罕見之氣道異物（筆蓋）及特殊的取出方法

A Rare Airway Foreign Body (Pen Cap) with a Novel Removal Technique

陳宜龍(Yih-Long Chen) ； 李學禹(Hsueh-Yu Li)

《台灣耳鼻喉頭頸外科雜誌》 44卷4期 (2009/08) Pp. 128-131

https://doi.org/10.6286/2009.44.4.128

摘要

氣道吸入異物具有高致命性的風險，通常發生於3-5歲以下的小孩，發生時必須儘快取出，且需要有經驗的耳鼻喉科及麻醉科醫師的高度配合。若未詳細詢問可能的異物嗆入病史，會延誤取出時間，進而造成嚴重併發症。本病例爲1名12歲男童，不慎嗆入筆蓋後，反覆咳嗽卻一直以為是氣喘而加以治療，兩年後發展成左側難治性肺炎(intractable pneumonia)。轉介至本院後，影像學檢查及纖維內視鏡檢顯示有氣道異物。硬式通氣式支氣管鏡術(rigid ventilation bronchoscopy)發現左側主支氣管內有濃稠的痰液，抽吸乾淨後，阻塞之異物疑似中空筆蓋。由於筆蓋緊貼氣管壁且發炎嚴重，無法以傳統方法夾出。於是將鉗子穿過筆蓋中間空洞，張開兩翼將之拖出。異物取出1個月後，病人之肺炎痊癒，不再有咳嗽的情形。此病例提醒我們學齡兒童也可能出現罕見的氣道異物（筆蓋的吸入）。對於慢性咳嗽一定要詳細詢問過去吸入氣道異物之病史。氣道異物之取出方式常須根據異物種類，以及現有器械而有所變化。正確的診斷和迅速及時的治療可避免嚴重的合併症。

關鍵字

氣道異物 ； 筆蓋 ； 支氣管鏡術

並列摘要

Foreign body aspiration is an emergent and potentially life-threatening event. Children and toddlers under 3-5 years are usual victims. Prompt diagnosis with early treatment is essential to prevent serious complications. A 12-year-old boy was treated as asthma for 2 years after an episode of foreign body aspiration. Intractable pneumonia of left lung was developed in spite of the intervention of systemic antibiotics. Computed tomography showed a suspected foreign body with obstruction of left main bronchus. Rigid ventilation bronchoscopy demonstrated a central hollow foreign body lodged in the left main bronchus after suction of thick mucous secretion. Removal of foreign body by grasping forceps was found to be difficult because of deep embedment of foreign body in the bronchial mucosa. We decided to fully utilize the characteristic of foreign body by inserting the forceps into the hollow foreign body, opening the forceps and then pulling the foreign body out of airway. The foreign body was found to be a head-hollow pen cap. The patient was free of cough and chest x-ray showed restoration of pulmonary parenchyma one month after bronchoscopy. The case reminds that school-aged children are not spared to foreign body aspiration. Aspiration of pen cap is possible when school child is biting pen cap with accidental aspiration. Accurate diagnosis and proper removal based on the nature of foreign body can significantly improve clinical symptoms, avoid complications and subsequent salvage operation.

並列關鍵字

airway foreign body ； pen cap ； bronchoscopy