MDCT及后处理技术在儿童呼吸道异物患者中的应用探讨

Application of MDCT and post-processing in children with tracheal foreign body

目的:探讨64排螺旋CT三维成像(MDCT)及后处理技术在儿童可疑呼吸道异物中的临床应用价值。方法:对200例可疑呼吸道异物患儿行MDCT及仿真内镜成像,并与支气管镜术中所见对比,比较MDCT及后处理的结果和术中所见情况符合度。结果:经MDCT后处理技术检出184例阳性患儿经支气管镜检查,结果179例为外源性异物,5例为痰栓(内源性异物)阻塞。经MDCT后处理技术诊断为无异物的16例患儿,经支气管镜检查,1例有异物,其异物位于声门裂(西瓜子壳),其余15例亦无异物;MDCT及后处理技术对儿童呼吸道异物诊断的灵敏性99.4%,特异性75%。经统计学分析处理,MDCT及后处理技术与支气管镜检查术对异物的检出率差异无统计学意义(P>0.05)。结论:虽然MDCT及后处理技术不能用于治疗支气管异物,但在支气管异物的诊断上与支气管镜相当。对于异物吸入史不明确、疑似气道异物时间长的患儿可在支气管镜检查之前行MDCT检查并做后处理,可指导支气管镜检查术中操作的关注点,提高诊疗水平。

Objective：To explore the clinical value of MDCT and post-processing in children with suspected foreign body in trachea. Method： Two hundred patients with suspected tracheal foreign body were treated with 64 - slice spiral CT （MDCT） and simulated endoscopic imaging, then compared with seen in bronchoscopy; Compare the results of MDCT and post-processing with the coincidence of intraoperative findings. Result.. One hundred and eighty-four cases of positive children were examined by MDCT postprocessing technique and bronchoscopy, 179 cases were obstructed by exogenous foreign body, 5 cases were phlegm thrombosis （endogenous foreign body） obstruction; 16 cases of children with no foreign body diagnosed by MDCT post-processing technique were also examined by bronchoscopy. The results showed that there was a foreign body in 1 case, and the foreign body was located in the pharyngeal cleft （watermelon spermoderm）, and the remaining 15 cases had no foreign body. MDCT and post-treatment techniques for children with tracheal foreign body diagnosis of 99.4 % sensitivity, specificity of 75 %. There was no significant difference in the detection rate of foreign body between the two techniques of MDCT and post-processing technique and bronchoscopy （P〉0.05）. Examed by MDCT and post-processing, we can understand the specific location and size of foreign body, nature, shape preoperatively. Conclusion： Although MDCT and post-processing techniques can not be used to treat tracheal foreign bodies, but the diagnostic rate of bronchial foreign bodies is comparable to that of bronchoscopy. We could apply MDCT examination and post processing before the bronchoscopy, for foreign body inhalation history is not clear, or suspected airway foreign body. We can improve the level of diagnosis and treatment through guiding the operation of bronchoscopy focus.