每日一题_2024.03.22

A healthy 14-year-old boy presented with a 6-hour history of hoarseness and difficulty swallowing after accidentally swallowing a coin. On physical examination, the patient was breathing comfortably without stridor or drooling. Radiographs of the chest (left, posteroanterior view) and neck (right, lateral view) showed a rounded radiopaque foreign object situated vertically within the subglottis. Which of the following is NOT an indication for urgent removal for this diagnosis?

患儿，男，14岁，因意外吞下一枚硬币，出现声音嘶哑、吞咽困难6 h就诊。体格检查时，患者呼吸舒适，无喘鸣和流涎。胸部x线片(左、后前位)和颈部x线片(右、侧位)显示一个圆形x线不透异物垂直位于声门下。下列哪项不是该诊断的紧急切除指征?

A. Evidence of near-complete esophageal obstruction 近完全食管梗阻的证据

B. Ingestion of an object less than 5cm in length 摄入长度小于5厘米的物体

C. Ingestion of sharp object 进食锐器

D. Ingestion of a high-powered magnet or magnets 吞食一个或多个高功率磁铁

E. Signs of airway compromise 气道损伤的体征

答案解析：

诊断为异物吸入。意外摄入的异物通常最终进入食管。当年长儿童吸入气道时，由于重力和较大的气道大小，异物通常停留在比本例更远的位置(在气管或主支气管内)。气道异物，特别是气管和喉部的异物，需要立即取出，以降低呼吸系统受损的风险。我们在患者全身麻醉下进行了硬质支气管镜检查，并在声门下观察到一个美国四分之一的支气管，然后用光学钳取出。

正确答案：B