软式支气管镜术对小儿喉喘鸣的病因诊断价值

The etiological diagnosis value of soft bronchoscopy in children with laryngeal stridor

目的:探讨软式支气管镜术对小儿喉喘鸣的病因诊断价值。方法:对2016年1月至2019年1月在安徽省儿童医院因喉喘鸣行软式支气管镜检查的402例患儿的临床资料进行回顾性分析。结果:402例喉喘鸣患儿经软式支气管镜检查诊断:呼吸道发育异常317例(78.8%),其中先天性喉软骨软化200例(49.7%,包括单发喉软骨软化132例,喉软骨软化合并其他气道发育异常68例),除喉软骨软化外,其他气道发育异常117例(29.1%);喉部炎症46例(11.5%);呼吸道获得性狭窄28例(7.0%);异物11例(2.7%)。402例喉喘鸣患儿根据其临床表现,结合X线胸片、胸部CT、CT血管造影、心脏彩超等影像学资料,诊断为:先天性喉软骨软化335例(83.3%);除喉软骨软化外其他气道发育异常16例(4.0%),包括声门下及气管狭窄6例,喉占位5例,气管支气管畸形4例,声门下血管瘤1例;喉部炎症35例(8.7%);获得性气道狭窄15例(3.7%),包括先天性心脏病13例,肺动脉吊带1例,纵隔囊肿1例;气管异物1例。先天性喉软骨软化、其他气道发育异常及气道异物经软式支气管镜检出与临床及影像学检查检出一致性较差,差异有统计学意义( P<0.05)。 结论:先天性喉软骨软化是喉喘鸣最常见的病因,但其常合并其他呼吸道发育异常;软式支气管镜检查可以为喉喘鸣患儿病因诊断提供依据,尤其在诊断气道发育异常、气道异物方面有更大的优势。

Objective To evaluate the etiological diagnosis value of soft bronchoscopy in children with laryngeal stridor.Methods The clinical data of 402 children with laryngeal stridor wheezing were retrospectively analyzed,which examined by soft bronchoscopy in Anhui Provincial Children′s Hospital from January 2016 to January 2019.Results A total of 402 cases of laryngeal stridor were diagnosed by soft bronchoscopy,317(78.8%)cases were diagnosed as congenital airway dysplasia,including 200(49.7%)cases of congenital laryngeal chondromalacia,which including 132 cases of single laryngeal chondromalacia and 68 cases with other respiratory tract dysplasia,and 117(29.1%)cases of respiratory dysplasia other than laryngeal chondromalacia;46(11.5%)cases of laryngitis;28(7.0%)cases of airway acquired stenosis and 11(2.7%)cases of foreign body.Among 402 cases of children with laryngeal stridor who were diagnosed according to clinical feature,combined with chest X-ray,chest CT,CT angiography and color Doppler echocardiography as well as other imaging data,335(83.3%)cases were congenital laryngeal chondromalacia,16(4.0%)cases were other respiratory tract dysplasia(including six cases of subglottic and tracheal stenosis,five cases of laryngeal space occupying lesions,four cases of tracheobronchial malformation,and one case of subglottic hemangioma),35(8.7%)cases of laryngitis,acquired airway stenosis in 15 cases including 13 cases of congenital heart disease,one case of pulmonary artery sling,one case of mediastinal cyst,and one case of foreign body.Congenital laryngeal chondromalacia,other causes of respiratory dysplasia and foreign body detected by flexible bronchoscopy were not consistent with clinical examination(P<0.05).Conclusion Congenital laryngeal chondromalacia is the main cause of laryngeal stridor,but it is often associated with other airway dysplasia.Soft bronchoscopy can provides etiological diagnosis for children with laryngeal stridor wheezing,especially in the diagnosis of respiratory tract dysplasia and airway foreign body.