易误诊为肺癌的支气管异物20例报告

摘要

目的 分析以"肺内阴影原因待查"入院的20例青、中年支气管异物患者的临床资料.方法 回顾性分析20例确诊为支气管异物患者的误吸史、影像学检查结果、支气管镜检查结果及治疗过程等临床资料,观察气道异物致肉芽肿的转归.结果 (1)20例患者的平均年龄为(46.39±3.26)岁,行支气管镜检查前均被误诊.(2)胸部CT显示支气管狭窄或阻塞伴有肺实变或肺不张,其中右侧18例,左侧2例.(3)气管镜下依据异物的形状、大小及误吸时间的长短,10例表现为异物堵塞支气管开口,这部分患者以异物钳将异物取出,确诊时间为3~6个月,平均(4.40±0.92)个月;4例为异物与肉芽组织并存,确诊时间为5~12个月,平均(8.25±2.86)个月;6例为气管腔内可见肿物,确诊时间为6~15个月,平均(10.17±2.85)个月.后10例患者(4例+6例)以气管插管气道介入治疗取出异物并去除肉芽组织.(4)20例患者经治疗24~72 h后,咳嗽、咳痰及痰中带血症状缓解,且无严重并发症.(5)异物取出后,患者气道内的肉芽组织在2周左右消失.结论 中、青年支气管异物以右侧多见,支气管镜是诊断和治疗的最佳手段.%Objective To analyze the clinical data of 20 young and middle-aged patients with bronchial foreign bodies who were hospitalized because of unknown lung shadow. Methods The clinical data of 20 confirmed cases, including history of aspiration, imaging examination results, bronchoscopy findings and therapeutic process were retrospectively analyzed. The outcome of bronchial foreign body granuloma in the airway was observed. Results ⑴100%of the 20 patients with an average age of (46.39±3.26) years were misdiagnosed before bronchoscope examination. (2) The results of chest CT showed that the 20 patients had bronchial stenosis or obstruction with pulmonary consolidation or atelectasis, of which 18 cases were on the right side and 2 on the left side. (3) According to the shape and size of the foreign bodies as well as the length of time of aspiration, the bronchial openings were blocked by foreign bodies in 10 patients, and the foreign bodies were taken out by foreign body forceps. The diagnosis was confirmed in 3-6 (average 4.40±0.92) months in 10 patients. Four patients were obstructed by foreign bodies and granulation tissue, which took 5-12 (average 8.25±2.86) months to diagnose, while in 6 cases, masses were found in tracheal cavity, which took 6-15 (average 10.17±2.85) months to diagnose. The latter 10 (4+6) patients were treated with endotracheal intubation to remove foreign bodies and granulation tissue. (4) After 24-72 hours of treatment, the symptoms of cough, expectoration and blood in the sputum were relieved, and no severe complications occurred in 20 patients. (5) About two weeks after bronchial foreign bodies were removed, the granulation tissue disappeared. Conclusion Foreign body aspiration on the right side is more common in the 20 young and middle-aged patients, and bronchoscope is the best means of diagnosis and treatment.