支气管镜检查在儿童支气管扩张诊治中的应用

Bronchoseopy in the diagnosis and treatment of children with bronchiectasis

摘要 目的分析支气管扩张患儿的临床特征，探讨支气管镜检查在儿童支气管扩张中的应用价值。方法选择2011年12月至2015年11月在南京医科大学附属儿童医院住院确诊为支气管扩张，且接受支气管镜检查的患儿，回顾性分析其临床表现、病原学检查、影像学检查、支气管镜检查结果。结果共收集33例支气管扩张病例，32例（97.0%）表现为持续性或间隙性的慢性咳嗽、咳脓痰。反复下呼吸感染为其主要病因（50%，16/33例）。高分辨率CT均表现为＂双轨征＂和/或＂印戒征＂ ，病变部位主要为下肺（60.6%，20/33例）。经支气管镜纤毛活检18例，发现纤毛数量减少2例，纤毛超微结构异常6例，其中2例确诊为Kartagener综合征。治疗原发病、抗感染、祛痰、配合支气管镜检查，临床症状均改善。出院后随访，15例偶有咳嗽，无明显咳痰，11例反复肺部感染，定期行支气管镜灌洗治疗，4例外科行肺叶切除术，术后恢复良好，死亡2例。结论对支气管扩张患儿早期行支气管镜检查，可明确病原及病因，同时还可进行支气管肺泡灌洗治疗，促进临床症状改善。

Objective To analyze the clinical features and the application of bronchoscopy in diagnosis and treatment of children with bronchiectasis. Methods All cases with bronchiectasis were collected from in - patient department of the Children＇s Hospital Affiliated to Nanjing Medical University from December 2011 to November 2015. Clinical manifestations,results of bronchoscopy examination were retrospectively analyzed. Results Of the 33 children, 32 cases （97.0%） had chronic cough and sputum. Lung infection was the main cause （50%, 16/33 cases）. High resolution CT showed ＂ signet ring sign＂ and/or ＂double -track sign＂ in lungs, and bronchiectatic lesions were most commonly found in the lower lobes （60.6%）. Eighteen cases underwent bronchoscope ciliary biopsy, and the number of cilia decrease was found in 2 cases, and cilia ultrastructure abnormalities were found in 6 cases, with 2 cases diagnosed as Kartagener syndrome. The treatment included the following： treatment of the underlying disease, aggressive treatment of infections, promotion of mucociliary clearance, and bronchoscopy. The symptoms of the most patients were relieved through the symptomatic treatment. Follow - ups after discharge, showed that 15 cases had a slight cough without obvious sputum, 11 cases with recurrent lung infections, regular bronchoscope lavage treatment; 4 cases underwent surgical lung resection and recovered well postoperative, and 2 cases died. Conclusion The bronchoscopy should be performed early in the children with bronchiectasis, which tan clearly detect pathogens and causes, so as to undertake lavage treatment to improve clinical symptoms.