纤维支气管镜联合320排CT检查在小儿罕见心肺畸形引起的肺部疾病诊断中的价值

Value of fiber bronchoscope combined with 320-row CT scan in diagnosis of pulmonary diseases induced by rare cardiopulmonary malformations in children

目的探讨纤维支气管镜联合320排CT检查在小儿罕见心肺畸形引起的肺部疾病诊断中的价值,为临床诊治提供参考。方法对13例湖北省妇幼保健院新发现的小儿罕见心肺畸形引起的肺部疾病的诊疗经过进行回顾性分析,比较纤维支气管镜、320排CT和普通CT筛查率及诊断率,评估纤维支气管镜及320排CT诊断小儿复杂心肺畸形引起的肺部疾病的临床意义。结果 13例患儿纤维支气管镜表现支气管分布异常、瘘口及局部狭窄。经320排CT确诊4例罕见心肺血管畸形,3例隔离肺,3例先天肺囊肿,1例先天肺囊腺瘤,1例先天气道狭窄引起的阻塞性肺气肿。经纤维支气管镜气管瘘口碘油造影确诊1例先天性气管胆管瘘。纤维支气管镜及320排CT筛查率明显优于普通CT(92.31%,92.31,53.85%),差异有统计学意义(χ~2=37.91、37.91,均P<0.001),320排CT诊断率明显优于纤维支气管镜及普通CT(92.31%,15.38%,23.08%),差异有统计学意义(χ~2=12.76、15.74,均P<0.001)。结论纤维支气管镜联合320排CT对于发现及诊断先天性心肺气道血管畸形引起的肺部疾病有重要意义,同时对于高度怀疑及无法确诊的气管瘘必要时需行纤维支气管镜下造影确诊。

Objective To explore the value of fiber bronchoscope combined with 320-row CT scan in diagnosis of pulmonary diseases induced by rare cardiopulmonary malformations in children, provide a reference for clinical diagnosis and treatment. Methods The diagno- sis and treatment of 13 newly discovered children with pulmonary diseases induced by rare cardiopulmonary malformations in Hubei Provincial Maternal and Child Health Care Hospital were analyzed retrospectively. The screening rates and diagnostic rates of fiber bronehoscope, 320- row CT, and common CT were compared. The clinical significance of fiber bronchoscope combined with 320-row CT scan in diagnosis of pul- monary diseases induced by rare cardiopulmonary malformations in children was evaluated. Results Abnormal distribution, orifieium fistu- lae, and local stenosis of bronchi were observed under fiber bronchoscope. Four children with rare cardiovascular and puhnonary vascular malformations, three children with pulmonary sequestration, three children with congenital pulmonary cyst, one child with congenital cystic adenomatiod malformation, and one child with obstructive emphysema induced by congenital airway stenosis were diagnosed definitely by 320-row CT scan, after lipiodolography of tracheal orificium fistulae under fiber bronchoscope, one child was diagnosed as congenital tracheobiliary fistulas. The screening rates of fiber bronehoscope and 320-row CT scan were 92. 31% and 92. 31% , respectively, which were statistically significantly higher than that of common CT scan （53.85%） （χ^2=37.91, 37.91, P〈0. 001 ） . The diagnostic rate of 320-row CT scan was 92. 31% , which was statistically significantly higher than those of fiber bronchoscope and common CT scan （ 15.38% and 23.08% , respectively） （χ^2 = 12. 76, 15.74, P〈0. 001 ） . Conclusion Fiber bronchoseope combined with 320-row CT scan has important significance in detection and diagnosis of pulmonary diseases induced by rare cardiopuhnonary malformations. Fiber bronchoseope is necessary for the children highly suspected of tracheal fistula.