临床误诊误治2024,Vol.37Issue(1) :5-10.DOI:10.3969/j.issn.1002-3429.2024.01.002

以慢性咳嗽为主要症状的成人隐匿性支气管异物延迟诊治及文献复习

Delayed Diagnosis and Treatment of Occult Bronchial Foreign Body in Adults with Chronic Cough as the Main Symptom and Literature Review

贾卫红 霍雪清 艾娜娜 王媛媛 杨栋才 杨倩 何军 张徽
临床误诊误治2024,Vol.37Issue(1) :5-10.DOI:10.3969/j.issn.1002-3429.2024.01.002

以慢性咳嗽为主要症状的成人隐匿性支气管异物延迟诊治及文献复习

Delayed Diagnosis and Treatment of Occult Bronchial Foreign Body in Adults with Chronic Cough as the Main Symptom and Literature Review

贾卫红 1霍雪清 1艾娜娜 1王媛媛 1杨栋才 1杨倩 2何军 2张徽2
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作者信息

  • 1. 710083 西安,西北大学附属医院西安市第三医院呼吸与危重症医学科
  • 2. 710083 西安,西北大学附属医院西安市第三医院麻醉科
  • 折叠

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.

Abstract

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 acci-dent 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 fail-ure 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 ate-lectasis and granulation tissue hyperplasia,and recurrent pneumonia.Bronchial foreign bodies in adults have the characteris-tics of high misdiagnosis rate and long duration of delayed diagnosis.Tracheoscopy under general anesthesia is the most effec-tive method for the diagnosis and treatment of OBFB.

关键词

异物/支气管疾病/成人/误诊/肺炎/肺脓肿/支气管炎

Key words

Foreign bodies/Bronchial diseases/Adults/Misdiagnosis/Pneumonia/Lung abscess/Bronchitis

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出版年

2024
临床误诊误治
解放军白求恩国际和平医院

临床误诊误治

CSTPCD
影响因子:0.914
ISSN:1002-3429
参考文献量23
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