threatening. However, the current clinicians’ understanding of the disease is still insufficient. Based on the current status of relevant research at home and abroad, this article introduces the medical history collection, clinical features and examination methods (including chest X-ray, chest CT and bronchoscopy), and the treatment and precautions of adult tracheobronchial foreign bodies, and aims to deepen doctors’ understanding of the disease, so as to minimize missed diagnosis and misdiagnosis.