1415例支气管镜下异常改变患儿的镜下病因及特点分析

Analysis of 1415 children＇s flexible bronchoscopy manifestation and characteristics

目的本研究通过分析1415例儿童纤维支气管镜的镜下改变资料，探讨纤维支气管镜在儿童呼吸系统疾病病因及病原学诊断中的价值。方法对2012年6月至2014年12月在我院小儿呼吸内科进行纤维支气管镜检查，有支气管适应证、资料完整、镜下发现异常并且诊断确切的1415例患儿进行支气管镜下影像学及病原分析。结果1415例患儿中，男孩占55．4％；5岁以下患儿占55．5％；喉软骨软化2例（0．14％），会厌囊肿1例（0．07％），气管软化3例（0．21％），支气管异物25例（1．8％），气管性支气管20例（1．4％），气管狭窄8例（5．7％），桥支气管2例（0．14％），闭塞性支气管炎5例（0．35％），支气管扩张6例（0．42％），纤毛不动综合征1例（0．07％），支气管结核10例（0．71％），曲霉菌感染1例（0．07％），肺含铁血黄素沉积症1例（0．07％），肺动静脉瘘2例（O．14％），塑形性支气管炎9例（0．63％），气管内膜炎症1316例（93％），其中充血水肿、黏膜皱襞形成350例（24．7％），黏液栓阻塞279例（19．7％），化脓性阻塞176例（12．4％），气管黏膜糜烂坏死355例（25．1％），管壁纤维化狭窄、闭塞156例（11．1％）。肺泡灌洗液中最常见的是肺炎支原体感染。1415例患儿中，最主要的不良反应是操作中气道阻塞性低氧。结论儿童纤维支气管镜是非常安全可靠的儿科呼吸系统疾病诊治方法，尤其在儿童气道先天发育性疾病的诊治及肺炎病原体的检测中起到了重要作用。

Objective This retrospective study was based on 1 415 cases that had been done the flex- ible bronchoscopy examination. The data were analysed to investigate the value of flexible bronchoscope in the children＇s respiratory system diseases diagnosis, treatment and etiological study. Methods A total of 1 415 cases who admitted from June 2012 to December 2013 were included in the study and they were all met the inclusion criteria, had complete clinical data, done bronchoscope examinations, abnormal in the broncho- scope and diagnosed definitely. The endoscopic manifestation, clinical symptoms, X-ray film, laboratory data were analysed. Results In 1 415 cases,55.4% were boy,and 55.5% were younger than 5 years. Two cases （0. 14% ） were laryngeal cartilage soften,one case（0.07% ） was epiglottic cyst,3 cases（0.21% ） were tra- cheomalacia,25 cases（ 1.8% ） were bronchial foreign bodies,20 cases（ 1.4% ） were tracheal bronchus de- formity,8 cases（5.7% ） were tracheal stenosis,two cases（0. 14% ） were bronchial bridge,5 cases（0. 35% ） were bronchiolitis obliterans, 6 cases （ 0.42% ） were bronchiectasis, one case （ 0.07% ） was immotile cilia syndrome, 10 cases （ 0.71% ） were bronchial tuberculosis, one case （ 0.07 % ） was aspergillosis, one case （0. 07% ） was pulmonary hemosiderosis, 2 cases （0. 14% ） were pulmonary arteriovenous fistula, 9 cases （0.63%） were plastic bronchitis, 1 316 cases（93% ） were founded tracheal intima inflammation, including the 350 cases（24. 7% ） of edema,mucosal folds form,279 cases（ 19. 7% ） of mucus plug obstruction, 176 cases（ 12.4% ） of suppurative obstruction,355 cases（25.1% ） of tracheal mucosal erosion necrosis, 156 ca- ses （ 11.1% ） of wall fibrosis, stenosis, occlusion. Mycoplasma pneumoniae was the most common pathogen dectected in alveolar lavage. We also found that mycoplasma pneumonia easily combined the infection of bac- teria. A total of 119 （22.7%）cases were no pathogens detected. In 1 415 cases, the main adverse reaction in the operations was hypoxemia caused by airway obstruction. Conclusion Flexible bronchoscopy examination is a very safe and reliable operation in diagnosis and treatment of respiratory diseases in pediat-rics, and plays an important role in the diagnosis of congenital developmental airway diseases, detection of pneumonia patho- gens and the treatment of lobe pneumonia.