软式支气管镜在小下颌畸形婴儿诊疗中的应用

Application of flexible bronchoscope in diagnosis and treatment of infants with micro mandibular deformity

目的探讨软式支气管镜在伴有呼吸困难的小下颌畸形婴儿中的应用及临床价值。方法2018年9月至2020年1月,解放军总医院第七医学中心八一儿童医院共收治小下颌畸形婴儿12例。患儿在完善相关辅助检查后,行软式支气管镜检查,观察鼻腔、咽部、会厌及声门,进入气道后观察气管位置、形态、黏膜色泽、软骨环的清晰度、隆突位置、依次检查各叶、段支气管。结果12例小下颌畸形患儿中,10例有不同程度吸气性呼吸困难,需辅助呼吸支持。12例患儿均有典型小下颌后缩畸形,并有不同程度喂养困难。软式支气管镜下可见舌根后坠,压迫会厌软骨,小角、楔状软骨、气道黏膜肿胀;均合并至少1种其他部位畸形。通过改善喂养、对症支持后,6例好转出院、2例行下颌延长术、3例放弃出院、1例死亡。结论软式支气管镜对小下颌畸形的诊断有积极意义,并在内科保守治疗及手术矫正中有指导价值。

Objective To investigate the clinical value of flexible bronchoscope in infants with dyspnea and micro mandibular deformity.Methods From September 2018 to January 2020,12 infants with micro mandibular deformity were treated in Bayi Children's Hospital of the Seventh Medical Center of the PLA General Hospital.All the infants received soft bronchoscopy to observe the nasal cavity,pharynx,epiglottis and glottis after completing relevant auxiliary examinations.After entering the airway,the position,shape,mucosal color,articulation of cartilage ring and carina position of the trachea were observed,and each lobe and segmental bronchus was examined.Results Ten of the 12 infants had different degrees of inspiratory dyspnea and needed respiratory support.All the patients had typical retraction of the micro mandibular deformity and varying degrees of feeding difficulty.It was shown gloss coma,the compression of epiglottis and edema of corbiculae cartilage,cartilage cuneiforms and airway mucosa under flexible bronchoscopy.After improvement of feeding style and symptomatic treatment,6 children were discharged and 2 children underwent mandibular lengthening.The other 3 children gave up and 1 child died.Conclusions The flexible bronchoscopy is valuable in the diagnosis of micro mandibular deformity.It also showed a guiding role in medical and surgical treatment.