支气管镜术对小儿上气道梗阻性疾病的病因诊断价值

Value of bronchoscopy in etiological diagnosis of upper airway obstruction in children

目的探讨支气管镜术对小儿上气道梗阻(UAO)的病因诊断价值。方法对2006年3月至2015年2月因上气道梗阻症状而行支气管镜检查的210例患儿的临床资料进行回顾性分析。结果 210例UAO患儿中,经支气管镜检查明确病因205例,病因诊断率97.6%。其中先天性UAO 114例,占54.3%,以喉软化、气管狭窄、会厌或舌根部囊肿最常见,分别占64.0%(73/114)、17.5%(20/114)、14.0%(16/114),2种以上畸形占17.5%(20/114)。后天性UAO 96例,占45.7%,以炎症、肿瘤或肉芽增生、异物最常见,分别占54.2%(52/96)、18.7%(18/96)、16.7%(16/96)。呼吸道先天畸形主要见于婴儿及新生儿期,炎症在各个年龄段均常见,肿瘤或肉芽增生主要见于幼儿期,异物主要见于幼儿期及学龄前期。结论支气管镜术对UAO的病因能发挥很好的诊断作用。呼吸道先天畸形(喉软化、气管狭窄、囊肿)、炎症、肿瘤或肉芽增生、异物是儿童UAO的常见病因,不同年龄组病因组成不同。

Objective To explore the diagnostic value of bronchoscopy in children with upper airway obstruction( UAO). Methods The bronchoscopy records and clinical data of 210 cases of UAO patients from Mar 2006 to Feb 2015 were retrospectively analyzed. Results Among the 210 cases,205 cases were identified by bronchoscopy,and the etiology diagnosis rate was 97. 7%. Among 114( 54. 3%) congenital UAO cases,the most common causes were laryngeal malacia,congenital tracheal stenosis,tongue or epiglottic cyst,accounting for64. 0%( 73 /114),17. 5%( 20 /114),14. 0%( 16 /114),respectively,and ratio of two or more malformation was 17. 5%( 20 /114). Among 96( 45. 7%) acquired UAO cases,inflammation,tumor or granulomatous hyperplasia,foreign body were the most common causes,accounting for 54. 2%( 52 /96),18. 7%( 18 /96),16. 7%( 16 /96),respectively. Respiratory congenital malformations were detected mainly in infants and neonatal period,tumor or granulomatous hyperplasia occurred chiefly in early childhood,and tracheal foreign bodies often appeared among preschool children. Meanwhile,inflammation might occur in all-age children. Conclusion Bronchoscopy may serve as a valuable tool for etiological diagnosis of UAO. Respiratory congenital malformations( laryngeal malacia,congenital tracheal stenosis,cyst),inflammation,tumor or granulomatous hyperplasia and tracheal foreign bodies are common causes in children with UAO,and the etiological composition in different age groups are varied.