77例儿童支气管结核气管镜下病变的特点

Bronchoscopic Characteristics of 77 children with bronchial tuberculosis

目的探讨儿童气管支气管结核(tracheobronchial tuberculosis,TBTB)的气管镜下病变特点,为TBTB早期诊断提供参考。方法回顾性分析2015年6月至2021年6月于深圳市第三人民医院确诊肺结核并进行气管镜检查的139名患儿的临床资料,按有无TBTB分为两组。结果TBTB组77例(55.4%),非TBTB组62例(44.6%)。与非TBTB组相比,TBTB组患儿多为女性,性别构成差异具有统计学意义(P<0.001)。影像学病变部位主要为双肺多发病灶、右上叶、左上叶,分别占21.6%(30/139)、21.6%(30/139)、17.3%(24/139)。气管镜镜下TBTB分型结果为炎症浸润型占53.2%(41/77)、溃疡坏死型占46.8%(36/77),肉芽增殖型占22.1%(17/77)、瘢痕狭窄型占44.2%(34/77)、管腔软化型占2.6%(2/77)、淋巴结瘘型占0%(0/77);TBTB累及气管占16.9%(13/77),右上叶支气管占19.5%(15/77),左主支气管占41.6%(32/77),左上叶支气管占35.1%(27/77)。结论儿童肺结核易合并支气管结核,特别是女性儿童。气管结核累及部位以主气管及双上叶支气管为主,气管结核类型多样。对怀疑肺结核儿童应尽早完成支气管镜检查,明确有无气管支气管结核。

Objective To understand clinical characteristics and bronchoscopy manifestation of tracheobronchial tuberculosis in children with pulmonary tuberculosis.Methods The clinical data of 139 children who were diagnosed as pulmonary tuberculosis and had gone through bronchoscopy from June 2015 to June 2021 in the Third People's Hospital of Shenzhen were retrospectively analyzed.They were divided into two groups based on whether they had TBTB or not.Results There were 77 cases(55.4%)in the TBTB group and 62 cases(44.6%)in the non-TBTB group.Compared with the non-TBTB group,most children in the TBTB group were girls.There was significant difference in gender between the two groups(P<0.001).Pulmonary radiological manifestation showed that lesions mainly occurred in the both upper lungs,right upper lobe and left upper lobe,and the proportion of each part were 21.6%(30/139),21.6%(30/139),17.3%(24/139)respectively.Bronchoscopy showed that the type of inflammatory infiltration was 53.2%(41/77),caseous necrosis was 46.8%(36/77),granulation hyperplasia was 22.1%(17/77),cicatricial stenosis type was 44.2%(34/77),malacia lesions was 2.6%(2/77),and lymph node fistula type was 0%(0/77).The most common sites of TBTB were in trachea(13/77,16.9%),right upper lobe(15/77,19.5%),left main bronchus(32/77,41.6%)and the left upper lobe(27/77,35.1%).Conclusion Pediatric PTB commonly combines with TBTB,especially in girls.The most common sites of TBTB are in main bronchus and the upper lobes of both lungs.Many types of TBTB could be occurred in children.For children suspected with TBTB,bronchoscopy should be performed as early as possible to confirm TBTB.