A Feasible Approach for Extraction of Dental Prostheses from the Airway by Flexible Bronchoscopy in Concert with Wire Loop Snares

利用軟式支氣管鏡合併圈套裝置執行呼吸道贗齒夾取的經驗回顧

沈德群(Te-Chun Shen) ； 涂智彥(Chih-Yen Tu) ； 陳家弘(Chia-Hung Chen) ； 陳鴻仁(Hung-Jen Chen) ； 劉奕亨(Yi-Heng Liu) ； 夏德椿(Te-Chun Hsia) ； 施純明(Chuen-Ming Shih) ； 徐武輝(Wu-Huei Hsu)

《胸腔醫學》 26卷5期 (2011/10) Pp. 261-267

https://doi.org/10.29806/TM.201110.0003

摘要

前言：呼吸道異物吸入可能是個相當棘手的問題。脫落的贗齒是最常見的呼吸道異物種類之一。硬式及軟式支氣管鏡搭配不同的器械，在臨床上，被廣泛地用來處理各式的呼吸道異物。本文引介使用軟式支氣管鏡合併圈套裝置，執行呼吸道贗齒夾取之經驗，並探討影響成功率的若干因子。方法：我們回顧了最近四年內，所有執行之支氣管鏡異物夾取的病例。其中有七例被確認是利用軟式支氣管鏡合併圈套裝置，來處理呼吸道贗齒嵌入的狀況。每個病例都被重新詳細地檢視及歸納，以期能獲得可信的結論。結果：七個病例當中，包括五位男性，兩位女性，平均年齡為五十八歲。其中有兩位病人執行檢查時，是被插管並輔以呼吸器使用的。贗齒嵌入的位置包括左下支氣管三例，左主支氣管兩例，右下支氣管一例與右中間支氣管一例。其中五個病例成功地將贗齒取出。兩個未能取出的病例都是單一顆牙齒，形狀都是接近圓形的臼齒或前臼齒。沒有任何術中或術後的相關併發症發生。結論：利用軟式支氣管鏡合併圈套裝置，執行呼吸道贗齒夾取是個相當可行的方式。由於病人只須在局部麻醉之下接受處置，相對來說，這是個侵入性低、省時、便利、安全又經濟的方法。

關鍵字

呼吸道 ； 支氣管鏡 ； 贗齒

並列摘要

Objective: Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increase with advancing age. Bronchoscopic removal of TFBs can be safely accomplished with both rigid and flexible bronchoscopes. A wide variety of instruments, such as biopsy forceps, Fogarty balloon catheters, alligator forceps, or wire baskets, are commonly available for removal. Our objective was to determine whether the use of flexible bronchoscope in concert with wire loop snares is effective in the extraction of airway dental prostheses, and the factors that affect the success rate of removal of airway dental prostheses using this method.Patients: The cases of 7 patients with airway dental prostheses aspiration from 2007 to 2010 were reviewed. All patients underwent flexible bronchoscopy with a wire loop snare under local anesthesia without fluoroscopic guidance throughout the procedure.Measurements and Main Results: Seven patients (mean [± SD] age, 58.4±17.4 years; 71% men) underwent flexible bronchoscopy in concert with wire loop snares to extract dental prostheses from the airway. Two patients (29%) were intubated with a mechanical ventilator during the procedure. The locations of these dental prostheses were the left lower bronchus (n=3, 43%), left main bronchus (n=2, 29%), right lower bronchus (n=1, 14%) and right tranchus intermidis (n=1, 14%). The dental prostheses of 5 (71%) of the 7 patients were extracted successfully. The prostheses that could not be extracted from the other 2 patients by this method were single tooth with a round shape, such as a molar or premolar. There were no complications as a result of the procedures.Conclusions: Although we have only 7 cases to illustrate this wire loop snare technique, we believe that this method can be of assistance to the pulmonologist in their approach to airway foreign body extraction, especially dental prostheses. A flexible bronchoscope in concert with a loop snare can grasp the dental prosthesis tighter than either grasping forceps or wire baskets, and with less need for a rigid bronchoscope or fluoroscope.

並列關鍵字

airway ； bronchoscopy ； dental prostheses