摘要:目的 研究小儿双侧支气管异物的临床特点、诊断要点、围手术期处理技巧，减少漏诊、误诊，提高救治率，减少并发症的发生。方法 回顾性分析诊治的25例双侧支气管异物患儿的临床资料，对其临床特点、手术技巧及诊治原则进行总结。结果 25例中22例有明确异物吸入史，3例异物史不明确。术前22例患者完成64排螺旋CT三维成像(MDCT)，其中10例显示双侧支气管异物，12例显示单侧支气管异物;另外3例患者病情较重考虑主气管异物直接急诊手术未做CT检查。手术均在全身麻醉下由经验丰富的医生实施硬质支气管镜取出，12例术前显示单侧支气管异物但术中为双侧支气管异物，可能与异物较碎、患儿剧烈咳嗽时引起异物变位有关，异物均取出顺利，无并发症发生。结论 双侧支气管异物具有病程短、临床症状重、出现呼吸困难时间短的特点，易误诊为单侧支气管或主气管异物。根据患儿有异物呛入后短时间内出现咳喘、呼吸困难进行性加重、听诊时双肺呼吸音相同程度或不同程度的减低及配合影像学检查可初步诊断是否为双侧支气管异物，一经诊断应尽快实施气管镜取出异物，减少死亡及并发症发生率。

摘要:ObjectiveTo explore the feasibility and effectiveness of modified Killian incision for nasal septoplasty.MethodsFrom Feb 2009 to June 2013, nasal septoplasty with modified incision was conducted to 382 cases with nasal septum deviation. Of them, 295 cases suffered from simple septum deviation, and 87 suffered from septum deviation with chronic sinusitis/nasal polyps. Different from Killian incision, the modified incision was located in front of the nasal septum cartilage. All 382 patients received nasal septoplasty via modified Killian incision. Meanwhile, the patients with hypertrophy of inferior turbinate were treated with inferior turbinotomy (fracture displacement or submucous resection of inferior turbinate) and those with chronic sinusitis/nasal polyps received functional endoscopy sinus surgery.ResultsThe operation time ranged from 8 to 35mins with a median time of 20 min. The amount of blood loss ranged from 10 to 80 ml with a median volume of 30 ml. All patients had been followed up for 6 to 12 months postoperatively. Deviation of nasal septum was corrected completely, nasal ventilation got improved in all the patients. No complications such as septum perforation, septum hematoma, saddle nose, or nasal adhesion occurred.ConclusionModified Killian incision can provide a clear operative field and correct the septum deformity completely in septoplasty. With advantages of reserving cartilage frame of nasal septum, less injury and bleeding, short operative time and less complication, this incision is minimally invasive for septoplasty.