摘要
目的探讨成人隐匿性支气管异物的临床特点与诊治经验。方法结合文献回顾性分析2017年2月—2023年7月收治的4例成人隐匿性支气管异物病例资料。结果4例中仅1例存在脑血管意外导致长期卧床,误吸发生支气管异物,其余3例均为正常成人。临床表现主要为慢性咳嗽。误诊为肺炎2例、肺脓肿、支气管炎各1例,后经支气管镜检查确诊。确诊后3例在全麻下行支气管异物摘除术,另一例在局麻气管镜失败后改为全麻下治疗,无并发症发生。4例中1例为动物性异物(鸭脖),2例为植物性异物(瓜子仁、菜叶、菜梗、辣子角),1例为金属物品(锡纸)。误诊时间3个月~10年。结论成人支气管异物少见,临床表现各异,非金属样异物或植物性异物在胸部影像学检查的早期多数呈阴性结果,使得不能及时诊断及治疗,导致肺不张及肉芽组织增生,引起反复肺炎。成人支气管异物存在误诊率高、延误诊断时间长的特点。全麻下气管镜诊治是诊断和治疗隐匿性支气管异物最为有效的方法。
Objective To explore the clinical characteristics,diagnosis and treatment experience of occult bronchial foreign body(OBFB)in adults.Methods The data of 4 adults with OBFB admitted from February 2017 to July 2023 were retrospectively analyzed based on literature review.Results Among the 4 patients,only 1 patient had cerebral vascular accident leading to long-term bed rest and bronchial foreign body aspiration,and the other 3 patients were normal adults.The main clinical manifestations were chronic cough.They were misdiagnosed as pneumonia(n=2),pulmonary abscess(n=1)and bronchitis(n=1),respectively,and the diagnosis was confirmed by bronchoscopy.After diagnosis,bronchial foreign bodies in 3 patients were removed under general anesthesia,and the other patient was changed to general anesthesia after failure of tracheoscopy under local anesthesia,and no complications occurred.Among the 4 patients,1 patient had animal foreign body(duck neck),2 patients had plant foreign body(melon seed kernel,vegetable stem,chili horn),and 1 patient had metal object(tinfoil).Misdiagnosis lasted from 3 months to 10 years.Conclusion Bronchial foreign bodies in adults are rare and have varying clinical manifestations.Most non-metallic foreign bodies or plant foreign bodies show negative results in the early stage of chest imaging examination,which can lead to delayed diagnosis and treatment of foreign bodies,causing atelectasis and granulation tissue hyperplasia,and recurrent pneumonia.Bronchial foreign bodies in adults have the characteristics of high misdiagnosis rate and long duration of delayed diagnosis.Tracheoscopy under general anesthesia is the most effective method for the diagnosis and treatment of OBFB.
作者
贾卫红
霍雪清
艾娜娜
王媛媛
杨栋才
杨倩
何军
张徽
JIA Weihong;HUO Xueqing;AI Nana;WANG Yuanyuan;YANG Dongcai;YANG Qian;HE Jun;ZHANG Hui(Department of Respiratory and Critical Care Medicine,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Xi'an 710083,China;Department of Anesthesiology,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Xi'an 710083,China)
出处
《临床误诊误治》
CAS
2024年第1期5-10,共6页
Clinical Misdiagnosis & Mistherapy
关键词
异物
支气管疾病
成人
误诊
肺炎
肺脓肿
支气管炎
Foreign bodies
Bronchial diseases
Adults
Misdiagnosis
Pneumonia
Lung abscess
Bronchitis
