気道異物症例の臨床的特徴 : 摘出に難渋した症例に関する考察  [in Japanese] Clinical Characteristics of Airway Foreign Bodies in Which Bronchoscopic Removal Was Difficult  [in Japanese]

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Author(s)

    • 高佐 顕之 Takasa Akiyuki
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 間藤 尚子 Mato Naoko
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 中屋 孝清 Nakaya Takakiyo
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 細野 達也 Hosono Tatsuya
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 坂東 政司 Bando Masashi
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 右藤 智啓 Uto Tomohiro
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 中澤 晶子 Nakazawa Syoko
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
    • 鈴木 恵理 Suzuki Eri
    • 自治医科大学附属病院呼吸器内科 Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University

Abstract

背景.気道異物は窒息や肺炎などの合併症を引き起こすことがあり,正確な診断と迅速な摘出が求められる.しかし時に通常の気管支内視鏡操作では摘出に難渋する症例も経験する.方法.当科で経験した気道異物15症例の臨床的特徴をまとめ,摘出に難渋した症例を中心に検討した.結果.平均年齢58歳,男性8例,女性7例.基礎疾患として認知症を4例認めた.誤嚥のエピソードを10例で認め,異物の種類は歯科関連異物が9例(60%)を占めた.胸部単純X線写真で11例(73%)は異物を確認でき,胸部CTでは全例異物とその嵌頓部位を確認できた.嵌頓部位は右中間幹,右底幹が多かった.摘出には8例で鰐口型把持鉗子,4例でバスケット鉗子を用い,2例は鉗子にバルーンカテーテルを併用した.3例(20%)は初回の手技で摘出できず,器具の変更や気管切開術,外科的肺切除術が必要であった.この3例で摘出に難渋した要因は,鋭的異物の長期間嵌による肉芽が異物周囲に形成されていたこと,認知症による不穏,また気管切開術後の気管狭窄であった.結語.気道異物周囲に肉芽が形成された症例,安静を保てない症例や,気道狭窄を認める症例では,異物の摘出に難渋することがあり,摘出手技や器具の工夫が必要と考えられた.

Background. Airway foreign bodies may cause suffocation and pneumonia. Therefore, accurate diagnosis and expeditious removal are needed. However, we sometimes experience difficulty in removing foreign bodies from the airway by bronchoscopy. Methods. We examined the clinical characteristics of 15 cases of foreign body managed in our institute over the past 19 years, and evaluated characteristic difficulties during bronchoscopic removal. Results. The mean age of cases was 58 years. Four patients had dementia as their underlying disease. Episodes of aspiration occurred in 10 patients. Dental foreign bodies were seen in 9 patients (60%). Chest X-ray films detected foreign bodies in 11 patients (73%), and chest computed tomography identified them in all patients. Alligator forceps and basket forceps were mainly used for removal. Fogarty forceps were also used in combination with the above in 2 patients. The foreign body was removed during the first procedure in 12 patients; however, further procedures were needed (20%) in the remaining 3 patients: using different bronchoscopic techniques, tracheotomy and surgical resection, respectively. The characteristics of these 3 cases were as follows; granulation forming around a sharp foreign body obstructing the bronchus for a prolonged period, inability of the patient to lie still due to dementia, and tracheal stenosis after tracheotomy. Conclusion. Characteristic difficulties during bronchoscopic removal were granulation around the foreign body, inability of the patient to lie still, and tracheal stenosis. When difficulties in bronchoscopic removal are expected, it is necessary to prepare a variety of devices in advance.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 34(1), 6-10, 2012

    The Japan Society for Respiratory Endoscopy

References:  11

Codes

  • NII Article ID (NAID)
    110009327973
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    0287-2137
  • Data Source
    CJP  NII-ELS  J-STAGE 
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