经支气管镜介入治疗在气道发育异常中的应用

支气管镜是诊治儿童呼吸系统疾病不可缺少的方法之一,是儿童肺介入治疗技术不断发展的基础。随着临床经验的不断积累及支气管镜在儿科的广泛应用,其价值得到了一致肯定。该文将对经支气管镜介入治疗在气道发育异常中的应用概况作一综述。     

电子纤维支气管镜介入治疗儿童左主支气管黏液表皮样癌一例并文献复习

目的：探讨支气管腔内黏液表皮样癌( mucoepidermoid carcinoma,MEC)的介入治疗方法可行性,提高患者生活质量。方法术前完善增强肺CT明确患儿肿物局限在腔内,患儿无左主支气管管壁浸润和淋巴结转移,采取单侧肺通气的麻醉方式,经电子纤维支气管镜下使用氩气、冷冻、电凝三种介入治疗相结合的方式将左主支气管腔内的MEC清除。结果经电子纤维支气管镜下使用氩气、冷冻、电凝三种介入治疗相结合的方式将左主支气管腔内MEC清除,使用纤维支气管镜探入左肺上下叶,将阻塞管腔的大量塑性痰栓清理干净,使左肺重新复张。随访1月,无复发。结论对于腔内生长的MEC,未见周围气管浸润和淋巴结转移,采用电子纤维支气管镜下介入治疗的方法是一种无创、安全的方法。     

支气管镜下肺介入治疗在儿童获得性声门下狭窄中的应用

目的:探讨电子支气管镜下肺介入治疗儿童获得性声门下狭窄的价值。方法:回顾性分析2019年湖南省儿童医院重症医学科收治的8例获得性声门下狭窄患儿的临床资料,病例均在支气管镜下诊断,均在全麻喉罩、支气管镜下行肺介入治疗(激光、钳夹、冷冻、球囊扩张)。所有患儿接受6-12个月的随访。结果:8例患儿术后即刻均顺利拔管撤机,1例因吸气困难反复插管,染色体结果提示猫叫综合征,家长放弃治疗;1例因再次肺部感染家长放弃治疗。另6例患儿呼吸困难、声音嘶哑、喉鸣等症状明显改善,内镜下可见狭窄处明显增宽,4.0 mm内镜均能顺利通过;4例已达临床治愈,治疗次数约3.25次/例(13/4);2例症状消失,目前尚在随诊中;患儿均未见严重出血、窒息、呼吸衰竭等并发症。结论:支气管镜下肺介入治疗是解决儿童声门下狭窄的安全有效方法。     

经支气管镜介入治疗儿童原发性气道肿瘤八例分析

目的了解儿童气道肿瘤经支气管镜介入治疗的可行性。方法对2016年11月至2018年3月在首都医科大学附属北京儿童医院住院经支气管镜介入治疗的8例原发性气道肿瘤患儿的临床表现、介入治疗结果和预后情况进行回顾性分析。结果8例原发性气道肿瘤患儿中,男5例、女3例,年龄4岁8月龄至9岁2月龄。临床表现主要为咳嗽伴喘息6例、咯血3例和反复肺部感染2例,均无淋巴结转移及肺外转移。8例患儿均经支气管镜介入肿瘤切除,对4例富含血流的肿瘤患儿支气管镜介入治疗术前行肿瘤供血处支气管动脉栓塞术。术中及术后未发生大出血、气胸等并发症。4例为低度恶性支气管黏液表皮样癌,2例为炎性肌纤维母细胞瘤,1例为多形性腺瘤,1例为支气管平滑肌梭形细胞瘤。术后随访2~4年,复发3例,其中2例炎性肌纤维母细胞瘤患儿中,1例因病灶位置深行外科切肺治疗,1例联合化疗治疗后病灶稳定;1例黏液表皮样癌介入冷冻治疗后随访中。结论儿童气道肿瘤临床表现不典型,主要有干咳、喘息、反复肺部感染和咯血等症状。经支气管镜下介入治疗儿童气道内良性和低度恶性肿瘤,是一种可行的选择。     

局麻下儿童支气管镜及球囊扩张术在呼吸系统疾病中的临床应用

目的：研究支气管镜及介入治疗对小儿呼吸系统疾病的诊断、治疗价值及其安全性。方法：438例患呼吸系统疾病患儿（男性236人,女性202人）,年龄最小17 d,最大15岁,经局麻开展支气管镜术包括支气管镜下介入治疗。结果：经支气管镜检查确诊肺部感染311例,肺不张68例,反复咳喘36例,咯血6例,支气管异物6例,先天性支气管肺发育异常5例,支气管扩张症2例,纤毛不动综合征1例,肺部肿瘤1例,先天性免疫缺陷病2例。经支气管镜检查及局部冲洗或肺泡灌洗以及异物取出等处理后,379例显效,46例有效;5例炎症后狭窄行支气管镜下高压球囊扩张术,取得满意疗效。支气管镜检术中无严重并发症的发生。结论：局麻下行支气管镜术及球囊扩张术是安全、有效的,在儿科呼吸系统疾病的诊断和治疗上具有重要价值。     

努力发展和推广儿科支气管镜术

支气管镜术是一个安全、有效的疾病诊疗手段,应在我国儿科积极推广普及.但儿科在介入治疗肺部疾病方面明显落后于成人科.优良的设备和高超技术的引入,大大提高了儿科疾病的诊断水平.开展氩等离子体凝固术(氩气刀)、激光治疗术、冷冻术、球囊扩张气道成型术、气管支气管支架置入术等介入治疗方法在儿科的应用研究,使其在儿科潜在的诊断和治疗作用得到进一步发展.由于儿童和成人不同,将成人科介入治疗方法引入到儿科是一个科学研究和再创新的艰苦过程,对此要做好允分的思想准备.     

儿科介入呼吸病学技术进展

随着儿科支气管镜术的发展、临床经验的积累,适应证不断地扩大,其在儿童呼吸系统疾病中的作用越来越重要。现通过介绍近年来儿科支气管镜术的新技术,如经支气管镜球囊扩张术、经支气管镜消融术、经支气管镜支架置入术、经支气管镜肺活检术、经支气管镜针吸活检术等,简要阐述儿童介入肺科学新技术进展情况。     

肺功能检查在儿童难治性肺炎支原体肺炎诊疗中的意义

目的 探讨肺功能检查在儿童难治性肺炎支原体肺炎诊疗中的价值.方法 收集2015年5月至2016年2月期间在中国医科大学附附属盛京医院住院患儿58例,所有患儿均经临床确诊为难治性肺炎支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP),急性期行支气管镜检查及介入治疗并于镜前24h内行肺功能检测,对支气管镜下表现和同期肺功能数值进行分析.按照支气管镜下黏膜是否完整将镜下表现分为轻度组和重度组,记录每个患儿的常规肺通气功能指标.结果 RMPP患儿镜下表现重度组急性期肺功能的大气道通气指标(FVC、FEV1、PEF)和小气道通气指标(FEF25、FEF50、FEF75、FEF25-75)较轻度组均降低,二者有显著统计学差异(P＜0.05).结论 RMPP急性期可出现不同的肺功能表现,包括肺功能正常、限制性或阻塞性或混合性通气功能障碍,最常见的是小气道功能改变,提示肺炎支原体感染后极易引起小气道受累.RMPP急性期镜下表现越重,同期的肺功能指标下降程度越重.通过肺功能检测对预测RMPP的严重程度及早期识别具有一定作用.肺功能指标对判断支气管镜介入治疗指征及评价介入治疗效果提供了更充分的依据.     

球囊扩张术在现代儿科介入呼吸病学的应用

球囊扩张术主要用于儿童良性气道狭窄的治疗。是一项安全、简便、微创的治疗手段,在一些特殊异物取出及大咯血的治疗中也有重要作用。支气管镜下的介入治疗是一门综合治疗技术,球囊扩张术也需要与其他方法联合应用。     

经支气管镜治疗儿童塑型性支气管炎的疗效

塑型性支气管炎(PB)是引起儿童严重呼吸窘迫的一种呼吸急症,支气管镜在儿童PB的诊断及治疗中有重要作用,儿科临床医师应提高对其的认识水平,并熟悉掌握经气管镜治疗PB的时机、硬式气管镜或软式气管镜的选择、经气管镜介入治疗的疗效及支气管镜治疗的安全性,使更多的PB患儿在支气管镜的检查及治疗中获益。     

Breastfeeding perceptions in communities in Mangochi district in Malawi

Aim: To investigate mothers’ perceptions of breastfeeding and influences from their social network. Methods: A cross‐sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi‐urban mother–infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby‐Friendly facility, OR = 5.22; 95% CI (1.92–14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.     

胶原成分在儿童系膜增生性肾小球肾炎中的变化

目的观察系膜增生性肾小球肾炎（ＭｓＰＧＮ）系膜区胶原成分的变化。方法应用链菌素亲生物素过氧化酶连接法观察了３０例轻度ＭｓＰＧＮ肾穿刺活组织标本和正常的肾小球系膜区Ⅳ型胶原及其α链（α１、α３、α５链）、Ⅵ型胶原及Ⅰ型胶原的变化。结果（１）正常肾脏组织中，Ⅳ型胶原及其α１（Ⅳ）链分布于系膜区和基底膜，α３（Ⅳ）、α５（Ⅳ）链分布于基底膜，Ⅵ型胶原分布于系膜区、肾小球基底膜和间质，Ⅰ型胶原仅分布于肾间质。（２）在轻度ＭｓＰＧＮ时，系膜区内Ⅳ型胶原及其α１链、Ⅵ型胶原含量较正常对照明显增多（Ｐ＜０．０１）；当系膜区系膜细胞超过４个时，Ⅰ型胶原开始在肾小球内出现，且在硬化肾小球内Ⅰ型胶原均呈阳性；α３（Ⅳ）、α５（Ⅳ）链与正常对照比较无明显变化，硬化肾小球α３（Ⅳ）、α５（Ⅳ）染色呈阳性。结论系膜区胶原成分增多可先于系膜细胞增生，并随系膜细胞增生而增多，间质胶原成分Ⅰ型胶原，不但出现于硬化肾小球内，而且出现于系膜细胞增生较重时     

Cardiomyopathy in children in Ahmedabad

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2–5 years and 10–16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.     

Achalasia in siblings in infancy

Achalasia is rare in children, more so familial. We report two siblings with familial achalasia who presented in their infancy with vomiting and failure to thrive. Achalasia can be misdiagnosed as upper gastrointestinal obstruction as happened in one of our siblings. Esophageal contrast roentgenography is diagnostic. Both the children were treated successfully by transabdominal esophagomyotomy with fundoplication.     

哮喘大鼠气道重塑中尾加压素-的表达变化

目的：研究哮喘大鼠气道重塑血清和支气管肺泡灌洗液（BALF）中尾加压素 Ⅱ（U-II）含量的变化及其作用。方法：32只雄性Sprague-Dawley大鼠随机分为正常对照组、哮喘2周组、哮喘4周组和哮喘8周组,每组8只。以卵清白蛋白(OVA)致敏与激发建立哮喘大鼠气道重塑模型,图像分析技术测量大鼠支气管壁总面积和平滑肌面积,计算单位基底膜周径(Pbm)的支气管壁厚度(Wat)和平滑肌厚度(Wam),ELISA法测定血清和BALF中U-II的含量。结果：哮喘各组Wat及Wam均明显高于正常对照组（P<0.01）;哮喘组血清和BALF中U-II含量均显著高于正常对照组（P<0.01）,其中哮喘8周组血清和BALF中U-II含量显著高于哮喘4周组和哮喘2周组（P<0.01）,哮喘4周组也显著高于哮喘2周组（P<0.01）。各组大鼠BALF中的U-II含量与Wat及Wam呈正相关,BALF与血清中U-II含量亦呈正相关。结论：哮喘大鼠气道重塑血清和BALF中U-II含量增加;且U-II含量的变化与气道重塑相关。［中国当代儿科杂志,2010,12（4）：287-289］     

北京地区2007年儿童A群轮状病毒腹泻的流行病学研究

目的 研究北京地区急性腹泻儿童中A群轮状病毒(RV)感染的流行病学特点.方法 收集2007年4月至12月我院肠道门诊就诊的2039例急性腹泻患儿的粪便标本,采用标记金的A群RV单克隆抗体,以免疫层析双抗体夹心法定性检测A群RV抗原.结果 2039份粪便标本中,621份检测到A群RV,总检出率为30.5%(621/2039),其中男430例(69.2%),女191例(30.8%).RV感染者中,以6个月～2岁年龄段的患儿为最多,共571例(91.9%).检出率以10～12月份最高,均在30%以上,其中高峰出现在11月份,达43.4%.北京地区18个区县的统计数据显示,距市区较近的区县RV抗原检出率较低,边远区县较高.少部分患儿合并肠道细菌感染.结论 A群RV为北京地区2岁以下儿童急性腹泻病的主病原,6个月～2岁婴幼儿是A群RV的易感人群,10～12月份为北京地区的流行高峰.在流行季节对肠道细菌感染患儿常规进行A群RV抗原检测有助于避免漏诊和进行更合理的治疗.     

转流术治疗小儿精索静脉曲张

目的 采用转流术治疗小儿精索静脉曲张，重新建立精索静脉通道，使静脉回流受阻立即得到改善，消除因睾丸淤血而造成的损害，以利睾丸的正常发育。方法 对28例30侧(左侧26例，双侧2例)精索静脉曲张与腹壁下静脉进行吻合，通过腹壁下静脉，髂静脉转流，手术在放大镜下应用显微外科技术进行，其中28侧用精索静脉主干，2侧结扎一条属支，用另一条静脉进行吻合。结果 通畅率为100％。术后扩张迂曲静脉团消失，阴囊下坠感消失。术后随访24例，时间为3个月-10年。除1例二次手术证实为一条静脉属支漏扎而复发外，另23例全部治愈。结论 精索静脉曲张转流术效果明显优于结扎术，可减少因睾丸淤血对其造成的进一步损害，且术后复发率低。     

Poisoning in children in Japan

The Japan Poison Information Centre (JPIC) received 31510 inquiries about poisoning in children under 6 years old being exposed to poison in the fiscal year 1995. The most frequently implicated products were tobacco (20%) and the peak age for ingestion of household products was 1 year and younger (83.3%). Especially, the inquiries related to children less than 1 year old were 35.7% of the cases. In contrast, the American Association of Poison Control Centers (AAPCC) data showed that the most common poisonings were due to pharmaceutical products and the inquiries related to children less than 1 year old were only 12.1%. The objective of this report was to find out the poison exposure in children in Japan and to compare the data with that of AAPCC.     

Rotavirus infection in children in Japan

Currently, a high morbidity of rotavirus diarrhea has been seen in children in developed and developing countries. Improvement of the vaccines is necessary in order to reduce the burden of diarrhea caused by rotavirus. A survey of rotavirus infection from diarrheal stool specimens in children of seven regions in Japan was conducted from 1984 to 1999. The present study discusses the survey results and reviews the national and international data of more than 23 papers and congress proceedings about rotavirus infection in Japan. We analyze the prevalence of rotavirus infection in acute diarrheal in- and outpatients, the distribution of rotavirus G-serotypes and surveillance data for seasonality and age groups in Japan. The data indicated that rotavirus is the most important cause of diarrhea in Japan among young children, with the prevalence ranging from approximately 9.7 to 88%. The most common rotavirus strains belonged to serotype G1, specifically since 1993. Serotypes G2, G3 and G4 had also been documented to be predominantly based in the area and year before 1992. However, untypeable rotavirus strains had been found each year, with a prevalence up to 56.7% which suggests that rare serotypes (except G1-4) or new serotypes might exist. Unexpectedly, in Tokyo and Sapporo from 1998 to 1999, G9 was found to be the first most prevailing serotype with a high prevalence of 52.9 and 71.4%, respectively. Despite these data from different geographic areas, the year under investigation was relatively clear in respect to seasonality, with a peak of rotavirus activity in late winter (February) through early spring (March). Age distribution had also characterized that the infection was predominant among children aged 1-2 years of age, although it was also common in children of 2-3 years. In addition, mixed infection with bacteria was documented.