儿童气管性支气管46例

Clinical analysis of tracheal bronchus in 46 children

目的探讨儿童气管性支气管（TB）的镜下改变及临床特征。方法对安徽省儿童医院呼吸科46例经支气管镜检查确诊的TB患儿的支气管镜资料、临床表现、治疗及转归情况进行回顾性分析。结果在46例TB患儿中，移位型31例，额外型13例，憩室型2例；发生在气管右侧壁45例，后壁1例。20例合并1种呼吸道畸形，3例合并2种呼吸道畸形。镜下多表现为管腔狭窄，黏膜可见纵形皱襞和／或黏液栓堵塞。临床上主要表现为反复或持续性咳嗽、喘息，难治性右上叶肺炎、肺不张或肺气肿，或无症状因其他疾病行胸部CT或支气管镜检查时意外发现。经抗感染、对症及支气管肺泡灌洗（BAL）治疗，38例症状好转或消失，有效率达82．6％。结论TB在临床上并不少见，主要发生在气管右侧壁，以移位型居多，常合并其他畸形。临床上遇到反复或持续性咳嗽、喘息、难治性右上叶肺炎、右上肺不张或肺气肿治疗效果不佳时，要考虑TB的可能。支气管镜不仅能帮助TB的诊断，而且能进行BAL治疗。

Objective To investigate changes in tracheal bronchus （TB） under bronchoscopy and its clinical features in children. Methods The bronchoscopy datum,clinical manifestations and treatments of 46 children with TB from Department of Respiratory Medicine, Anhui Provincial Children＇s Hospital, were retrospectively analyzed. Results Among 46 cases,31 patients had displaced TB, 13 patients had supernumerary TB, and 2 patients had trachea diverticulum. Meanwhile, in 45 cases was located at the right tracheal wall and 1 case was located at the posterior tracheal wall. Besides ,20 cases were found accompanied with one type of tracheo bronchial anomalies, and the other 3 patients had 2 types of anomalies. Luminal stenosis, mucous membrane longitudinal fold and/or mucous plug were mostly revealed by bronchoscopy. Clinically, the main symptoms included recurrent or persistent cough, wheezing, refractory pneumonia, atelectasis or hyperinflation in the right upper lobe. Some cases showed no symptoms and were found accidentally by using chest CT or bronchoscope to check other diseases. Through anti - inflammatory and bronchoalveolar lavage （BAL） treatment, symptoms were improved or disappeared in 38 cases, the efficient rate was 82. 6%. Conclusions TB is not unusual in pediatric patients, and mainly be found at the right wall of the trachea. Displaced TB is the most common type and frequently accompanied with the other anomalies. TB should be considered when recurrent or persistent cough, wheezing, or refractory pneumonia, atelectasis or hyperinflation in the right upper lobe occurred. Bronchoscopic technology is an important tool in the diagnosis and treatment of children with TB and may be used widely in pediatric diseases clinically.