数字X线成像与多排螺旋CT对小儿呼吸道透X线异物检出效果的比较

目的 探讨小儿呼吸道透X线异物的临床特点,比较数字X线成像(DR)与16排螺旋CT对其的检出效果.方法 收集本院2007年1月-2011年1月收治的50例经纤维支气管镜检查证实为呼吸道异物患儿的临床资料.男28例,女22例；年龄10个月～11岁.有明确异物吸入史31例,可疑异物吸入史并伴相应症状3例.患儿均经DR行胸部正侧位检查,以及16排螺旋CT检查和CT呼吸道三维重建.结果 31例患儿首诊有异物吸入史,均有不同程度刺激性呛咳、发热、喘鸣等.体格检查发现呼吸音减弱32例,发绀21例,三凹征19例.50例患儿胸部DR均不能直接发现透X线异物；16排螺旋CT三维重建模拟支气管镜可直接发现呼吸道透X线异物.异物附着在管壁上或嵌顿于管腔内.胸壁双边影15例；节段性肺不张12例；纵隔双边影或纵隔移位8例；支气管扩张18例；肺部感染8例;肺野静止征16例.CT的诊断阳性符合率为96％,DR为62％.结论 16排螺旋CT对小儿呼吸道透X线异物的诊断及手术定位具有重要价值,与DR相比具有明显的优势.

Comparison of Digital Radiography and Multi - Slice Spiral Computerized Tomography in Diagnosis of Foreign Body through X Ray in Respiratory Tract in Children

Objective To investigate the clinical features of pediatric airway foreign bodies through X ray and to compare the diagnostic effects of digital X-ray imaging(digital radiography,DR) and 16-slice spiral CT detection for airway foreign bodies. Methods The clinical data of 50 patients from Ningxia People′s Hospital from Jan.2007 to Jan.2011,who were treated with fiberoptic bronchoscopy for airway foreign body were collected,28 cases were male and 22 cases were female,aged 10 months to 11 years.Thirty-one cases had a clear history of foreign body aspiration,3 cases had suspicious history of foreign body aspiration and accompanied with corresponding symptoms.All patients were detected by DR chest radiographs,16-slice spiral CT three dimensional reconstruction of the respiratory tract and CT. Results Thirty-one cases of children were initially diagnosed with the history of foreign body inhalation,and they had varying degrees of irritating cough,fever,wheezing,etc.Physical examination found 32 cases of children with decreased breath sounds,21 patients with cyanosis,and 19 patients with three depressions sign.Fifty cases of children with this information could not be directly found with DR chest X ray foreign body penetration;16-slice spiral CT three dimensional reconstruction of simulated bronchoscopy could directly show foreign bodies,the foreign attachment incarcerated in the wall or lumen.Fifteen cases were of chest wall bilateral shadow;segmental atelectasis in 12 cases;affect bilateral or mediastinal shift mediastinal in 8 cases;bronchiectasis in 18 cases;lung infection in 8 cases;and lung field still imposed in 16 cases.CT diagnosis of positive consistent rate was 96% and DR was 62%. Conclusions Sixteen-slice spiral CT had great value for detecting respiratory tract foreign bodies through the X ray diagnosis and surgical positioning,compared with the DR,it had obvious advantages.