小儿内生性支气管异物的临床特点及支气管镜术的应用

Clinical features of endogenous bronchial foreign bodies and application of bronchoscopy in children

目的探讨小儿内生性支气管异物的临床特点及支气管镜术应用的意义。方法经胸部X线片检查提示肺叶或肺段不张,支气管镜检查除外外界性支气管异物患儿106例,原发病:支原体肺炎62例,支气管结核24例,支气管肺炎16例,肾病综合征2例,喉气管支气管炎1例,毛细支气管炎1例;全部病例在原发病常规治疗的基础上进行支气管镜术;与同期住院80例外界性支气管异物的临床特点进行对比分析。结果内生性异物性质:黏液栓子77例,干酪样物质24例,树枝状白色胶冻状物4例,血栓1例,片状伪膜1例;其中25例可见肉芽组织增生,原发病以支气管结核为主。外界性支气管异物组并发纵膈气肿、气胸4例,内生性支气管异物组无一例合并纵膈气肿、气胸;内生性支气管异物组需要重复行支气管镜术的次数较外界性支气管异物组高(P<0.01)。结论对内生性支气管异物行支气管镜术,其诊断及治疗意义肯定。

Objective To study the clinical features of endogenous bronchial foreign bodies and the value of bronchoscopy in children.Methods One hundred and six children who presented lobe or lung segment atelectasis by the chest X-ray and bronchial foreign body inhalation was excluded by bronchoscopy were enrolled.The original diseases included Mycoplasma pneumonia （n=62）,endobronchial tuberculosis （n=24）,bronchial pneumonia （n=16）,nephrotic syndrome （n=2）,laryngotracheal bronchitis （n=1） and bronchiolitis （n=1）.On the basis of conventional treatment of the original diseases,bronchoscopy was performed in the children.Eighty children with bronchial foreign body inhalation severed as the control group.Results Bronchoscopy showed the properties of endogenous foreign bodies：mucus emboli in 77 cases,cheese substances in 24 cases,dendritic white membrane in 4 cases,thrombosis in 1 case,and flaky pseudomembrane in 1 case.Hyperplasia of granulation tissue was seen in 25 cases.Of the 25 cases,endobronchial tuberculosis as the original disease was found in 22 cases.Mediastinal emphysema and pneumothorax occurred in 4 cases in the control group,but none in the endogenous foreign bodies group.The number of bronchoalveolar lavage by bronchoscopy in the endogenous foreign bodies group was significantly higher than that in the control group.Conclusions Bronchoscopy is valuable in the diagnosis and treatment of endogenous bronchial foreign bodies.