先天性气管支气管异常51例临床分析

目的分析经支气管镜检查诊断的先天性气管支气管异常患儿的临床特征。方法回顾分析了2003年1月至2007年11月在深圳市儿童医院接受诊断性支气管镜检查的135例患儿的结果,135例均采用异丙酚为主的静脉复合麻醉。结果共检出先天性气管支气管异常51例,检出率为37.8%(51/135),依次为气管、支气管软化32例,气管、支气管狭窄13例,气管性支气管11例,其中5例为2种或2种以上气道异常。21例患儿接受胸部CT检查,仅7例CT作出了正确诊断。对治疗反应不佳的喘息是先天性气管支气管异常最常见的症状,其他症状包括持续性局限性肺炎、肺不张或局限性肺气肿,气管插管困难,插管后拨管失败。18例(35.3%)合并其他部位畸形,分别为先天性心脏病、喉软化和气管食管瘘。结论先天性气管支气管异常在临床上并不少见,但其临床表现缺乏特异性,因此对可疑患儿应及时进行支气管镜检查以明确诊断。

CKnical study on children with congenital tracheobronchial anomalies

Objective To investigate the clinical features of 51 patients with congenital tracheobronchial anomalies (TBA) diagnosed by bronchoscope.Methods Totally 135 patients receiving diagnostic bronchoscope procedures from January 2003 to November 2007 in Shenzhen Children's Hospital were retrospectively analyzed.All procedures were performed under anesthesia with propofol.Results Totally 51 of 135(37.8%) patients were identified as congenital TBA,the tracheal or bronchial malacia were in 32,tracheal or bronchial stenosis were in 13,and tracheal bronchus were in 11;5 patients had more than two types of TBA.Only 7(30%) of 21patients who received chest CT scan were initially diagnosed correctly.Difficult-to-control wheeze was the most common symptom in the patients with TBA,and other symptoms included localized persistent pneumonia,atelectasis,localized hyperinflation,difficult intubation,and failure to withdrawal of endotracheal tube.In 51 patients,18 (35.3%) had 3 associated disease including congenital heart disease,laryngomalacia,tracheoesophageal fistula.Conclusion Congenital TBA is not unusual in pediatric patients,and its clinical features lack specificity.The bronchoscopy should be performed early in the suspected patients for definite diagnosis.