Diagnosis and treatment of special type of laryngeal foreign body with granuloma in children
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摘要: 目的 探讨儿童特殊类型伴肉芽肿喉异物的诊断和治疗，为该病的规范化诊治提供临床参考。方法 对我科收治的1例，以及结合相关文献报道的5例儿童特殊类型喉异物伴肉芽肿的临床资料进行回顾性分析，总结该病的临床特征，并探讨其诊断和治疗方案。结果 ① 初诊时6例患儿均被误诊，病程较长，其中5例无明确异物史，1例有异物史但未发现异物。②临床症状多样化，可表现为声嘶、咳嗽、喘鸣、呼吸困难，也可无明显症状。③3例采用喉镜检查确诊，3例采用喉镜结合影像学检查确诊。④未被肉芽肿包裹的异物，先取出异物再治疗肉芽肿；肉芽肿包裹的异物，先切除肉芽肿，再取出异物。结论 特殊类型伴肉芽肿的喉异物可由于缺乏异物史等原因，致异物长期滞留，导致肉芽肿形成，引起误诊。电子喉镜结合喉部CT检查可早期明确诊断。可视喉镜结合喉内镜使用方便，等离子刀有利于精准切除肉芽肿，并在一定程度上避免气管切开。Abstract: Objective This article explores the diagnosis and treatment of a special type of laryngeal foreign body with granuloma in children, providing a clinical reference for standardized diagnosis and treatment.Methods This article retrospectively analyzes one case admitted to our department and five other cases reported in relevant literature involving a special type of laryngeal foreign body with granuloma in children. It summarizes the clinical characteristics of this disease and explores its diagnosis and treatment.Results ① A total of 6 cases were misdiagnosed and had a long course of illness. Five cases had no clear history of foreign body at the first visit. One case had foreign body history but no foreign body was found. ②The clinical symptoms were diverse, which could be hoarseness, cough, wheezing, dyspnea, or no symptoms. ③A total of 3 cases were diagnosed by laryngoscopy, and 3 cases were diagnosed by laryngoscopy and imaging examination. ④Foreign bodies that were not wrapped in granulomas, were removed first and then the granulomas were treated; foreign bodies wrapped in granulomas were removed after the removal of granulomas.Conclusion A special type of laryngeal foreign body with granuloma may lack of accurate foreign body history, resulting in long-term retention of foreign bodies, leading to granuloma formation and misdiagnosis. Electronic laryngoscopy combined with CT examination contribute to early diagnosis. Low temperature plasma under endoscope and anesthetic laryngoscope is conducive to the exposure and precise removal of foreign bodies and avoids tracheotomy to a certain extent.
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Key words:
- children /
- foreign body /
- granuloma /
- diagnosis /
- treatment
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表 1 6例伴肉芽肿喉异物患儿的临床资料
临床资料 病例来源 本病例 张晓玲等[3] 邱汉平等[4] Ambu等[5] Cinar等[6] Bakshi等[7] 性别 男 男 男 男 女 女 年龄/岁 2 10 1.8 3 10 3.5 临床症状 无明显症状 渐进性声嘶 发热、咳嗽、声嘶、呼吸困难 声嘶 咳嗽、喘鸣、声嘶 咳嗽、呼吸困难 误诊疾病 喉肿物 喉肿物 咽喉炎 咽喉炎 哮喘 支气管炎 病程 6个月 2月余 6个月 2个月 1个月 半个月 检查方法 CT+电子喉镜 直接喉镜 直接喉镜 直接喉镜+X线 喉镜 直接喉镜+X线 异物种类 鱼刺 草秆 骨片 禽类骨 骨片 金属弹簧 异物部位 左侧杓状软骨外侧壁 右声带 杓间区 声门区 声门区 左侧室带前方 肉芽肿包裹异物情况 完全包裹 完全包裹 未完全包裹 未完全包裹 未完全包裹 完全包裹 麻醉方式 全身麻醉 全身麻醉 无麻醉 全身麻醉 全身麻醉 全身麻醉 气管切开 无 无 无 有 无 有 手术方式 可视喉镜结合喉内镜下等离子切除肉芽肿后取异物 直接喉镜下切除肉芽肿后取异物 直接喉镜下取异物未切除肉芽肿 直接喉镜下取异物未切除肉芽肿 直接喉镜下取异物后切除肉芽肿 直接喉镜下切除肉芽肿后取异物 术后治疗 布地奈德混悬液雾化 否 否 抗感染 否 口服抗生素、泼尼松 确诊后回顾异物史 吃鱼后呕吐、不适 扬草时呛咳 喝骨头汤后咳嗽、声嘶 有异物史初诊未发现 无明确异物史 无明确异物史 病理检查 炎性肉芽 炎性肉芽 无 无 无 无 
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