外科治疗儿童支气管扩张症的单中心回顾

Review of single-center experience for surgical treatment of bronchiectasis in children

目的总结儿童支气管扩张症的外科诊治经验。方法回顾性分析2017年1月至2020年12月于四川大学华西医院小儿外科接受手术治疗的13例支气管扩张症患儿临床资料,其中男7例,女6例;年龄1岁3个月至15岁;均经术前高分辨率CT(high-resolution computed tomography,HRCT)及术后肺组织病理结果明确诊断,收集患儿治疗方法及预后情况。结果13例术前HRCT均提示局限性肺部支气管明显扩张伴管壁增厚,9例因异物或反复感染进展为支气管扩张不可逆期。11例行肺叶切除术,2例行肺段切除术,均获得满意疗效。术后病理检查结果提示支气管扩张的病因分别为:4例为先天性肺畸形,5例为异物吸入,1例为肺部感染,3例原因不明。术后并发症:皮下气肿4例,同侧或对侧肺部感染2例,肺不张1例,伤口感染1例;均经伤口换药、抗感染、雾化祛痰、翻身拍背及体位引流等治愈。门诊随访1~5年,患儿临床症状及生活质量均明显改善,复查胸部CT均恢复良好,随访过程中无一例复发。结论不同潜在病因所致支气管扩张症应采取不同的诊治策略,先天性肺畸形、异物吸入及终末期肺部感染是儿童支气管扩张症的主要手术指征。

Objective To summarize the surgical experiences of bronchiectasis with pneumonectomy in children.Methods From January 2017 to December 2020,retrospective review was conducted for clinical data of children with bronchiectasis undergoing pneumonectomy at West China Hospital.There were 7 boys and 6 girls with an age range of(15-156)months.A definite diagnosed was made with high-resolution computed tomography(HRCT)and postoperative histopathology.Results Preoperative HRCT revealed marked restricted pulmonary bronchodilation with tube wall thickening partly due to foreign bodies or recurrent infection progression to bronchodilation formation(irreversible period).The procedures were lobectomy(n=11)or segsectomy(n=2).The major causes were congenital lung malformations(n=4),foreign body(n=5),pulmonary infection(n=1)and unknown(n=3).Postoperative complications included subcutaneous emphysema(n=4,30.8%),ipsilateral or contralateral lung infection(n=2,15.4%),atelectasis(n=1,7.7%)and wound infection(n=1,7.7%).Cure was achieved after conservative treatments of wound debridement,antibiotics,atomization expectorant,turnaround,back-patting and postural drainage.The outpatient follow-up period was 1 to 5 years.All clinical symptoms and quality-of-life improved significantly post-operation.Re-examination of chest HRCT hinted at an excellent recovery and there was no recurrence during follow-ups.Conclusion Congenital lung malformation,foreign body inhalation and end-stage lung infection are three major surgical indications of bronchiectasis in children.Bronchiectasis caused by various causes should be treated according to their corresponding clinical characteristics.