纤维支气管镜在小儿气管支气管异物诊治中的应用

应用硬质气管镜(简称硬支镜)治疗气管和一级支气管异物可获得满意效果[1-2].对于异物较小或硬支镜不能达到部位的支气管异物,纤维支气管镜(纤支镜FB)操作简便,逐渐成为重要工具[2-3].现将本院采用纤维支气管镜(纤支镜)诊治的小儿气管支气管异物12例报告如下.     

纤维支气管镜在小儿气管支气管异物诊治中的应用

目的探讨纤维支气管镜(纤支镜)在儿童气管支气管异物诊治中的应用价值。方法对2002—2006年在安徽省立儿童医院52例经纤支镜检查确诊为气管支气管异物患儿的临床资料进行回顾分析。结果异物主要发生在3岁以下婴幼儿(71·2%),男女之比为2·3:1,左侧(48·1%)略高于右侧(42·3%),以食物性异物为主(92·3%);症状主要表现为咳嗽、喘息、发热;影像学检查对深部异物有较高的漏诊率,易造成误诊误治。14例深部异物经纤支镜取出,38例气管、Ⅰ级支气管异物经纤支镜定性定位后由硬质气管镜取出,合并的肺炎、肺气肿、肺不张等并发症在异物取出后经支气管灌洗、抗感染等治疗均恢复正常。结论纤支镜在儿童气管支气管异物的诊断中发挥着重要作用,可作为深部支气管异物治疗的有效手段,其操作简便、安全,值得推广。     

小儿气管支气管软化症临床表现及纤维支气管镜诊断研究

目的　探讨气管支气管软化症的临床特征及发病情况。方法　对常规诊治无明显好转的持续喘鸣及慢性反复咳嗽患儿应用纤维支气管镜 (纤支镜 )检查 ,观察气管支气管内腔变化 ,并对镜下有感染灶者行纤支镜局部治疗。结果　诊断气管支气管软化症 6 0例 ,其中总气管软化症 35例 ,总支气管软化症 2 4例 ,支气管软化症 1例。在原发性气管支气管软化症 5 2例中 ,3例曾于新生儿期经历食管闭锁手术 ,2例伴有气管瘘 ,4例伴有胃食管反流 ;8例继发性气管支气管软化症均有管外压迫。 6 0例患儿中镜下发现喉软化 10例 (16 7% ) ,气管粘膜炎性狭窄、肉芽及化脓等炎症表现 5 0例 (83 3% ) ;经X线 ,肺CT等检查证实合并肺感染 38例 (6 3 3% )。结论　气管支气管软化症是引起小儿经常咳喘的病因之一 ,纤支镜是目前诊断气管支气管软化症的金指标。     

新生儿气管插管计算公式的探讨

在临床工作中，气管插管是新生儿急救常用的操作技术，要求快速，准确。新生儿气管插管的型号及深度，一般是按表方法选择，但临床应用中不易记忆，运用极不方便。为此，笔者依自己的临床经验，结合有关资料，总结出新生儿气管插管的型号及深度的快速计算公式，以供临床及教学参考。     

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。     

儿童小肠镜临床应用管理专家共识

小肠疾病是消化系统疾病诊治难点之一,检查技术有限,严重制约了儿童消化道疾病的诊疗水平。随着小肠镜在儿科临床应用的推广与小肠镜设备和附件的优化,小肠镜技术为儿科消化道诊疗提供了新的手段,但临床操作规范化和镜下治疗面临诸多问题和挑战。为规范儿童小肠镜诊疗技术及提高小肠疾病的诊疗水平,中华医学会儿科学分会消化学组牵头,组织专家充分讨论,并参考儿童小肠镜临床应用的最新进展,制定了儿童小肠镜临床应用管理专家共识。     

小儿光导纤维支气管镜引导三步气管插管技术的临床评估

目的 评价小儿光导纤维支气管镜(FOB)引导三步气管插管技术的可操作性和临床应用价值.方法 收治美国麻醉医师协会(ASA)Ⅰ级,年龄4～13岁,拟施择期外科手术患儿10例.常规静脉麻醉诱导,通过ID为5.5 mm的成人型FOB引导将ID为7.0 mm的较粗气管导管顶在声门口,小心退出FOB(第1步);在人工通气证实气管导管是位于喉口后,经较粗气管导管向气管内插入一根合适的可通气性气管导管交换芯(VETC),沿VETC退出较粗的气管导管(第2步).然后沿VETC将润滑良好且直径合适的细气管导管插人气管内(第3步).记录整个气管插管操作所需的时间和操作中遇到的困难及其采取的辅助措施,手术后随访有无呼吸道并发症发生.结果 本组患儿10例FOB引导三步气管插管成功100%.在沿VETC推送气管导管时,虽然2例小儿因润滑不满意和VETC外径不合适出现了沿VETC推送气管导管困难的情况,经过相应的处理措施均被有效解决.完成气管插管所需的时间为(124.1±15.2)s.所有患者手术后随访未发现呼吸道并发症.结论 在小儿,FOB引导三步气管插管技术具有操作简单、成功率高的优点,该方法可有效解决无法将成人型粗直径FOB应用于小儿困难呼吸道处理的临床难题.     

经支气管针吸活检术在儿科中的临床应用现状及展望北大核心CSCD

经支气管针吸活检术（transbronchial needle aspiration,TBNA）是采用特制的带可弯曲导管的穿刺针,通过支气管镜活检通道进入气道内,穿透气道壁对气管、支气管腔外病灶进行穿刺吸引,获取气道壁、肺实质以及邻近支气管树纵隔内病变部位的细胞学、组织学或微生物学标本的一种新技术。1949年,阿根廷医生Schieppati将1根直径1mm钢针通过硬质气管镜吸取隆突下淋巴结进行活检,协助食管癌或支气管癌的诊断,当时尚未引起世人关注。     

儿童食管异物现状及硬质食管镜的临床应用研究

目的结合儿童食管异物现状,分析硬质食管镜在儿童食管异物取出术的临床应用价值。方法分析南京医科大学附属儿童医院2016年4月至2017年6月收治的186例食管异物患儿,术前常规检查,选取食管异物未脱落食管以下消化道患儿148例,行全麻下硬质食管镜异物取出术。结果 186例中硬币类异物138例(74.2%)、鱼刺骨头类27例(14.5%)、食物类8例(4.3%)、纽扣电池类2例(1.1%),其他11例(5.9%)。嵌顿第一狭窄处多,有177例(95.2%)。就诊时间24 h 155例(83.3%)。术前常规检查有37例患儿食管异物脱落食管以下消化道,电话随访36例自行排出,其中1例患儿行胃镜下取出;自行吐出异物1例。148例患儿行全麻下硬质食管镜下食管异物取出术,成功取出异物144例,其中2例异物为骨头类术中未见,术后复查排除食管异物,2例异物为硬币的术中脱落至食管以下消化道,出院后自行排出;148例患儿术后无明显并发症。结论根据患儿异物性质,选取适合的手术方式,硬质食管镜在儿童食管异物取出术中仍有重要的临床价值。     

PICU患儿气管切开49例临床分析

ＰＩＣＵ患儿气管切开４９例临床分析北京儿童医院急救中心（１０００４５）耿荣，陈贤楠，李克华，张锡沛，王雷，樊寻梅自从聚氯乙烯和硅胶聚乙烯气管插管应用以来，需要机械通气的危重患儿绝大多数使用这种导管作气管插管，它刺激性小，操作方便。但气管插管并不是应用...     

硬性支气管镜在婴幼儿食管异物取出术中的应用

目的：探讨硬性支气管镜在婴幼儿食管异物取出术中的应用价值。方法回顾性分析我们采用硬性支气管镜实施食管异物取出术的13例患儿临床资料。结果13例年龄小于1岁的食管异物患儿均在全麻下经硬性支气管镜成功取出异物。结论对于婴幼儿食管异物的诊治,硬性支气管镜是一种清晰度高、安全、适宜的工具,值得在临床上推广。     

Bronchoscopy precautions and recommendations in the COVID-19 pandemic

As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. When available single-use flexible bronchoscopes may be considered for use; devices are available with a range of diameters, and improved image quality and degrees of angulation. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children.     

Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma.

AIM: To investigate the safety of bronchoscopy and endobronchial biopsy in children with difficult asthma, and discuss the ethical issues associated with the procedure. METHODS: A three year prospective observational study was performed in two tertiary paediatric respiratory centres specialising in the management of children with difficult asthma. A total of 48 children with difficult asthma and 35 non-asthmatic children were studied. RESULTS: Flexible bronchoscopy was performed under general anaesthesia in 38 children with difficult asthma, and rigid bronchoscopy was performed in 10, following a two week course of prednisolone. Endobronchial biopsy was performed in 47 patients. Perioperative complications occurred in one asthmatic undergoing flexible bronchoscopy (desaturation) and in two undergoing rigid bronchoscopy (desaturation in one, and bronchospasm and desaturation in one). There were no cases of significant bleeding or pneumothorax among the asthmatics. Flexible bronchoscopy was performed in 35 non-asthmatic patients with a variety of clinical indications. The total number of perioperative complications was greater in the non-asthmatics undergoing flexible bronchoscopy than in the asthmatics (17 complications in 35 children versus one in 38). Fever requiring hospital admission was documented in two asthmatics following bronchoscopy. Four asthmatics reported an increase in symptoms in the week following bronchoscopy. CONCLUSIONS: Bronchoscopy and endobronchial biopsy under general anaesthesia can be performed safely in children with difficult asthma, when the bronchoscopist and anaesthetist are suitably trained. The procedure is acceptable to the families involved.     

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.     

Management strategies in foreign-body aspiration

Objective  The aim of this study is to outline a management algorithm to ensure effective teamwork in decreasing morbidity and mortality in pediatric Foreign-Body Aspirations (FBA). Furthermore, the role of flexible bronchoscopy when compared to rigid bronchoscopy in FBA was evaluated. Methods  Charts of patients with suspected FBA from October 1999 to September 2006 were reviewed and data with regards to the history, presenting symptoms, diagnostics and therapeutic tactics, was collected. Results  A total of 77 children with suspicion of FBA were managed in the 7 year period. Bronchoscopies were performed in 63 patients and in 26 foreign-bodies (FB) were found and extracted. At referral, 53 patients did not present acute respiratory symptoms, but had a positive history of FBA, and in 13 FB were found. Despite negative chest x-rays in 55 patients, FB were found in 8. Rigid bronchoscopy was performed in 53 and flexible in 10 patients. In 3 out of 10 patients who had undergone flexible bronchoscopy a FB was identified, the extraction of which was performed using a rigid bronchoscope. Conclusion  Clinical and radiological findings in children with typical history of suspected FBA are not enough to confirm the presence of FB. Successful management with an extremely low rate of morbidity and no mortality was observed using the algorithm used at our center. Flexible bronchoscopy reduces the chances of airway tract injury; however a rigid bronchoscope is necessary for FB removal.     

Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma

AIM—To investigate the safety of bronchoscopy and endobronchial biopsy in children with difficult asthma, and discuss the ethical issues associated with the procedure.METHODS—A three year prospective observational study was performed in two tertiary paediatric respiratory centres specialising in the management of children with difficult asthma. A total of 48children with difficult asthma and 35 non-asthmatic children were studied.RESULTS—Flexible bronchoscopy was performed under general anaesthesia in 38 children with difficult asthma, and rigid bronchoscopy was performed in 10, following a two week course of prednisolone. Endobronchial biopsy was performed in 47 patients. Perioperative complications occurred in one asthmatic undergoing flexible bronchoscopy (desaturation) and in two undergoing rigid bronchoscopy (desaturation in one, and bronchospasm and desaturation in one). There were no cases of significant bleeding or pneumothorax among the asthmatics. Flexible bronchoscopy was performed in 35 non-asthmatic patients with a variety of clinical indications. The total number of perioperative complications was greater in the non-asthmatics undergoing flexible bronchoscopy than in the asthmatics (17 complications in 35 children versus one in 38). Fever requiring hospital admission was documented in two asthmatics following bronchoscopy. Four asthmatics reported an increase in symptoms in the week following bronchoscopy.CONCLUSIONS—Bronchoscopy and endobronchial biopsy under general anaesthesia can be performed safely in children with difficult asthma, when the bronchoscopist and anaesthetist are suitably trained. The procedure is acceptable to the families involved.     

Utility of multidetector CT and virtual bronchoscopy in tracheobronchial obstruction in children

Purpose: The aim of this study was to evaluate the potential use of multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation of tracheobronchial patency in children with suspected bronchial obstruction and to compare its findings with fibreoptic/rigid bronchoscopy or surgery. Patients and methods: A total of 43 children (15 girls, 28 boys) with clinically suspected bronchial obstruction underwent contrast enhanced MDCT, using an age‐ and weight‐ adjusted low dose protocol. Post‐processing was performed and VB and multiplanar reformations (MPR) were obtained at the same sitting. Findings obtained at MDCT and VB were compared with fibreoptic/rigid bronchoscopy and surgery. Results: Obstructive pathology was found in 26 children, which included endoluminal foreign body, mucus plugs in 13 children, endobronchial tumour in three children and extrinsic compression (lymph node, aberrant Vessels, mediastinal cysts/tumours) of the tracheobronchial tree in 10 children. In 17 children, no obstructive lesion was identified. Excellent positive correlation was obtained, between MDCT‐VB and bronchoscopy/surgery, however, in one child with endobronchial obstruction caused by tracheitis, low dose MDCT‐VB was normal, but bronchoscopy revealed granularity and plaques. Conclusion: MDCT‐Virtual bronchoscopy is useful in evaluating bronchial stenosis and obstruction caused by both endoluminal pathology and external compression and has the advantage of looking beyond stenosis. Its main application lies in providing the exact location of suspected foreign body, prior to bronchoscopy. However, it fails to disclose exact nature of obstructing pathology.     

Foreign body aspiration in children: diagnosis and treatment

A total of 235 children, aged between 7 months and 15 years had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of symptoms, signs, and chest x-rays, and rate of negative bronchoscopy. The sensitivity of choking and coughing was high (82% and 80%), but the specificity was poor (37% and 34%). The sensitivity of a chest radiograph was 66%, the specificity was 51%. The sensitivity of asymmetric auscultation was 80% and specificity was 72%. The sensitivity and specificity of combination of symptoms, signs and abnormal chest radiograph was 61% and 83%, respectively. In 206 (87.7%) children a foreign body was identified and extracted. The remaining 29 patients (12.3%) had negative bronchoscopy. A wide variety of objects was recovered, the most common being seeds and peanuts. Foreign bodies were in the right and left main bronchus in 72 (35%), 50 (24.3%) cases, respectively, while in the remaining 84 cases, the foreign bodies were in other parts of the respiratory tree. In 204 (99%) patients with foreign body aspiration, the foreign bodies were removed successfully using a rigid bronchoscopy. Minor complications like subglottic edema and bronchospasm occurred in 4 children. In conclusion, rigid bronchoscopy is a safe procedure and the only tool that will give certainty about the correct diagnosis of foreign body aspiration in children. Asymmetric auscultation is more specific than history and chest radiograph. The combination of history, clinical signs and radiological signs are more specific than each one separately.     

CT virtual bronchoscopy: New non invasive tool in pediatric patients with foreign body aspiration

A 2-year-old girl presented with recurrent cough, wheese and breathing difficulty. Her imaging (CT and virtual bronchoscopy) revealed a foreign body in tracheobronchial tree, that was removed by rigid bronchoscopy.