软式支气管镜在儿童呼吸系统疾病中的应用

目的探讨软式支气管镜在儿童呼吸系统疾病中的临床应用价值。方法对80例因呼吸系统疾病住院(包括重症肺炎、肺炎支原体肺炎并肺不张/肺实变/局限性肺气肿、迁延性肺炎、咳喘原因待查、慢性咳嗽查因、喉喘鸣)接受软式支气管镜检查/肺泡灌洗治疗患儿的临床资料进行回顾性分析。结果支气管镜检查发现,80例患儿均有支气管内膜炎症,其中分泌物严重雍塞气道28例。在支气管内膜炎症基础上合并先天性气道发育异常24例,另发现支气管异物3例。咳喘原因待查及喉喘鸣的患儿中,部分患儿存在先天性气道发育异常或支气管异物等病变。27例肺炎支原体肺炎患儿中,分泌物严重雍塞/栓塞气道26例;25例患儿(93%)在肺泡灌洗治疗后2周复查胸部影像学,显示肺部完全或大部分复张。行支气管镜检查的80例患儿中,术中出现严重低氧血症3例,鼻出血1例,肺泡灌洗术中少量出血1例,支气管短暂性痉挛3例,术后发热5例,均经对症处理后好转。结论软式支气管镜在儿童呼吸系统疾病的临床应用是安全可靠的。重症/难治性肺炎支原体肺炎患儿建议早期行软式支气管镜下肺泡灌洗治疗,可改善预后。反复咳喘及持续喉喘鸣患儿均建议积极行软式支气管镜检查,内镜直视下了解咽喉部及气道情况,避免误诊和漏诊。     

纤维支气管镜在儿童咯血病因诊断和治疗中的价值

目的评价纤维支气管镜在儿童咯血病因诊断及治疗中的价值及安全性。方法回顾性分析22例咯血患儿纤维支气管镜检查结果及临床资料。结果引起咯血的主要疾病为支气管、肺部炎症8例(其中伴支气管扩张2例),支气管异物3例,特发性肺含铁血黄素沉着症3例,气道内肿物2例,疑诊肺血管发育异常4例(未行血管造影确诊),原因不明2例。术中并发低氧血症2例。6例患儿镜下有活动性出血,局部予有效止血治疗;3例患儿于右肺下叶取出支气管异物;1例肉芽组织增生导致的肺不张患儿实施病变部位冷冻治疗2次,2周后支气管镜复查阻塞气道的肉芽组织消失,CT检查肺不张消失。结论纤维支气管镜检查是咯血患儿必要且安全的检查方法之一,具有重要的临床诊断和治疗价值。     

纤维支气管镜在呼吸系统疾病的应用

目的　提高纤维支气管镜在儿科呼吸系统疾病的诊断和治疗水平。方法　对行纤维支气管镜 (纤支镜 )术 15 4例患儿的临床资料进行总结。结果　共进行 165例次纤支镜术 ,治疗 68例肺部感染、14例肺不张、10例吸入性肺炎 ;为 3 9例疑为支气管异物者明确诊断 ,取支气管异物 12例 ;对 2 3例反复咳喘的患儿检查 ,发现 7例支气管软化症 ,3例为支气管结构异常。结论　纤支镜术有助于儿科呼吸系统疾病的诊断和治疗。     

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目的探讨高压球囊扩张术在儿童支气管狭窄临床应用中的疗效及安全性。方法对天津市儿童医院2010年6-12月住院的5例支气管狭窄患儿(包括先天性狭窄1例),经支气管镜进行高压球囊扩张术,每次球囊扩张1～3min,对比术前及末次球囊扩张术后胸片的改变,并定期随访1～6个月。对其临床资料进行回顾分析。结果 5例患儿经高压球囊扩张2～4次,狭窄段支气管管腔明显增宽,临床症状及体征明显改善,复查胸片肺实变及肺不张均有不同程度好转,肺气肿明显减轻。随访1～6个月,4例肺炎肺不张患儿复查胸片基本正常,1例先天性狭窄患儿未再出现高调金属样咳嗽,胸片示肺气肿消失。结论经支气管镜高压球囊扩张术治疗儿童支气管狭窄是一种安全、有效、简便的方法。     

电子支气管镜在小儿不明原因呼吸困难疾病诊断中的应用

目的 探讨电子支气管镜在小儿呼吸困难疾病中的诊断价值.方法对53例临床表现为呼吸困难且常规内科治疗无明显好转的患儿行电子支气管镜检查,并对临床资料进行回顾性分析.结果 53例不明原因呼吸困难患儿中喉-气管-支气管软化22例,气管支气管畸形15例,支气管异物4例,肿瘤或支气管赘生物4例,肺结核1例,肺出血1例,未发现异常6例(考虑炎症所致),总诊断率为88.6%.结论电子支气管镜在小儿呼吸系统疾病中具有诊断和治疗双重作用,值得推广应用.     

支气管镜与多层螺旋CT在婴儿先天性呼吸系统发育异常中诊断价值的比较

目的 比较支气管镜与多层螺旋CT在婴儿先天性呼吸系统发育异常中的诊断价值。方法 对行支气管镜或/和多层螺旋CT检查,诊断为先天性呼吸系统发育异常的319例患儿(年龄≤1岁)的临床资料、支气管镜结果、CT检查结果等进行分析。结果 319例患儿中,先天性呼吸系统发育异常476例次,包括原发性呼吸系统发育异常392例次和外压性呼吸系统发育异常84例次。392例次原发性呼吸系统发育异常中,支气管镜确诊225例次(57.4%),高于多层螺旋CT(167例次,42.6%)。支气管镜与多层螺旋CT诊断先天性呼吸系统发育异常的病因构成差异有统计学意义(P<0.05)。气管支气管软化致原发性呼吸系统发育异常76例次,均通过支气管镜检查确诊。肺组织发育异常致原发性呼吸系统发育异常17例次,均通过多层螺旋CT确诊。外压性呼吸系统异常84例中,多层螺旋CT确诊74例次,支气管镜确诊仅10例次。结论 支气管镜检查较多层螺旋CT更易直观发现原发性呼吸系统发育异常,且对气管支气管软化有确诊价值。多层螺旋CT对肺组织发育异常的诊断价值高于支气管镜。     

儿童塑型性支气管炎7例北大核心CSCD

目的分析儿童塑型性支气管炎7例患儿临床资料,复习相关文献,以提高对本病临床特征、诊断及治疗的认识。方法对2006年9月至2012年3月南京医科大学附属南京儿童医院收治的7例塑型性支气管炎患儿（2～12岁）的临床资料进行回顾性分析。其中男6例,女1例。主要表现为咳嗽、喘息、呼吸困难。患儿行纤维支气管镜或硬质支气管镜检查及呼吸道内异物取出术,辅以氧疗、抗感染、雾化等治疗。结果7例患儿急性起病,6例主诉为咳嗽、气促,1例主诉为咯血,均出现呼吸困难、低氧血症。影像学改变：7例患儿均存在肺不张,3例并肺气肿,3例并胸腔积液。塑型阻塞部位在左侧支气管1例,右侧支气管6例。1例行硬质支气管镜术,1例行硬质支气管镜术后再次行纤维支气管镜术,5例仅行纤维支气管镜术。经1次手术治愈5例,2例需再次行纤维支气管镜内生性异物取出术,7例患儿取出物均为内生性支气管树状异物,组织病理示I型炎症型6例,Ⅱ型非细胞型1例。4例病情明显好转,3例治愈出院。结论儿童塑型性支气管炎病情危重,需紧急行纤维支气管镜或硬质支气管镜进行诊断和介入治疗,清除呼吸道内管型,可获得良好的治疗效果。     

小儿内生性支气管异物的临床特点及支气管镜术的应用

目的：探讨小儿内生性支气管异物的临床特点及支气管镜术应用的意义。方法：经胸部X 线片检查提示肺叶或肺段不张,支气管镜检查除外外界性支气管异物患儿106例,原发病：支原体肺炎62例,支气管结核24例,支气管肺炎16例,肾病综合征2例,喉气管支气管炎1例,毛细支气管炎1例;全部病例在原发病常规治疗的基础上进行支气管镜术;与同期住院80例外界性支气管异物的临床特点进行对比分析。结果：内生性异物性质：黏液栓子77例,干酪样物质24例,树枝状白色胶冻状物4例,血栓1例,片状伪膜1例;其中25例可见肉芽组织增生,原发病以支气管结核为主。外界性支气管异物组并发纵膈气肿、气胸4例,内生性支气管异物组无一例合并纵膈气肿、气胸;内生性支气管异物组需要重复行支气管镜术的次数较外界性支气管异物组高(P＜0.01)。结论：对内生性支气管异物行支气管镜术,其诊断及治疗意义肯定。［中国当代儿科杂志,2010,12（9）：712-714］     

多排螺旋CT在气管、支气管异物临床诊断中的价值

目的 探讨多排螺旋CT(MDCT)在小儿气管、支气管异物临床诊断中的价值.方法 回顾性分析临床高度怀疑气管、支气管异物且行MDCT扫描并行支气管镜检查的97例患儿的临床及MDCT表现.MDCT重建方法采用多平面重建(MPR)、CT仿真支气管镜(CTVB)、表面遮盖 (SSD)、最小密度投影(MinIP)等技术重建.结果 气管、支气管异物患儿大多数临床症状不典型,以喘息、咳嗽及肺部某一部位反复感染为常见症状.97例患儿中,异物种类以不透光植物性异物为主,且大多数位于肺叶、段以下支气管内及左、右主支气管.其中89例通过各种MDCT重建方式直接显示异物,并发现由异物所引起的阻塞性肺炎、肺气肿、肺不张及纵隔气肿等各类并发症.4例未显示异物,仅显示一侧阻塞性肺气肿及肺内斑片状炎症,支气管镜探查取出异物.4例经支气管镜检查,在MDCT提示异物的支气管管腔内未发现异物,其中2例为黏稠痰栓,此4例经抗炎治疗后肺部炎症及临床症状消失.在CT影像结果指导下行支气管镜检查,93例钳取到异物.MDCT诊断小儿气管、支气管异物准确性为95.9%.结论 MDCT在小儿气管、支气管异物诊断中有实用价值,但在使用时要密切结合临床病史及体征.     

纤维支气管镜术在PICU呼吸道危重症患儿中的应用

目的 探讨纤维支气管镜术(flexible fiberoptic bronchoscopy,FFB)在诊治PICU呼吸系统危重症患儿气道病变中的应用价值.方法 2010年7月至2011年1月本院PICU对189例呼吸系统危重症患儿实施FFB,其中157例(83.06％)患儿的年龄＜3岁.经鼻进镜226次,经气管插管进镜25次.将纤维支气管镜嵌入节段支气管中,向肺段注入生理盐水,进行支气管肺泡灌洗,然后将其吸出,进行病原学诊断.结果 189例患儿中,支气管肺泡灌洗液定量培养阳性80例,阳性率42.3％,其中G-杆菌51例,G+球菌21例,真菌8例.通过FFB诊断气管、支气管异物6例,呼吸道解剖结构异常31例.40例重症肺炎合并呼吸衰竭患儿经FFB肺泡灌洗治疗后,有效35例,无效5例.20例重症肺炎合并肺不张患儿中,16例经灌洗如雾化及全身用药后复张,4例好转.6例气管、支气管异物患儿经FFB全部取出.FFB过程中仅1例出现明显的心动过缓,紧急处理后缓解,无FFB相关的死亡病例.结论 PICU中FFB可安全用于呼吸系统危重症患儿,既可行病因诊断,又可行纤维支气管镜下的介入治疗.     

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目的探讨纤维支气管镜(纤支镜)术在小儿呼吸道疾病诊治中的价值和安全性。方法回顾性分析贵阳儿童医院呼吸科2004年8月至2011年3月期间,对病因不明或疗效不佳肺不张、反复喘息和慢性咳嗽及咯血等小儿呼吸系统疾病567例,应用纤支镜进行检查及治疗,通过镜下直视、支气管肺泡灌洗、支气管黏膜刷检、组织活检明确病因,肺泡灌洗及注药进行局部治疗,并评判其疗效和并发症发生情况。结果 567例患儿共进行纤支镜诊治术593例次,镜下表现最多的为支气管内膜炎,其次为气管-支气管异物和先天性支气管-肺-血管发育畸形。引起197例肺不张患儿的病因主要为气道炎症或肿胀阻塞115例(58.4%),其次为气道异物73例(37.1%)及支气管内膜结核和(或)干酪样改变3例(1.5%)。115例炎性肺不张经过支气管肺泡灌洗治疗2周79例(68.7%)肺大部分或全部复张,1月105例(91.3%)肺大部分或全部复张。在164例反复喘息/慢性咳嗽病例中气道炎症及黏液栓形成73例(44.5%),其次支气管异物34例(20.7%),先天性心肺发育畸形25例(15.2%)及支气管内膜结核7例(4.4%)。119例发现支气管异物,其中98例(82.4%)用纤支镜取出。气管黏膜刷检涂片找到革兰阳性和(或)阴性细菌127例(127/26448.1%),肺泡灌洗液细菌培养阳性59例(59/30219.5%)。593例次行纤支镜术的患儿中共有151例/次(25.5%)出现术中或术后并发症,均为一过性。大多并发症轻微、短暂。经相应对症处理后各不良反应均消失,无心跳、呼吸骤停及麻醉过敏等影响预后的严重并发症。结论纤支镜术是儿童肺部疾病鉴别诊断和治疗的重要手段之一,可为临床诊断及治疗提供可靠依据。虽然可有轻微并发症,但总体安全可靠。     

纤维支气管镜术在小儿慢性咳嗽诊断及治疗中的价值

目的 探讨纤维支气管镜(纤支镜)术在小儿慢性咳嗽诊断及治疗中的价值.方法 对2006年8月-2011年3月在本院应用纤支镜进行检查和(或)治疗的61例慢性咳嗽患儿的临床资料进行回顾性分析.病例均采用局部麻醉的方法,而且患儿均经临床程序排除咳嗽变异性哮喘和胃食管反流.通过镜下直视、支气管刷检及肺泡灌洗液,明确病因诊断;应用支气管肺泡灌洗、局部注药和钳取异物进行治疗,并对疗效做出评价.结果 61例患儿中男36例,女25例;年龄8个月～13岁.61例患儿镜下炎性改变21例(34.5％),先天性心肺发育畸形12例(19.7％),支气管异物10例(16.4％),上呼吸道咳嗽综合征8例(13.1％),支气管内膜结核7例(11.5％),未见异常3例(4.9％).气管黏膜刷检涂片找到革兰阳性细菌和(或)革兰阴性细菌12例(12/31例,38.7％),肺泡灌洗液细菌培养阳性5例(5/40例,12.5％),未找到抗酸杆菌和癌细胞.对镜下炎性改变重、有痰栓阻塞者经纤支镜行支气管灌洗治疗,取得较好疗效.10例支气管异物经纤支镜成功取出8例.结论 小儿慢性咳嗽经纤支镜检查发现以炎症及支呼吸管异物多见,婴幼儿期慢性咳嗽应警惕心肺发育异常及呼吸道异物.纤支镜检查对儿童慢性咳嗽的病因诊断与治疗具有重要价值,尤其对先天性心肺发育畸形及支气管细小异物的诊断有独特价值.     

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。     

纤维支气管镜术在反复喘息性疾病诊断及治疗中的应用

目的 探讨纤维支气管镜(纤支镜)术对小儿反复喘息性疾病的诊断及治疗价值.方法 收集本院2006年4月-2011年4月因反复喘息住院并应用纤支镜诊疗的72例患儿的临床资料.病例均在局部表面麻醉下行纤支镜术,通过镜下直视、支气管内膜刷检、支气管肺泡灌洗液病原学检查进一步明确病因,行支气管肺泡灌洗及注药等局部治疗,并评判其疗效和并发症发生情况.结果 72例反复喘息患儿镜下表现:支气管内膜炎改变45例(62.5％),支气管异物11例(15.3％),支气管软化10例(13.9％),支气管狭窄4例(5.6％),支气管内膜结核2例(2.8％).45例患儿支气管肺泡灌洗液病原学检查阳性5例(11.1％),其中肺炎克雷伯杆菌1例,肺炎支原体和支气管内膜结核各2例.镜下炎症改变重、分泌物黏稠、痰栓阻塞患儿经纤支镜支气管冲洗,咳喘明显减轻,取得较好疗效.11例支气管异物经纤支镜成功取出9例.12例行纤支镜术的患儿出现术中或术后轻微一过性并发症,经相应对症处理后均消失.结论 小儿反复喘息的病因以炎症、先天性发育异常及呼吸道异物多见,婴幼儿反复喘息应警惕心肺发育异常及呼吸道异物.纤支镜检查对儿童反复喘息的病因诊断具有重要价值.     

Atelectasis in children

BACKGROUND: In children with lower respiratory tract symptoms, the elicited signs are not enough to distinguish common diagnosis like pneumonic consolidation, foreign body aspiration and atelectasis. Radiology and bronchoscopy would identify the true nature of the etiology. DESIGN: Prospective study. SUBJECTS: Thirty five children with both acute and chronic lower respiratory tract symptomatology, were analyzed for clinical and radiological signs of atelectasis. RESULTS: There were 23 cases in the acute group and 12 in chronic group. Acute group included cases of pneumonia, foreign body aspiration and mucus plug syndrome. Chronic group included cases of congenital heart disease, endobronchial tuberculosis and bronchial stenosis. Clinical recognition of atelectasis on the basis of localized loss of breath sounds and mediastinal shift was seen only in a minority of cases (8/35). The presence of atelectasis in children with pneumonia, missed clinically were diagnosed by the presence of tracheal shift, elevated hemidiaphragm and silhouette sign. In 21 cases, silhouette sign was positive making it an important radiological sign. Twenty one children underwent either diagnostic or/and therapeutic bronchoscopy. Findings included foreign bodies (n = 5), mucus plugs (n = 4), narrowing of main bronchus (n = 4) and inflammatory mucoid secretions and narrowing of lumen (n = 8). There were no major complications. CONCLUSION: The diagnosis of atelectasis in children may pose difficulties and there is a need to have a high index of suspicion to exclude atelectasis in children with either acute or chronic respiratory tract symptomatology.     

Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children

Background: A significant proportion of cases of tracheobronchial foreign body aspiration due to life‐threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature. Methods: One hundred and eighty‐four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used. Results: The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X‐ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin. Conclusions: Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.     

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??Abstract: Objective To assess the efficiency and safety of the flexible bronchoscopic balloon dilatation tracheoplasty in children?? and discuss the optimal indication and combined therapy of central airway stenosis in children. Methods From July 2009 to April 2012?? 34 cases were diagnosed as central airway stenosis by chest CT scan and bronchoscpy in Shanghai Children's Medical Center??and received the treatment of the flexible bronchoscopic balloon dilatation tracheoplasty. The data about the efficiency?? complication and prognosis of the treatment were collected. Results In the 34 cases?? 16 cases were improved after the treatment and the overall response rate was 47.1%. According to the pathology of the stenosis?? these cases were divided into three types: 9 cases were membranous stenosis?? 5 cases were muscular stenosis and 20 cases were osseous stenosis. The response rate was 47.1%?? 100%?? and 20% respectively. According to the anatomy morphology of the stenosis?? 20 cases were short distance stenosis and the response rate was 75%?? 12 cases were long distance stenosis and the response rate was 8.3%?? 2 cases were funnel stenosis and the response rate was 0. Among these cases?? 3 cases accepted the operation of pulmonary artery sling and tracheal sliding angioplasty?? the total response rate being raised to 55.9%. The most common complication in the flexible bronchoscopic balloon dilatation tracheoplasty was transient oxygen desaturation. Conclusion The severity?? length?? pathology?? indication and time of the treatment should be considered completely before the flexible bronchoscopic balloon dilatation tracheoplasty. The balloon dilatation therapy is suitable for membranous with short distance stenosis. The combined interventional treatment is good for muscular stenosis??and the surgery and palliative treatment is an option for osseous with long distance stenosis.     

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??Abstract?? Objective To study balloon dilatation with cryotherapy under bronchoscope for subglottic stenosis in infants and young children??and to explore the efficacy of this new technology??the timing of treatment and safety. MethodFrom July 2009 to May 2014 in 28 SGS cases aged from 1 month to 3 years?? bronchoscopic balloon dilatation treatment with CO2 cryotherapy was performed?? and different types of SGS treated by minimal invasi were assessed regarding efficacy, complications and outcome. Results The infant SGS were divided into ??°~??° by severity?? and soft membrane SGS and scarring SGS by the causes of stenosis. ??° SGS included 16 cases, in which 8 cases soft membrane SGS were treated by balloon dilatation effectively?? 9 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 4 cases after combined therapy; ??° SGS included 8 cases?? soft membrane SGS were treated effectively in 2 cases?? 4 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 2 cases after combined therapy; ?? °SGS included 4 cases?? 1 case of soft membrane SGS and 1 case of scarring SGS responded well to integrated treatment .Conclusion MSCT and bronchoscopy assessment is used in grading the extent and causes of stratification in infants with subglottic stenosis?? and then we can select the appropriate treatment programs to improve the prognosis of the disease and improve life quality of SGS children.