纤维支气管镜术在小儿非异物性肺不张中的应用

Application of pediatric flexible fiberoptic bronchoscopy in management of non-foreign body atelectasis

目的探讨纤维支气管镜(纤支镜)术在儿科非异物性肺不张(肺不张)诊断和治疗中的应用价值。方法总结2004-2006年收治的387例行纤支镜术的肺不张患儿诊治结果。采用Olympus公司生产的BFXP40、BF3C30、BFP40三种型号的纤支镜,根据患儿年龄、体重选用不同型号的纤支镜。结果本组病例共进行425例次纤支镜术,纤支镜下发现病变352例,其中炎症214例(55.3%),其次为气道狭窄、软化及分支开口异常;未见明显异常35例。年龄不同,肺不张的病因不同,<1岁组气道软化、狭窄所占比例较大。全部病例均进行灌洗治疗。356例灌洗治疗后复查胸片或胸部CT显示,4周内完全复张253例(71.1%),部分复张74例(20.8%),未复张29例;3个月内完全复张305例(85.7%),部分复张42例(11.8%),未复张9例(2.5%)。结论肺不张的病因因年龄而异,<1岁患儿气道软化、狭窄所占比例较大。早期给予纤支镜下支气管肺泡灌洗可促使其尽早复张。

Objectives To explore the application of pediatric flexible fiberoptic bronchoscopy in management of non-foreign body atelectasis. Methods The flexible fiberoptic bronchoscopy records were retrospectively reviewed in 387 pediatric patients with non-foreign body atelectasis from 2004 to 2006. According to age and weight, 3 types of fiberoptic bronchoscopies were chosen, which were BFXP40, BF3C30 and BFP40 （Olympus Co.）. Results In 387 patients, flexible fiberoptic bronchoscopy were performed 425 times. Obvious lesions were observed in 352 cases. Inflammation was in 214 cases （55.3%）, followed by bronchial narrow and bronchomalacia. The causes of atelectasis were dependent on age, the bronchial narrow or bronchomalacia accounted for a high proportion in infants. All the cases underwent lavages. After lavage, the chest X-ray or computer tomography was rechecked. It showed that 253 patients （71.1%） had completely expanded, 74 （20.8%） partially expanded , 29 （8.1%） no progress within 4 weeks; then 305 （85.7%） had completely expanded, 42 （11.8%） had partially expanded, 9 （2.5%） no progress within 3 months. Conclusions The etiology of atelectasis depends on age. Early bronchoalveolar lavage might promote the expansion of collapsed lungs.