经支气管镜综合介入治疗儿童支气管内膜结核45例

Integrated interventional bronchoscopy for endobrohchial tuberculosis in 45 children

目的探讨电子支气管镜下综合介入治疗儿童支气管内膜结核（EBTB）的疗效及安全性。方法2011年1月至2014年8月入组EBTB患儿45例，其中男31例，女14例；年龄4个月-12岁，全部患儿在常规抗结核治疗基础上，采用支气管镜行电凝、激光、冷冻或球囊扩张等综合治疗，追踪观察疗效、不良反应等。以患儿治疗后的主要症状、胸部影像学、支气管镜下观察病灶恢复、呼吸道黏膜、管腔通畅情况为判断依据，评价疗效。患儿均接受6～12个月的随访。结果45例EBTB患儿中，溃疡及干酪坏死性改变者9例，占20．0％；肉芽增殖性改变者8例，占17．8％；瘢痕狭窄性改变者7例，占15．5％；镜下见混合型者44例，占97．8％。对20例EBTB患儿的病变部位进行活检，其中抗酸染色阳性12例，占60．8％。均经抗结核及支气管镜联合治疗，治疗8～13次／例，现治疗显效32例，占71．1％，有效10例，占22．2％，失访3例，总有效率93．3％。患儿均无气胸、肺部继发感染、咯血等不良反应。结论在EBTB常规抗结核治疗基础上，支气管镜综合介入治疗可有效地清除干酪样坏死物、减少肉芽增生，解除呼吸道梗阻，促进病灶吸收，利于肺不张恢复，且安全可靠，值得临床应用。

Objective To investigate the efficacy and safety of integrated interventional treatment for children with endobronchial tuberculosis by electronic bronchoscopy. Methods From January of 2011 to August of 2014,45 cases（ 31 boys andl4 girls ）were enrolled,their age ranged from 4 months to 12 years old. On the basis of the conventional anti - tuberculosis treatment in all the patients, electrocoagulation under the bronchoseopy was perfoimed, together with laser, refrigerant or balloon expansion. The tracking observation of curative effect and adverse reaction were observed. Based on the main symptoms of patients after treatment, and the conditions of chest imaging, bronchoscopy, the lesion repair, airway mucosa,lumen patency, therapy efficacy were evaluated. All patients underwent 6 - 12 months follow - ups. Results Among 45 cases of endobronchial tuberculosis in children, there were 9 cases suffering from ulcers and cheese necrotic changes （20.0%）, granulation proliferative changes in 8 cases, accounting for 17.8%, stenosis scar changes in 7 cases（ 15.5% ） ;44 mixed cases （97.8%） were observed under the microscope, of which 20 cases had tuberculosis lesions by bronchial biopsy, and of them acidfast staining was positive in 12 cases （60.8%） confirmed by bronchoscopy combined with anti -tuberculosis treatment, and they received 8 to 13 times of treatment,32 ca- ses were markedly effective, accounting for 71.1%, 10 cases were effective, accounting for 22.2% ;3 cases lost follow - up, and the total efficiency was 93.3% ; all patients had no pneumothorax, pulmonary secondary infection, hemoptysis and other adverse reactions. Conclusions In addition to conventional anti - tuberculosis treatment, local comprehensive interventional treatment under the bronchoscopy can effectively remove cheese -like necrosis and reduce granulation hyperplasia and relieve the airway obstruction, promote the absorption of lesions and atelectasis recovery. The therapy is safe and reliable and worth of clinical application.