螺旋CT三维重建和纤维支气管镜对小儿气管支气管畸形的诊断价值

Diagnostic value of multi-slice helical CT and flexible bronchoscopy for congenital tracheobronchial anomalies in children

目的探讨螺旋CT三维重建和纤维支气管镜对小儿先天性气管支气管畸形的诊断价值。方法2004年2月至2008年6月间收住温州医学院附属育英儿童医院呼吸科，符合相应标准的0-14岁儿童128例，其中男86例，女42例；年龄〈3个月28例，-1岁53例，-3岁31例，-14岁16例。全部患儿给予螺旋CT和纤维支气管镜检查以明确有无先天性气管支气管畸形，利用诊断试验计算并比较螺旋CT与纤维支气管镜在诊断气管支气管畸形中的敏感性、特异性、阳性预测值和阴性预测值。结果（1）诊断为先天性气管支气管畸形共46例，其中气管支气管软化10例；支气管起源异常15例；气管支气管狭窄21例。（2）10例气管支气管软化均有纤维支气管镜检查明确；螺旋CT三维重建对诊断气管支气管起源异常的特异性和纤维支气管镜相仿，但敏感性明显高于纤维支气管镜；CT三维重建对诊断气管支气管狭窄的敏感性和准确率与纤维支气管镜相当。结论螺旋CT三维重建对气管支气管起源异常和支气管狭窄有较大的诊断价值，纤维支气管镜则能弥补CT对气管支气管软化诊断的不足，两者联合能有利于小儿气管支气管畸形的早期诊断。

Objective To investigate the diagnostic value of multi-slice helical CT and fiberoptic bronchoscopy tor congenital tracheobronchial anomalies in children. Methods From February 2004 to June 2008, 128 hospitalized patients aged 0-14 years including 86 boys and 42 girls were enrolled in the study. Congenital tracheobronchial anomalies were identified with multi-slice helical CT and fiberoptic bronchoscopy. The sensibility, specificity, positive prediction value and negative prediction value of multi-slice helical CT and fiberoptic bronchoscopy were calculated. Results There were 46 cases of congenital tracheobronchial anomalies, including 10 cases of tracheobronchial softening, 15 cases of abnormal origin of the tracheal bronchus and 21 cases of tracheobronehial stenosis. Ten cases of tracheobronchial softening were all diagnosed by fiberoptic bronchoscopy, the multi-slice helical CT had the similar specificity of diagnosing abnormal origin of the tracheal bronchus to fiberoptie bronchoscopy, but had higher sensibility. Both procedures had the same specificity and sensibility in diagnosis of tracheobronchial stenosis. Conclusion Multi-slice helical CT and fiberoptic bronchoscopy can compensate each other in early diagnosis of congenital tracheobronchial anomalies in children.