Experience in the removal of difficult and high risk tracheobronchial foreign body by bronchoscopy
10.3760/cma.j.issn.1673-0860.2012.12.004
- VernacularTitle:支气管镜直接法取高难高危气管支气管异物的体会
- Author:
En-Ming XU
1
;
Zhong-Qiang XU
;
Zhi-Nan WANG
;
Yan WANG
;
Ping CHEN
;
Ya-Min ZHANG
;
Fei XIA
;
Yan ZHANG
Author Information
1. 430030,武汉市儿童医院耳鼻咽喉科
- Keywords:
Foreign bodies;
Tracheal diseases;
Bronchial diseases;
Bronchoscopy;
Child
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2012;47(12):982-986
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the best methods and skill for the removal of difficult and high risk tracheobronchial foreign body under bronchoscope.Methods A retrospective review was performed between August 1995 to August 2012.There were 4217 children with tracheobronchial foreign body,among them,272 were diagnosed as high-risk,highly difficult tracheobronchial foreign bodies confirmed by clinical manifestations,foreign body type and bronchoscopy.Results In 271 children,the tracheobronchial foreign body was removed under bronchoscope,the success rate was 99.6％ ; only one child with a pen cap blocking the left lower lobe bronchus was transferred to the department of thoracic surgery,and the foreign body was finally removed by thoracotomy.Eighty-five children (among them,82 children were under 1 year of age)had Ⅱ-Ⅱ degree laryngeal obstruction,the emergency surgery was performed to remove the foreign body and to relieve the laryngeal obstruction.Twenty-six children had lung infection and 27 children had failed foreign body removal surgery before,in all these children,the foreign body was removed after infection control.There were 17 children with the pen cap as the tracheobronchial foreign body,direct removal was successful in 12 children with the history less than two weeks; in 4 children,the foreign body was removed after 0.1％ epinephrine saline flush,and 1 case with the homemade bronchial foreign body hook remove.There were 26 children with the whistle as the foreign body,and 32 children had large and sharp foreign bodies.In these cases,the foreign bodies were removed together with the bronchoscope.Forty-two children had multiple or fragile foreign bodies,and 16 children had subsegmental bronchial foreign bodies.In these cases,the foreign bodies were removed with forceps under direct vision and intraoperative bronchial lavage.In This series,129 children received intraoperative bronchial lavage,among them,127 children showed normal X-ray changes one week after operation.Two children with a history of more than 1 month complicated with pulmonary consolidation.After bronchial lavage,pneumothorax and subcutaneous emphysema occured,which recovered after treatment.No glottic edema,asphyxia,and other complications were found,the complication rate of surgery was 0.7％.Conclusion For the removal of highly difficult and high risk tracheobronchial foreign bodies,preoperative analysis and discussion shoule be sufficient,appropriate surgical skill and surgical instruments may improve the success rate of the surgery and prevent the operation complications.
