多排螺旋CT低剂量扫描对小儿气道透X线异物的诊断价值

Multislice spiral CT low dose scanning children's airway translucent foreign bodies:Diagnostic value

目的探讨多排螺旋CT低剂量扫描技术在小儿气道透X线异物中的临床应用。方法选择2016年10月—2017年10月笔者所在医院收治的40例气道异物患儿临床资料,40例患儿均经纤维支气管镜证实为气道异物,患儿年龄1~5岁,男20例,女20例。7例有可疑异物吸入史,其中4例伴有异物吸入症状,3例未伴有典型症状;5例未有明确异物吸入史,其中3例具有异物吸入症状;28例有明确异物吸入史,其中20例伴有典型临床症状,8例未伴有典型临床症状。所有患儿均经多排螺旋CT低剂量扫描及CT呼吸道三维模拟支气管镜重建。结果40例中首诊28例有明确异物吸入史,仅27例具有不同程度刺激性呛咳、发热、三凹征、喘鸣、发绀等典型异物吸入症状。38例经多排螺旋CT低剂量扫描技术可直接发现呼吸道透X线异物,低剂量CT显示异物嵌顿于气道管腔,其中1例异物位于气管隆嵴处,12例异物位于主支气管,20例位于叶性支气管,5例位于段支气管。2例CT未发现异物,但出现间接CT表现。低剂量CT间接表现:肺不张21例;支气管扩张15例;肺不张伴发感染13例;纵隔双边影或纵隔移位18例;局部肺部感染23例。低剂量多排螺旋CT对比纤维支气管镜,其直接诊断异物阳性符合率为92%(38/40例)。结论多排螺旋CT低剂量扫描技术对小儿气道透X线异物的诊断及定位具有重要价值,且能明显降低患儿辐射剂量,减少辐射相关损伤。

Objective To investigate the clinical effect of multi slice spiral CT low dose scanning technique in children＇s airway translucent foreign bodies. Methods The clinical data of 40 children with airway foreign bodies admitted in author＇s hospital from October 2016 to October 2017 yr. were selected,who were confirmed by airway bronchoscopy,aged 1 to 5 years old,20 males and 20 females. Among them 7 cases were suspected having foreign body aspiration history,including 4 with foreign body aspiration symptoms,3 without typical symptoms;5 cases had clear history of foreign body,3 with foreign body aspiration symptoms;28 cases had clear history of foreign body,including 20 patients with typical clinical symptoms,8 cases without typical clinical symptoms. All the children patients were scanned with multislice spiral CT low dose and CT airway three-dimensional simulated bronchoscopy reconstruction. Results In the 40 patients first diagnosed 28 had clear history of foreign body aspiration,only 27 had different degrees of irritating cough,fever,wheezing,cyanosis, ＂three concave syndrome＂ and other typical clinical symptoms of foreign body aspiration;38 cases diagnosed by multi-slice spiral CT low dose scanning technology can be directly found in respiratory tract nonopaque foreign body,low dose CT showed foreign body incarcerated in the airway lumen or attached on the pipe wall,including 1 case of foreign body was in trachea,12 of foreign body were in bronchus;20 were at lobar bronchus,5 were at bronchial. No foreign body was found in 2 cases by CT,but in indirect CT appeared. Indirect manifestations of low dose CT include segmental atelectasis in 21 cases,limited bronchiectasis in 15,bilateral chest wall shadow in13,mediastinal bilateral shadow or mediastinal disconnection in 18,and pulmonary infection in 23. The positive coincidence rate of the direct diagnosis of foreign body was 92%（38/40） by contrast fiberoptic bronchoscopy with low dose multislice spiral CT. Conclusion Multi-slice spiral CT low dose scanning technology is of great value in the diagnosis and location of airway foreign body in children patients,and it can significantly reduce the radiation dose and radiation related injury in children patients.