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。

A study on tracheobronchomalacia in children

Objective To explore the clinical features,diagnositic criteria and treatment of trachcobronchomalacia in children.Methods Children with persistent wheezing or intractable cough were explored by flexible bronchoscopy in Beijing Children's Hospital.Results 60 patients were determined to be as tracheobronchomalacia ,in which 35 were tracheomalacia,24 tracheobronchomalacia and 1 bronchomalacia.Most of them had been mis dignosed as infants asthma,reactive airway disease before.In 52 patients with primary tracheo broncomalacia, 3 cases were operated during the neonatal period because of oesophageal atresia,2 accompanied by tracheoesophageal fistula and 4 by gastroesophageal reflux.Extrinsic compression of the trachea was found in 8 patients secondary tracheobronchmalacia.Of the 65 patients,10 (16.7%) were laryngomalacia,50(83.3%)tracheostenosis.Conclusins Tracheobroncomalacia is one of the reasons in causing wheezing and cough of children.Flexible bronchoscopy can be regarded as a "golden criteria"for diagnosis of tracheobroncomalacia.