發(fā)布時(shí)間：2018-05-11 18:58

  本文選題：支氣管異物 + 成人　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討成人支氣管異物吸入的臨床特點(diǎn)，提高其診斷及治療水平。 方法：回顧性分析2003年1月至2014年1月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院的27例成人支氣管異物患者的臨床資料，包括患者的性別、年齡、異物在支氣管內(nèi)的位置、治療史、異物吸入史、異物類型、內(nèi)鏡治療情況、異物鏡下表現(xiàn)及術(shù)前影像學(xué)表現(xiàn)。 結(jié)果：1.本研究中，男19例，女8例，年齡25.5-82歲。平均年齡為57.7歲。其中60歲以上者占51.8%。病史4天-50年。病史大于1月占77.8%。有明確誤吸病史11例。 2.常見(jiàn)癥狀有咳嗽27例，咳痰26例，發(fā)熱6例、氣促6例、喘息4例，咯血或血絲痰5例，胸痛5例。有2例有腦血管意外病史。4例有明確的肺部疾病。17人病程中曾誤診,包括肺炎、肺癌、支氣管擴(kuò)張癥等。 3.絕大多數(shù)異物為有機(jī)類異物，，占80.7%。動(dòng)物骨頭最為常見(jiàn)，占55.6%。余下均為植物性異物。非有機(jī)類異物包括金屬環(huán)、金屬義齒、“紐扣樣”塑料玩具各1例。18例異物位于右側(cè)支氣管內(nèi)，其中右中間干及右下葉共15例。 4.共有9例行胸片檢查，胸片均未能發(fā)現(xiàn)異物。20例行CT檢查，僅10例確診或疑診支氣管異物（5例確診，5例疑診）。常見(jiàn)的影像學(xué)表現(xiàn)有肺炎或阻塞性肺炎、肺不張等。 5.26例FB下可見(jiàn)異物。異物存留時(shí)間大于10天者（22例）均有不同程度的肉芽增生，骨類異物所致肉芽增生顯著多于植物類異物和非有機(jī)類異物。均行FB嘗試取異物，取出異物25例，成功率達(dá)92.6%。6例應(yīng)用高頻電燒灼術(shù)，其中1例聯(lián)合應(yīng)用球囊擴(kuò)張術(shù)。 結(jié)論：1.成人異物吸入老年男性多見(jiàn)，癥狀主要為咳嗽、咳痰，延誤診治或誤診不少見(jiàn)。 2.有機(jī)類異物多見(jiàn)，異物多位于右中干及右下葉支氣管。肉芽增生明顯多見(jiàn)于骨性異物吸入者。 3.經(jīng)纖支鏡取異物方法簡(jiǎn)單、并發(fā)癥少、安全有效。 4.對(duì)于病史長(zhǎng)、一般情況良好者，影像學(xué)提示同一部位反復(fù)阻塞性肺炎，應(yīng)考慮異物吸入可能。應(yīng)盡早行纖支鏡檢查。
[Abstract]:Objective: to explore the clinical features of inhalation of foreign body in adult bronchus and to improve its diagnosis and treatment. Methods: the clinical data of 27 adult bronchial foreign bodies hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2003 to January 2014 were retrospectively analyzed, including gender, age, location of foreign bodies in the bronchus, and history of treatment. History of foreign body inhalation, types of foreign bodies, endoscopic treatment, foreign body findings and preoperative imaging findings. The result is 1: 1. In this study, there were 19 males and 8 females aged 25.5-82 years. The average age was 57.7 years. 51.8% of them were over 60 years old. History 4 days-50 years. The history of the disease was greater than that of 1 month (77.8%). There were 11 cases with clear history of aspiration by mistake. 2. The common symptoms included cough in 27 cases, expectoration in 26 cases, fever in 6 cases, shortness of breath in 6 cases, wheezing in 4 cases, hemoptysis or blood sputum in 5 cases, chest pain in 5 cases. There were 2 cases with cerebrovascular accident history. 4 cases with definite pulmonary disease. 17 cases were misdiagnosed, including pneumonia, lung cancer, bronchiectasis and so on. 3. The vast majority of foreign bodies are organic foreign bodies, accounting for 80.7. Animal bones were the most common, accounting for 55. 6%. The rest were plant foreign bodies. Non-organic foreign bodies included metal ring, denture and "button like" plastic toys. 18 cases of foreign bodies were located in the right bronchus, including 15 cases of right middle trunk and right lower lobe. 4. There were 9 cases of chest X-ray examination, none of which could find foreign body. 20 cases had CT examination, only 10 cases diagnosed or suspected bronchus foreign body in 5 cases, 5 cases suspected diagnosis. Common imaging findings include pneumonia or obstructive pneumonia, atelectasis, and so on. Foreign bodies were found in 5.26 cases under FB. The granulation hyperplasia was more than 10 days in 22 cases. The granulation hyperplasia caused by bone foreign body was significantly more than that of plant foreign body and non-organic foreign body. 25 cases of foreign bodies were removed by FB. The success rate was 92.6.6 cases with high frequency electric cauterization, and one case with balloon dilatation. Conclusion 1. Adult foreign body inhalation is more common in elderly men with symptoms of cough, expectoration, delayed diagnosis and treatment or misdiagnosis. 2. Most of the organic foreign bodies were located in the right middle trunk and the right lower lobe bronchus. Granulation hyperplasia is more common in bone foreign bodies inhaled. 3. The method of foreign body extraction by fiberoptic bronchoscope is simple, less complication and safe and effective. 4. For those with long history and good condition, the imaging suggests repeated obstructive pneumonia at the same site, and the possibility of foreign body inhalation should be considered. Fiber bronchoscopy should be performed as soon as possible.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R768

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 閭長(zhǎng)安;陶廣宇;鮑健;;84例小兒支氣管異物的X線診斷體會(huì)[J];重慶醫(yī)學(xué);2006年02期

2 劉軍,張文奇,楊振嶺,謝衛(wèi)民;冠狀位CT掃描對(duì)小兒支氣管異物的診斷價(jià)值[J];臨床耳鼻咽喉科雜志;2002年06期

3 周鴻江;柳廣南;;成人支氣管異物誤診原因分析[J];臨床薈萃;2007年06期

4 李國(guó)良;;小兒支氣管異物多層螺旋CT仿真支氣管鏡診斷誤差分析[J];臨床誤診誤治;2010年05期

5 吳天清;戴志輝;廖曉彬;;54例成人支氣管異物誤診分析[J];川北醫(yī)學(xué)院學(xué)報(bào);2008年06期

6 林順漲,王錦玲,孫愛(ài)華;小兒支氣管異物誤診45例臨床分析[J];上海醫(yī)學(xué);2000年07期

7 朱躍弟;劉濤;;小兒支氣管異物病因分析[J];實(shí)用醫(yī)技雜志;2007年36期

8 沙志榮,張振新;2例支氣管異物手術(shù)失敗原因分析[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2001年06期

9 遲勝勇,王兆壯,張建基;小兒支氣管異物好發(fā)部位的再探討(附258例分析)[J];醫(yī)學(xué)影像學(xué)雜志;2001年02期

10 袁順達(dá);周軍慶;崔健;何斌軍;魏德勝;王海勇;喻光懋;周偉軍;王彬;張楚;;成人支氣管異物開(kāi)胸手術(shù)7例[J];當(dāng)代醫(yī)學(xué)(學(xué)術(shù)版);2008年19期

本文編號(hào)：1875168