目的 总结成人支气管内异物的诊断治疗方法,并对其中需要外科处理的病例进行分析. 方法 2006年9月~2015年11月,我中心共收治14例成年支气管内异物患者,男9例,女5例,年龄27~70岁.病史0~19年,中位时间1个月.就诊时症状包括咳嗽、咳痰、咯血、胸闷和胸痛等. 5例无明确异物吸入史.均行胸部正侧位片或CT检查,8例支气管内异物位于右侧支气管(金属导丝、金属勺柄、铁钉、塑料螺钉、鱼骨、玻璃、辣椒等),6例位于左侧支气管(注射器针头、蛋壳、假牙、辣椒等).拟行异物取出的方法包括纤维支气管镜、硬质支气管镜或胸腔镜手术探查. 结果 1例于纤维支气管镜下将异物取出,10例行硬质支气管镜+纤维支气管镜异物取出术. 3例可疑支气管内异物但纤维支气管镜未能发现明确异物, CT显示肺内广泛炎症、实变且抗炎治疗无效,不能除外肺部肿瘤,或合并气道内活动性出血者,行胸腔镜探查+肺叶切除术.结论 硬质支气管镜是处理成人支气管异物的最佳选择,如异物仍难以取出或有肺部并发症,可行胸腔镜手术治疗.%Objective To discuss the diagnosis and management of bronchial foreign body in adults. Methods A total of 14 patients with bronchial foreign bodies, 9 males and 5 females, were admitted to this hospital from September 2006 to November 2015. Their history varied from 0 to 19 years (median, 1 month), with symptoms of cough, expectoration, hemoptysis and chest pain. Five patients could not recall foreign body aspiration history. All the patients received chest radiography or computed tomography (CT). Foreign bodies were located in bronchus of right side in 8 patients ( steel wire, spoon, nail, plastic screw, fishbone, glass, cayenne, etc. ) and in left side in 6 patients (syringe needle, eggshell, denture, cayenne, etc. ). The foreign bodies were removed by flexible bronchoscopy, rigid bronchoscopy, or thoracoscopic exploration. Results Foreign bodies were removed by flexible bronchoscopy in 1 patient. Ten patients underwent rigid (or rigid plus flexible) bronchoscopy to retrieve the foreign bodies. Because of the negative bronchoscopic examination results, pulmonary extensive inflammation and consolidation under CT scanning and ineffective to anti-inflammatory treatment, and the suspicion of malignancies or the persistent airway hemorrhage, thoracoscopic exploration and lobectomies were applied in the other 3 patients. Conclusions Rigid bronchoscopy is the best choice in the diagnosis and treatment of bronchial foreign body in adults. Thoracoscopic surgery is necessary if the extraction failed or the exact pathogen of pulmonary lesion is undetermined.
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