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        纖維喉鏡下單人操作咽部困難異物取出84例的臨床分析

        發(fā)布時間:2018-06-23 來源: 人生感悟 點擊:


          【摘要】 目的:探討單人操作纖維喉鏡在咽部困難異物取出術中的臨床應用。方法:選取2016年10月-2017年5月本院收治的困難異物患者84例,其中未明確異物者52例,發(fā)現(xiàn)異物而取出困難者32例,均經(jīng)纖維喉鏡下單人操作檢查,發(fā)現(xiàn)異物者同時行異物取出術。結(jié)果:52例未明確異物患者中,發(fā)現(xiàn)異物者30例,余22例患者仍未發(fā)現(xiàn)異物,隨訪未發(fā)現(xiàn)異物;32例難取異物患者,通過纖維喉鏡檢查均順利取出。結(jié)論:咽部困難異物可通過纖維喉鏡下檢查并取出,效果顯著,且可單人操作,廣泛應用于門急診工作。
          【關鍵詞】 咽; 異物; 纖維喉鏡
          Clinical Analysis of 84 Cases of Difficult Pharynx Foreign Body Removal from Single Person Operation Under Fiberoptic Laryngoscope/GUO Xiaojuan,HOU Yanpeng,WANG Guoxin.//Medical Innovation of China,2018,15(07):121-124
          【Abstract】 Objective:To investigate the clinical application of single-operated fiberoptic laryngoscope in the extraction of difficult foreign bodies in pharynx.Method:A total of 84 patients with difficult foreign body treated in our hospital from October 2016 to May 2017 were selected,among them 52 cases were not found foreign bodies and 32 cases were find the foreign body and remove the difficult person,they were examined by single person operation under fiberoptic laryngoscope,and those who found foreign bodies were taken out of foreign bodies at the same time.Result:Among 52 cases of unidentified foreign bodies,30 cases were found foreign bodies,22 cases had not found foreign bodies,and not foreign bodies were found during follow-up.32 patients with difficult foreign bodies were removed successfully by fiberoptic laryngoscope.Conclusion:Difficult foreign body of pharynx can be examined and removed by fiberoptic laryngoscope,the effect is obvious and can be operated by single person.It is widely used in outpatient and emergency work.
          【Key words】 Pharynx; Foreign body; Fiberoptic laryngoscope
          First-author’s address:The Fourth People’s Hospital of Shenyang,Shenyang 110031,China
          doi:10.3969/j.issn.1674-4985.2018.07.034
          咽部異物是耳鼻咽喉科常見的急診之一,多可通過直接鉗取或間接喉鏡下鉗取出。但臨床診治過程中,由于患者咽腔狹窄、咽反射過于敏感、所卡異物位置隱蔽等,異物難以被發(fā)現(xiàn)或取出。對難以發(fā)現(xiàn)異物和難以取出異物,統(tǒng)稱為困難異物,本研究借助纖維喉鏡輔助工作,提高了困難異物的檢出率及取出率,同時筆者進行單人操作嘗試,取得滿意效果,現(xiàn)報道如下。
          1 資料與方法
          1.1 一般資料 選取2016年10月-2017年5月就診于本院門急診的咽部困難異物患者84例,其中男48例,女36例;年齡8~78歲,就診時間10 min~1周;未發(fā)現(xiàn)異物者52例,發(fā)現(xiàn)異物而取出困難者32例;颊呔姓`吞異物史;來診后通過口咽部檢查、間接喉鏡檢查、間接鼻咽鏡檢查而不能發(fā)現(xiàn)異物或發(fā)現(xiàn)異物卻不能取出。本研究已經(jīng)院倫理委員會審核批準。
          1.2 方法 患者均行表麻下纖維鏡檢查,患者坐位或仰臥位,2%利多卡因、1%鹽酸羥甲唑啉麻醉收縮患側(cè)鼻腔,必要時同時麻醉收縮對側(cè)鼻腔,2%利多卡因同時表面麻醉口咽部和喉咽部黏膜。采用Olympus耳鼻喉用纖維喉鏡經(jīng)患側(cè)鼻腔進境,鼻腔進鏡有困難者可經(jīng)口進鏡,上下牙之間放牙墊以防纖維喉鏡被損壞。單人操作時進鏡前將活檢鉗經(jīng)纖維喉鏡側(cè)孔推送至纖維喉鏡遠端,仔細檢查鼻咽部、咽側(cè)壁、扁桃體、會厭谷、舌根、梨狀窩和環(huán)后區(qū)等處,發(fā)現(xiàn)異物后繼續(xù)推送喉鉗至合適位置,同時調(diào)整鉗口方向,取出異物。
          2 結(jié)果
          通過纖維喉鏡檢查,未明確異物者52例中發(fā)現(xiàn)異物者30例,仍未發(fā)現(xiàn)異物者22例,隨訪未發(fā)現(xiàn)異物;難取異物者32例通過纖維喉鏡檢查均順利取出,其中2例患者因異物較大,應用纖維喉鏡下普通喉部異物鉗取出(患者異物位于梨狀窩的草魚骨架1例,位于會厭谷的大塊桃果肉1例)。進行纖維喉鏡檢查并明確咽部異物患者62例,其中,位于扁桃體上16%(10/62),扁桃體與咽側(cè)壁之間13%(8/62),舌根上29%(18/62),舌根與會厭谷之間32%(20/62),梨狀窩10%(6/62)。

        相關熱詞搜索:喉鏡 異物 取出 臨床 纖維

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