X线与螺旋CT在小儿气管、支气管异物诊断中的选择

Choice between X-ray radiography and spiral CT for diagnosing tracheal or bronchial foreign bodies of children

目的:分析X线检查(胸部正位片+胸部透视)和螺旋CT扫描在诊断小儿气管、支气管异物中的时机选择,在保证准确性的基础上,尽量减少螺旋CT的使用,从而减少患儿所接受的辐射剂量。方法:选取2013年怀疑小儿气管、支气管异物患儿734例。对于有明确异物吸入史,听诊有一侧呼吸音减低或者有呼吸困难,怀疑气管异物采用普通X线检查。对于没有异物吸入史或者有异物吸入史,但是听诊没有呼吸音减低的患儿采用螺旋CT检查。结果:经支气管镜检查证实总的阳性率96.59%(709/734),其中采用X线检查529例,阳性率97.16%(514/529);采用螺旋CT检查205例,阳性率95.12%(195/205),两者比较没有显著性统计学差异(P>0.05)。螺旋CT在诊断中使用率27.93%(205/734)。结论 :对于多数的小儿气管、支气管异物诊断应尽量选择X线检查,减少患儿遭受辐射危害。

Objective To analyze the selection and timing for the performance of X-ray examination（covering chest radiograph and chest fluoroscopy） and spiral CT scanning for diagnosing tracheal or bronchial foreign bodies of children so as to reduce the radiation dose of children by decreasing the application of spiral CT to the least.Methods Totally 734 children suspected with tracheal or bronchial foreign bodies in 2013 were enrolled in the study.The children with aspiration histories as well as diminished breath sound or dyspnea in one side went through conventional X-ray examination,and the ones with no aspiration history or no diminished breath sound in spite of aspiration history underwent spiral CT scanning.Results Bronchoscopy proved that the total positive rate was 96.59%（709/734）.X-ray examination found 514 cases from 529 ones with the positive rate of 97.16%,spiral CT found 195 cases from 205 ones with the positive rate of 95.12%,and there was no significant difference between the positive rates by the two methods（P〈0.05）.Of the 734 children,there were 205 ones undergoing spiral CT scanning,with the utilization rate being 27.93%.Conclusion Tracheal or bronchial foreign bodies of children had better be diagnosed by X-ray radiography to reduce the radiation dose to children.