儿童支气管扩张症22例临床分析

目的探讨儿童支气管扩张症的病因、临床表现、影像学改变、实验室检查以及治疗方法。方法对临床诊断为支气管扩张症的22例患儿的资料进行分析。结果患儿临床表现为进行性慢性持续性或间歇性咳嗽、咳痰、咯血、杵状指等;入院前多被诊断为支气管肺炎、哮喘或肺结核等;体液免疫异常16例(72.7%),细胞免疫异常15例(68.2%),普通X线胸片显示无异常4例(18.2%),高分辨率CT表现为单纯柱状即表现有双轨征3例(13.6%)、囊状葡萄串状阴影4例(18.2%)、蜂窝状2例(9.1%)、曲张形囊柱状即支气管呈粗细不均的改变6例(27.3%)、棒状或结节状2例(9.1%);病变累及左、右下叶12例(54.5%),右中叶8例(36.4%)。结论支气管扩张症的病因主要是肺部感染,病程迁延而危重,症状多持续或反复,易误诊或漏诊,依据临床表现和实验室以及必要的影像学检查是早期诊断的关键,治疗较困难,须采用综合治疗。

Clinical analysis of 22 children with bronchiectasis

Objective To investigate the etiology,clinical symptom,imaging change,laboratory examination and treatment of bronchiectasis in children.Methods Through epidemiological investigation,data of 22 pediatrics patients diagnosed with bronchiectasis were analyzed.Results Chronic continuously or intermittent cough,sputum,hemoptysis and clubbed fingers were the main clinical manifestation in patients and most of them had been diagnosed with bronchopneumonitis,asthma or tuberculosis and others before the hospital admission.There were humoral immunity deficiency(16/22 cases,72.7%),cellular immune deficiency(15/22 cases,68.2%),normal X-ray in chest(4/22 cases,18.2%).HRCT showed simple columnar change namely double-trace sign(4/22 cases,18.2%),cyst-like change(4/22 cases,18.2%)and alveolus change alveolar(2/22 cases,9.1%),expanded cyst-like columnar namely inhomogeneous change of bronchus(6/22 cases,27.7%)and nodule and rod-shape change(2/22 cases,9.1%).Conclusions The main cause of bronchiectasis in children was lung infection and its symptom and course were very serious and continuous.It was often misdiagnosed.Therefore,the key to early diagnosis depended on clinical symptom,laboratory examination and essential imaging data.The comprehensive treatment should be applied.