应用球囊扩张气道成形术治疗儿童支原体肺炎肺不张的探讨

Balloon dilatation bronchoplasty in management of bronchial stenosis in children with mycoplasma pneumonia

目的对支气管镜介导下球囊扩张气道成形术治疗支原体肺炎肺不张患儿4—5级气道炎性狭窄的疗效和安全性进行评价。方法对30例支原体肺炎所致的气道炎性狭窄并肺不张患儿，实施支气管镜介导下球囊扩张气道成形术。分别于术前和最后一次球囊扩张术后胸部CT检查，对肺不张的情况进行评价。所有患儿均接受了1～6个月的随访。结果（1）30例气道狭窄的患儿分别接受球囊扩张1—3次。经过球囊扩张气道成形术后，25例患儿狭窄段管径增大，球囊扩张部位远端肺组织复张；5例狭窄段扩开不明显，其中3例病变部位有肉芽组织形成，经球囊联合冷冻治疗后，球囊扩张部位远端肺组织复张；另2例患儿病程超过3个月，扩张治疗无效。（2）经1～6个月随访，肺复张的28例患儿胸部CT显示扩张治疗部位影像正常，2例扩张治疗无效的患儿胸部CT显示的肺不张范围较前无变化。（3）30例接受此方法治疗的患儿，20例扩张时出现扩张部位的支气管黏膜轻微出血，5例术后轻微胸痛，没有其他严重并发症发生。结论支气管镜介导下的球囊扩张气道成形术治疗儿童肺部感染后气道狭窄有效、安全。

Objective To assess the efficacy and safety of balloon dilatation through flexible bronchoscopy in the management of inflammatory stenosis of grade 4-5 bronchus. Method Thirty patients with inflammatory bronchial stenosis caused by mycoplasmal pneumonia complicated with pulmonary atelectasis were treated with balloon dilatation through fiberoptic bronchoscopy. Before the procedure and after the last operation, therapeutic effect on pulmonary atelectasis were evaluated with CT and all of the patients were followed-up for 1 -6 months. Result One to three operations were required to achieve satisfactory dilatation. After balloon dilatation, the average airway diameter increased obviously and the farther airways were opened after the therapy with irrigation. In 25 of 30 cases satisfactory immediate effects were obtained, a narrow airway diameter above expansion significantly increased as compared with preoperative diameter. In 5 children treated with balloon dilatation, the stenosis could not be improved significantly. In 3 patients with hyperplasia of granulation tissue, cryotherapy had to be applied. The operations were ineffective in the other two patiens whose course of disease exeeded 3 months. After follow- up periods of 1-6 months, chest CT manifestation of expanded sites was improved in 28 patients and atelectasis disappeared. No severe complication was found in any patients. Conclusion Bronchoplasty by balloon dilatation through flexible fiberoptic bronchoscopy is a simple, effective and safe method to treat childhood tracheobronchial stenosis after pulmonary infections.