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.     

螺旋CT在小儿气管、支气管异物诊断中应用

气管、支气管异物是小儿最常见的意外事故，多见于学龄前儿童，严重者可引起窒息死亡，故及时准确的诊断极为重要。我们总结4年来我院应用螺旋CT诊断小儿气管、支气管异物的经验和研究结果，以探讨螺旋CT在小儿气管、支气管芹物诊断中的应用价值。     

螺旋CT多平面重建对支气管异物的诊断价值

目的探讨螺旋CT多平面重建技术对气管支气管异物的诊断价值。方法分析19例气管支气管异物的CT冠状位多平面重建表现，对比与普通X线透视、CT轴位及冠状位扫描的差异。结果螺旋CT多平面重建技术可清晰地显示出气管支气管腔内异物的位鼍、形态，阳性率（19／19例）高于传统X线透视（13／19例），CT轴位扫描（17／19例）及冠状位扫描（11／19例）。结论螺旋CT多平面重建技术在气管支气管异物的诊断中较普通X线透视、CT轴位及冠状位扫描有更大的优势。     

儿童气管支气管异物的临床特征分析

目的 了解儿童气管支气管异物的临床特征,为实施切实可行的预防措施提供依据。方法 回顾性分析2012年2月至2013年2月114例经纤维支气管镜确诊的气管支气管异物患儿的临床资料。结果 儿童气管支气管异物主要发生在1~3岁（71.9%）,男童多于女童,性别比为2：1。冬季发生比例高于夏季。农村儿童气管支气管异物的发生比例较城市高。不同部位气管、支气管异物的CT阳性率存在明显差异,气管异物病例的胸部CT阳性率明显低于左、右主支气管异物（PP结论 儿童气管支气管异物的预防相关健康教育应以农村地区为重点;气管支气管异物多发于1~3岁幼儿;对于气管支气管异物疑诊病例,需尽早行支气管镜检查确诊。     

螺旋CT三维成像对儿童气管狭窄的诊断价值

螺旋CT三维重建气管、支气管树成像（CT tracheobmnchography,CTB）是近年来用于气管、支气管病变新的检查方法,我们对15例患儿采用了CTB诊断气管狭窄,探讨其对气管狭窄的诊断价值。     

儿童气管支气管异物临床诊治探讨

目的探讨儿童气道不同部位异物的临床特征、诊治方法及应用硬气管镜、纤维支气管镜或开胸等治疗方法的最佳时机.方法回顾性总结首都医科大学附属儿童医院纤维支气管镜(纤支镜)室1990年12月至2003年12月间诊治的下气道异物临床资料;应用纤支镜对硬气管镜难以取出、又无开胸指征的气道异物进行治疗;追踪临床转归.结果经纤支镜诊断下气道异物192例,位于Ⅱ级以下支气管159例;年龄12d至14岁;病程4h至8年,3d内仅24例.食物性异物146例,小塑料制品异物22例,仅18例可通过X线检查确诊异物.临床特点45例无确切异物史,41例有反复呼吸道感染,5例因植物性及硬果壳类异物致咯血,滞留达7个月至3年.X线表现肺炎113例(58.9%),肺不张50例(26.0%),肺透光增强及支气管阻塞征各37例(19.3%),纵隔摆动或心影反常大小28例(14.6%),胸膜炎或胸腔积液12例(6.3%),异物远端支气管扩张7例(3.6%),25例(13.0%)X线正常.转归取出异物175例开胸14例(其中6例病肺叶、段切除);硬气管镜取异物47例56次(3例未取出);纤支镜取118例并灌洗吸入性肺炎14例,共380次.治愈149例,好转41例,2例未愈.结论支气管异物临床过程不同于气管异物,是慢性肺疾患的病因之一;纤支镜检查直观、操作灵巧,可以发现硬气管镜和X线检查所不能发现的支气管异物,在治疗上弥补硬气管镜和单纯药物治疗的不足,避免慢性肺疾患的发生和发展.     

多层螺旋CT三维气道重建在支气管狭窄诊断中的临床应用研究

目的 探讨多层螺旋CT(MSCT)三维气道重建在支气管狭窄诊断中的应用价值.方法 10例临床上疑似支气管狭窄的患儿行MSCT三维气道重建检查,并对其临床资料进行分析.结果 MSCT三维气道重建成像清晰,完整显示段以上支气管气道狭窄的部位、大小、形状;其中2例经纤维支气管镜检查,与之相吻合.结论 MSCT三维气道重建在支气管狭窄诊断中有较高的临床应用价值,特别是对于婴幼儿或无条件行纤维支气管镜检查患儿更具有使用价值.     

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??Objective To evaluate the clinical characteristics of children with trachea or bronchus foreign body. Methods The data of 84 children with confirmed diagnosis of trachea or bronchus foreign body was retrospectively analyzed in this study form Jun 2011 to Jun 2016 in Tianjin Children Hospital??including general situation??history of foreign body aspiration??medical history??course of disease??foreign body property??clinical and imaging characteristics. Results The rate for tracheobronchial foreign body occurring in boys and girls were 2.23??1 with the main incidence age of 6 months to 3 years old. The incidence rate in countryside was higher than that in city??69.05% vs. 30.95%????especially boys in countryside. Children who are able to provide an accurate history of foreign body aspiration may be helpful in early diagnosis and treatment of trachea or bronchus foreign body??P??0.05??. The main type of foreign body was food??especially nuts. The proportion of bronchial foreign body which remained in the left or right main bronchial tubes was not different??but the number of cases in right lobe was higher than that in the left. The clinical symptom was different according to the different lesions with block of foreign bodies. The main symptom was cough??98.81%?? and breezing??58.33%????with the imaging characteristics of emphysema ??55.95%??. Conclusion In prevention and control of tracheobronchial foreign bodies??boys under the age of 3 should be paid most attention to in rural areas. The children should be reduced contact with nuts food. The guardian must attach more importance to tracheobronchial foreign body. For children with symptom of cough and wheezing weakening breathing sounds on single side by physical examination??emphysema and pulmonary atelectasis on imaging??health providers should pay attention to the history of foreign body aspiration or cough history??and should actively perform bronchoscopy for early diagnosis and treatment.     

三维CT对支气管异物诊断价值的临床研究

目的 探讨三维CT在支气管异物诊断和鉴别诊断中的作用.方法 对37例可疑支气管异物的患儿行螺旋CT检查,并进行支气管三维CT重建,通过支气管镜检术、保守及手术治疗的结果 判断三维CT检查结果 的准确性.结果 37例可疑支气管异物的患儿中,X线胸部透视提示支气管异物8例(A组);X线胸部透视不提示支气管异物29例(B组).A组中,CT提示肺内感染5例、先天性肺发育异常-肺叶缺如2例、气管食管瘘1例.B组29例患儿中,CT提示支气管异物25例,经支气管镜检证实其中24例存在植物性异物,1例为气管内肿物;CT不提示支气管异物4例,证实为肺内感染、小儿急性喉炎各2例.手术证实存在植物性异物的24例中,CT显示气管支气管内异物影共14例次,不规则狭窄共6例次;阻塞性肺不张、肺气肿、肺炎共7例次;前两项为直接征象,占74%(20/27),后三项为间接征象,占26%(7/27).结论 三维CT检查对支气管异物的诊断及鉴别诊断有重要意义,有助于疑难病例的诊断和鉴别诊断.     

Atypical intrathoracic rib in a pediatric patient requiring helical CT scan with 3-D reconstruction for diagnosis

Intrathoracic rib is a rare congenital anomaly that is usually discovered incidentally. It represents a benign lesion but can mimic intrathoracic pathology, so it is important to recognize it to prevent further unnecessary investigation or intervention. Typically, the classic appearance allows diagnosis with confidence on the chest radiograph alone; however, an atypical appearance of an intrathoracic rib might limit the diagnostic capabilities of plain radiography, warranting further imaging with newer technologies. We report the case of an atypical presentation of an intrathoracic rib in an 8-year-old girl where radiographs were inconclusive and helical CT scan with 3-D reconstructions were required for a definitive diagnosis.     

儿童气道异物取出术围术期发生呼吸系统严重并发症的危险因素分析

目的探讨儿童气道异物取出术围术期发生呼吸系统严重并发症的相关危险因素。方法入选263例行硬质支气管镜气道异物取出术患儿,根据术中及术后24 h内是否发生呼吸系统严重并发症分为并发症组和非并发症组,并通过比较两组患儿既往史、术前呼吸道感染率、异物存留时间、异物种类、手术时间、麻醉效果等差异,分析儿童气道异物取出术围术期发生呼吸系统严重并发症的独立危险因素。结果入选263例患儿中31例发生呼吸系统严重并发症,发生率为11.8%。单因素分析提示,与未发生并发症的患儿比较,发生呼吸系统严重并发症患儿的术前呼吸道感染率更高,异物存留时间更长,手术时间更长,麻醉效果不佳发生率更高,差异均有统计学意义(P均0.05)。多因素logistic回归分析显示:麻醉效果不佳(OR=11.07,95%CI:3.16~38.75)、术前有呼吸道感染(OR=2.99,95%CI:1.04~8.59)、手术时间越长(OR=1.07,95%CI:1.00~1.14)是儿童气道异物取出术围手术期发生呼吸系统严重并发症的独立危险因素(P均0.05)。结论对于麻醉效果不佳、术前合并呼吸道感染、手术时间长的患儿,需警惕气道异物取出术围手术期发生呼吸系统严重并发症,并采取相应预防措施。     

Clinical applications of computerized tomography 3-D reconstruction imaging for diagnosis and surgery in children with large liver tumors or tumors at the hepatic hilum

The present study assessed the benefits of 3-D reconstruction of spiral computerized tomography (CT) scans for the diagnosis of and surgical guidance to large liver tumors or tumors at the hepatic hilum. We retrospectively analyzed the cases of 18 children with large liver tumors or with tumors at the hepatic hilum treated in past 5 years. The ages ranged from 45 days to 14 years. Ten cases were examined using the three-dimensional reconstruction using 64 slice spiral CT and eight patients underwent conventional CT or conventional enhanced CT scanning. In 16 cases, the volume of tissue removed exceeded one-third the entire volume of the liver (considered “large” tumors). The largest tumor removed weighed 4.8 kg. In two cases, the excised tissue represented less than one-third of the total liver volume, but in these cases the location of the tumor was considered “complex” due to the proximity to major hepatic vessels. Seven tumors were located in the right lobe, three in the left lateral segment, three in medial segment, three extended beyond the right lobe and two extended beyond the left lateral segment. Pathological diagnoses included hepatoblastoma (n = 9), hepatocellular carcinoma (n = 2), mesenchymal hamartoma (n = 4), teratoma (n = 1) and adenoma (n = 2). The 3-D reconstructed images could be rotated to view the image from several sides, were semitransparent and allowed for the measurement of tumor size and determination of spatial relation to blood vessels. All 18 children had curative resections as indicated by “tumor-free” microscopic margins. No major intra- or postoperative complications were encountered. Three-dimensional CT imaging can provide high quality images of the tumors and location of the tumor relative to vital hepatic blood vessels. This technique offers a kind of comparatively accurate method compared with traditional imaging techniques, it could help the surgeon identify the tumor borders accurately and devise a comparative safe surgical strategy. With its help the surgeon could identify vital hepatic blood vessels before operation, so they can avoid massive hemorrhaging and avoid massive hemorrhaging during operation. This technique should be more widely applied in the resection of large or complex liver tumors.