闭塞性支气管炎二例及文献复习

Bronchitis obliterans in children： report of two cases and literature review

目的 探讨儿童闭塞性支气管炎的临床诊断与治疗.方法 总结2例闭塞性支气管炎患儿的临床表现和影像学特点,并复习相关文献.结果 2例患儿临床表现为咳嗽、咯痰以及活动后气喘.患侧肺部可闻及管状呼吸音.肺部影像学显示大气道通畅,患侧总支气管扩张、扭曲,呈支气管空气征.2例肺炎支原体抗体阳性.根据临床和影像表现以及闭塞性支气管炎的诊断依据,确诊为闭塞性支气管炎.给予小剂量红霉素[5 mg/（kg·d）]口服、吸入用布地奈德混悬液雾化吸入、多次电子支气管镜灌洗治疗后,随访例1患儿右肺复张较明显,例2影像学无明显改善.结论 对以肺不张就诊的患儿,要注意闭塞性支气管炎的可能性.影像学特征具有诊断意义.治疗首先建议保守治疗,必要时行肺叶切除术.

Objective Bronchitis obliterans is a severe and extremely rare complication of respiratory tract infections in children and is characterized by massive atelectasis and collapse of the affected lung. Method The clinical manifestations, characteristic imaging of two cases with bronchitis obliterans were summarized. Result These two cases complained of cough and episodes of wheezing with exercise.Chest auscultation revealed bronchial breath sounds on the right side. High-resohltion computed tomography （HRCT） scan showed atelectasis of the right lung and dilated central airways. Mycoplasma complement nebulized Pulmicort inhalation, and regular bronchoscopic lavage. Follow-up of the two cases showed that case one had a partial lung re-expansion after six months, but case two had no significant improvement.Conclusion In the process of diagnosis of atelectasis, bronchitis obliterans should be noticed. A conservative treatment is effective in certain cases, but pneumonectomy or lobectomy should only be considered as the last option.