Removal of Airway Foreign Body by Fiberoptic Bronchoscopy through a Laryngeal Mask Airway

經喉面罩以纖維支氣管鏡移除呼吸道異物

湯恩魁(En-Kwei Tang) ； 張晃宙(Huang-Chou Chang) ； 許宏基(Hon-Ki Hsu)

《胸腔醫學》 20卷4期 (2005/08) Pp. 324-328

https://doi.org/10.29806/TM.200508.0011

摘要

一位七十八歲男性，因為支氣管異物轉至我們醫院急診室。胸部X光片顯示此異物位於右側主支氣管合併遠端肺塌陷。在其他醫院曾試著以纖維支氣管鏡移除此支氣管異物，但沒有成功。住院之後，在加護病房試著再以纖維支氣管鏡移除一次，仍然失敗。經會診胸腔外科之後，決定在手術房中，全身麻醉下以喉面罩當呼吸道來執行纖維支氣管鏡以移除此支氣管異物，最後終於成功地移除。此異物為五顆假牙。隨著纖維支氣管鏡的發展，目前大部份人均選擇以纖維支氣管鏡來診斷及移除成人的呼吸道異物。隨著喉面罩的發展，已經有人以喉面罩當呼吸道來執行纖維支氣管鏡。對於局部麻醉下無法完成的纖維支氣管鏡異物移除，我們建議全身麻醉下，以喉面罩來代替氣管內管作為呼吸道，因為它可提供較大管徑及較小阻力讓我們更容易操作纖維支氣管鏡，以利於呼吸道異物移除。

關鍵字

呼吸道異物 ； 纖維支氣管鏡 ； 喉面罩

並列摘要

A male patient, 78 years old, was referred to our emergency department (ED) for what was thought to be a foreign body in the right bronchial tree. The chest roentgenogram revealed a denture (3.6×1 cm) impacted in the right main bronchus with distal consolidation. A fiberoptic bronchoscope was used in an attempt to remove the foreign body at a local hospital, but failed. After admission to our hospital, a repeat flexible bronchoscopy was performed to retrieve the foreign body under topical anesthesia, but also failed. A chest surgeon was consulted. Another bronchoscopy was performed under general anesthesia with a laryngeal mask airway. Grasping forceps were inserted through the working channel of the bronchoscope to capture the denture. The denture contained 5 false teeth. Increased experience and the development of better accessories has advanced the acceptance of the flexible bronchoscope as the preferred initial instrument for both the diagnosis and removal of airway foreign bodies in adults. With the development of the laryngeal mask airway, a flexible bronchoscopy can be performed with reasonable airway control, even with deeper sedation. For patients who cannot tolerate a fiberoptic bronchoscopy under topical anesthesia, we advise using the laryngeal mask airway with general anesthesia, because it offers a larger diameter and less resistance than an endotracheal tube, thus facilitating the bronchoscopy and the removal of the airway foreign body.

並列關鍵字

airway foreign body ； fiberoptic bronchoscope ； laryngeal mask airway