纤维支气管镜诊治小儿气管支气管软化症53例分析

Analysis of 53 cases with bronchoscopically confirmed pediatric tracheobronchomalacia

目的探讨小儿气管支气管软化症(TBM)的临床特征,并分析纤维支气管镜术在其诊断中的价值。方法 2004年4月至2006年4月因诊治需要对229名患儿行纤维支气管镜术,依据术中直观检查诊断 TBM53例,对其内镜下病变特征、一般情况、临床表现、其他辅助检查、治疗及转归等进行综合分析。结果 (1)53例 TBM 中仅22例术前疑诊此病,另31例在术前的临床诊断主要为难治性肺炎及哮喘、原因不明肺不张等。(2)TBM 年龄构成:患儿年龄为1个月～8岁,<1岁41例,～2岁6例,～3岁4例,>3岁2例;性别构成:女10例,男43例。(3)TBM 病变部位:总气管软化11例,气管-支气管软化24例,支气管软化18例;两肺分布:左肺支气管软化12例;右肺支气管软化11例,左右肺均有软化19例;病变程度:轻度病变21例,中度病变25例,重度病变7例。(4)53例 TBM患儿中,临床表现为反复或持续喘息28例,慢性咳嗽16例,反复呼吸道感染5例,肺不张2例,呼吸困难2例。结论 TBM 多见于婴幼儿,临床表现多样,多有呼气性喘鸣和咳嗽;纤维支气管镜检查可提高其诊断准确率,避免漏诊、误诊。

Objective Tracheobronchomalacia is one of the common respiratory tract dysplasia in children. Its symptoms are nonspecific, and routine methods are unreliable in the assessment of tracheobronchomalacia in children. In addition, many physicians are confused about its clinical characteristics,so tracheobronchomalacia is often underdiagnosed. The purpose of this study was to explore the clinical features of tracheobronchomalacia in children and to investigate the diagnostic value of flexible bronchoscopy for children with tracheobronchomalacia. Method For diagnosis and treatment, 229 children out of 4725 patients hospitalized in the division of respiratory disorders were examined by Olympus BF3c-20 flexible bronchoscopy or by Olympus BF-P20 flexible bronchoscopy under general anesthesia with propofol, in Chongqing Children＇ s Hosptial from April 2004 to April 2006. Fifty-three cases were confirmed to have tracheobronchomalacia by bronchoscopy, patients＇ data including airway lesion, age, sex, clinical characteristics,aided examinations, treatment, final outcomes, were collected and analyzed. Results （1） Of the 53 children with tracheobronchomalacia, 31 were not suspected for this diagnosis prior to bronchoscopy,who were instead misdiagnosed as refractory pneumonia, difflcult-to-control asthma, bronchial foreign body, bronchopulmonary dysplasia and pulmonary atelectasis of unknown origin or bronchiolitis. （ 2 ） In the 53 children with tracheobronchomalacia aged one month to eight years ,41 were infants ,6 were younger than two years, 4 were younger than 3 years and the rest 2 cases were older than 3 years. The risk of tracheobronchomalacia related inversely with ages. Ten cases were girls and 43 were boys. （3） Eleven cases had tracheomalacia,24 bronchomalacia,18 tracheobronchomalacia; 12 cases had malacia on left lung, 11 on right lung,19 on both sides;21 children were mild cases, 25 moderate cases, 7 severe cases. （4） In the 53 children with tracheobronchomalacia, 28 had recurrent or prolonged wheezing, 16 chronic cough,5 recurrent respiratory infections,2 atelectasis of unknown origin, and 2 dyspnea. Conclusions The infants and toddlers seem to be predisposed more to the broncbomalacia than the older children. Clinical features of children with airway malacia were variable and atypical, expiratory stridor and cough are the most commonly reported symptoms. Flexible bronchoscopy should be regarded as a ＂golden standard＂ method for diagnosing TBM.