252例儿童气管支气管结核分型探讨

Classification of tracheobronchial tuberculosis in 252 children

目的分析儿童气管支气管结核(tracheobronchial tuberculosis,TBTB)的临床特点、支气管镜下分型及治疗效果,为儿童TBTB的早期诊断、准确分型提供理论依据。方法回顾性分析2006年1月至2019年12月首都医科大学附属北京儿童医院收治入院并进行了支气管镜检查的TBTB患儿的基本资料、临床表现、影像学特征、支气管镜下特点、介入治疗效果。对研究结果使用SPSS 22.0统计学软件对相关数据进行统计学描述与分析。结果252例TBTB患儿的中位年龄为1.7(0.8,5.2)岁。在TBTB的分型中,淋巴结瘘型TBTB患儿占96.4%(243/252)、溃疡坏死型1.2%(3/252)、肉芽增殖型0.4%(1/252)、瘢痕狭窄型0.8%(2/252),此外,1.2%(3/252)的TBTB患儿支气管镜下表现与淋巴结瘘型相同,但影像学上无法明确管腔内干酪样物质是淋巴结破溃所致,不除外干酪性肺炎相关的肺-支气管瘘可能,故提出“支气管瘘型”。结论淋巴结瘘型是儿童最常见的TBTB类型,介入治疗效果显著,但此分型若要明确瘘口来自纵隔或肺门淋巴结,需要依赖影像学证据,临床中可能存在分型不明确的情况。

Objective To provide theoretical basis for early diagnosis and accurate bronchoscopic classification of tracheobronchial tuberculosis(TBTB)in children through analyzing the clinical characteristics,bronchoscopic classifications and treatment effect in children with TBTB.Methods In this respective study,we collected clinical data of patients with TBTB who accepted bronchoscopies in Interventional Pulmonology Department of Beijing Children′s Hospital Affiliated to Capital Medical University between January,2006 and December,2019.The basic data,including clinical manifestations,imaging features,bronchoscopic characteristics and effects of interventional therapy were analyzed.The results of the study were statistically described and analyzed using SPSS 22.0 statistical software for relevant data.Results Total 252 children with TBTB were included in this study.The median age was 1.7 years(quartile:0.8 years,5.2 years).Analysis of the classification of TBTB showed that the percent of lymph node fistula type was 96.4%(243/252),ulcerative necrosis type 1.2%(3/252),granulation proliferation type 0.4%(1/252),and cicatricial stricture type 0.8%(2/252).In addition,1.2%(3/252)of the cases showed the same bronchoscopic manifestations as lymph node fistula type,but it was not clear on imaging whether the caseous material in the lumen was caused by lymph node or lung erosion.Therefore,the"bronchial fistula type"was proposed.Conclusions Lymph node fistula type of TBTB was the common in children.The classification of lymph node fistula mostly depended on imaging evidence,and this may lead to some uncertainty in classifying TBTB in cases with no imaging evidence of enlarged lymph nodes.