儿童疑难支气管结核12例

Clinical analysis of 12 cases of childhood atypical endobronchial tuberculosis

目的探讨儿童疑难支气管结核（EBTB）的临床特征及支气管镜对其诊断和治疗的价值。方法收集2008年1月至2011年12月重庆医科大学附属儿童医院收治的12例疑难EBTB患儿病史、临床表现、实验室检查、影像学及支气管镜检查等资料。其中12例患儿行纤维支气管镜术及灌洗术以辅助诊断，4例行支气管内膜病理活检。分析12例患儿临床及支气管镜特征。结果12例患儿临床症状多样，主要为咳嗽（11例，91．7％），发热（7例，58．3％），另外还有喘息（3例，25．0％）、活动后气促（2例，16．7％）等表现，咯血少见（1例，8．3％）；影像学表现主要为肺门和（或）纵隔淋巴结大（10例，83．3％），出现阻塞性肺气肿、肺不张5例（占41．7％），其发生率较其他类型肺结核高；纤维支气管镜示肉芽组织及赘生物阻塞7例（58．3％），干酪样坏死4例（33．3％），管外压迫4例（33．3％），开口狭窄2例（16．7％）；其中病变位于右肺8例（66．7％），左肺4例（33．3％）。灌洗液结核菌培养阳性6例（50．0％），4例经支气管镜行内膜活检确诊，2例纤维支气管镜检查后胃液涂片找到结核菌。结论儿童疑难EBTB临床表现多样，支气管镜直观检查、肺泡灌洗术、内膜病理活检对其诊断及病理分型均有重要作用。

Objective To analyze the clinical characteristics of atypical endobronchial tuberculosis（EBTB） in children and explore the value of bronchoscopy examination in diagnosis and treatment of this disease. Methods The records of 12 children diagnosed as atypical EBTB in Children＇s Hospital of Chongqing Medical University from Jan. 2008 to Dec. 2011 were reviewed, and their medical history, clinical manifestation, imaging and laboratory findings were analyzed. They all had fiberoptic bronchoscopy and bronchoalveolar lavage. Four patients had bronchial lining pathologic biopsy. Bronchoscope findings of the 12 children were analyzed. Results The clinical manifestations of childhood atypical EBTB were various. The major were cough（ 11 cases,91.7% ） and fever（7 cases,58.3% ） , other manifesta- tions included wheeze （3 cases,25.0% ）, shortness of breath following exercise （2 cases, 16.7% ）, and so on. Only 1 case had hemoptysis （8.3%）. The major imaging findings were lymph node enlargement of hilar and（or） mediastinum （10 cases,83.3% ）. Five cases were with obstructive pulmonary emphysema and atelectasis （41.7%）. It was more common than other type of pulmonary tuberculosis. It mainly expressed granulation tissue and neoplasm （7 cases, 58.3% ）, caseoussubstance （4 cases, 33.3% ）, extrinsic compression （ 4 cases, 33.3% ） and narrowed orifice of the lobe bronchus （ 2 cases, 16.7% ） under fiber bronchoscopy. The detection rate of mycobacterium tuberculosis was 50.0% （6 cases） through bronchoalveolar lavage fluid, Four children were diagnosed by transbronchial biopsy and 2 children were diagnosed by gastrointestinal fluid smear after fiberoptic bronchoscopy. Conclusions The clinical manifestations of childhood atypical EBTB are various. Bronchoscopy examination, hronchoalveolar lavage and transbronchial biopsy play very important role in diagnosis and pathological classification of childhood atypical EBTB.