纤维支气管镜在大血管疾病合并气道狭窄中的诊断价值

Airway obstruction caused by large blood vessel anomalies：assessment by flexible bronehoscopy

目的评价纤维支气管镜（简称纤支镜）在先天性大血管病变合并气道狭窄中的诊断价值及安全性。方法回顾性分析2005年10月至2009年6月NICU收治的经纤支镜检查确诊气道狭窄的先天性大血管病变患儿34例，其中血管环10例，主动脉梗阻性病变24例，年龄6d-11个月，体重2．2～8．7kg[（4．6±1．4）kg]；记录纤支镜发现的气道狭窄情况、CT及手术所见确诊的心血管畸形及气道狭窄情况，总结分析纤支镜检查发现的气道狭窄与心血管畸形的关系、气道狭窄的处理及转归。结果所有病例均在NICU或手术过程中顺利完成纤支镜检查。（1）34例气道狭窄的首发症状为气促、喘鸣、反复肺部感染和呼吸机依赖。（2）10例血管环患儿均先经纤支镜检查，发现气道外压性狭窄，提示血管环，气道狭窄以气管下段为主；9例经CT、1例经手术证实为血管环，其中7例伴先天性气管狭窄。（3）24例主动脉病变中5例为术前CT提示气管狭窄，其中1例纤支镜提示气道狭窄，余19例在主动脉梗阻性畸形矫治术中、术后经纤支镜发现气道压迫狭窄。24例主动脉病变中21例有左主支气管狭窄，2例有先天性气管狭窄。纤支镜检查与CT检查对气管狭窄的诊断基本吻合。（4）34例纤支镜检查过程中2例出现一过性血氧饱和度下降，5例出现一过性心动过速，其余患儿无不良反应。结论纤支镜检查在大血管畸形伴气道狭窄的诊断中起重要作用，具有准确、安全、方便、快捷的优点，但对气管狭窄的情况、气管周围结构和血管畸形的了解需结合CT检查。

Objective To evaluate the diagnostic value and safety of flexible bronchoscopy in congenital great vessel diseases complicated with airway compression. Method The medical records of patients with great vessels abnormalities who were admitted to the neonatal intensive care unit （NICU） from October 2005 to June 2009 were retrospectively reviewed; 34 cases were diagnosed as airway compression by flexible bronchoscopy, 10 eases as vascular ring, 24 eases as aortal arch obstruction. The age of the patients was 6 d - 11 m, body weight 2. 2 - 8.7 kg[ （4. 6 ± 1.4） kg]. Recorded airway abnormalities detected by bronchonscopy and CT, cardiac vascular defects and airway compression were consistent with the findings on operation. The relation between the airway compression and cardiac vaseular abnormalities, treatment of the airway compression and outcome were analysed. Result Bronchoseopic assessment was successfully performed in NICU or operating room for all the patients. （ 1 ） Initial presentation of the 34 cases were taehypnea, stridor, refractory lung infection and prolonged mechanieal ventilation. （2） Extrinsic compression was found in all the 10 cases with vascular ring by bronchoseopy initially which indicated vascular ring, airway compression was mainly of lower part of trachea. Diagnosis of 9 cases was consistent with CT diagnosis and in 1 case the diagnosis was eonfirmed by surgery ; among these cases, 7 had congenital tracheal stenosis. （3） In the 24 eases with aortic obstructive lesion, 5 were deteeted to have traeheal stenosis by CT before correction of vascular abnormality, among whom one case was indicated to have tracheal stenosis by bronchoscopy, the other 19 eases were found with airway compression by broncbescopy during or after vascular correction. Among the 24 eases, 21 had left main bronehial stenosis, 2 had congenital tracheal stenosis. Airway compression diagnosed by bronchoscopy agreed with the findings of CT. Two cases developed transient decrease of oxygen saturation, 5 cases developed transient tachycardia. Conclusion Flexible bronchoscopy plays an important role in assessment of the airway compression complicated with great vessel abnormalities. Bronchoscopy is an accurate, convenient, safe and rapid way for airway assessment, but further examination of the peripheral structure and vascular malformation need combined examination with CT.