支气管镜下冷冻治疗儿童肉芽及瘢痕组织导致的下气道狭窄及阻塞22例  

Effect of bronchoscopic cryosurgery in twenty-two children with lower airway stenosis

作　　者：倪彩云[1] 刘霞[1] 马静[1] 陈红[1] 张利红[2] 张忠晓[1] 闫秀丽[1] 张赟[1] 韩晓蓉[1] 孟晨[1] 

机构地区：[1]山东大学齐鲁儿童医院呼吸介入中心,济南250022 [2]山东大学齐鲁儿童医院病理科,济南250022

出　　处：《中华儿科杂志》2012年第1期45-49,共5页Chinese Journal of Pediatrics

基　　金：济南市科学技术发展计划（济科计[2005]16）;济南市2010年科学技术发展计划（济科计[2010]25）

摘　　要：目的探讨支气管镜下冷冻治疗儿童肉芽及瘢痕组织致下气道阻塞和狭窄的疗效及安全性。方法22例包括：肺炎支原体肺炎18例，支气管内膜结核2例，支气管异物导致的肉芽组织增生，阻塞气道，引起阻塞远端肺不张1例，先天性心脏病手术气管插管后气管瘢痕引起气管重度狭窄1例。对患儿实施支气管镜下病变部位多次冷冻治疗。气管插管后导致气管狭窄的患儿，配合电凝治疗。分别于术前和最后一次冷冻治疗后，评价临床症状及支气管镜下病变部位情况，肺不张病例根据胸部cT肺不张的面积、气管重度狭窄的病例根据潮气量进行评估。结果22例分别接受冷冻治疗1—4次。显效16例：临床症状完全改善，支气管镜下肉芽及瘢痕组织消失，灌洗治疗病变远端管腔通畅，CT见肺不张消失或基本消失。气管重度狭窄病例管腔直径由2mm增宽为约5mm，潮气量由3．0ml／kg提高至8．8ml／kg。有效5例：临床症状完全改善，支气管镜下肉芽及瘢痕组织消失，病变部位远端的部分气道变形、狭窄及闭锁，灌洗治疗不畅，CT见肺不张面积缩小1／3—2／3。无效1例（1／22）：临床症状完全改善，支气管镜下管腔肉芽及瘢痕组织消失，但病变部位远端大部分气道管腔闭锁，灌洗治疗管腔不通畅，CT见肺不张面积未改变。总有效率95．5％。冷冻治疗术中及术后无并发症，经1—12个月随访未见病情复发。结论支气管镜下冷冻治疗肉芽及瘢痕组织导致的儿童下气道狭窄及阻塞有效、安全。Objective To analyze the effect and safety of bronchoscopie cryosurgery in children with lower airway stenosis caused by granulation and fiber hyperplasia. Method Twenty-two patients had undergone bronchoscopic examination and cryosurgery , 18 patients with atelectasis caused by Myeoplasma pneumoniae pneumonia, 2 patients with endobronchial tuberculosis （EBTB）, 1 patient with ateleetasis caused by granulation tissue after bronchial foreign body, and 1 case who had severe dyspnea, with tracheal stenosis after long-term endotraehea] intubation during surgery for heart disease. All the patients under went bronchoscopic cryosurgery for several times, 1 case with severe tracheal stenosis was operated by electric coagulation before cryosurgery. Before and after the treatment, all the patients were evaluated based on clinical symptoms, tracheal lumen by bronchoseopy, chest CT for ateleetasis and pulmonary function for tracheal stenosis. Result The patients were treated with cryosurgery for 1-4 times. Sixteen cases were markedly improved, clinical symptoms disappeared completely, no granulation and fiber hyperplasia were found during bronehoscopy, and all the ateleetasis were cured. After the treatment, the bronchial lumen diameter of the patient with tracheal stenosis was increased from 2 mm to about 5 ram, the tidal volume increased from 3.0 ml/kg to 8.8 ml/kg. Five cases were effectively improved, the clinical symptoms also disappeared, during bronchoscopy and bronchial alveolar lavage （BAL）, no granulation and fiber hyperplasia were found, but some distal bronchial tubes were atresic or narrowed, the lumen was patent, the atelectasis recovered partially. In 1 case the treatment was ineffective, as the clinical symptoms and granulation disappeared, but because almost all distal bronchi were atresic or narrow, the lumen was not patent during BAL, there was no change on chest CT. The total effective rate was 21/22（95. 5% ）. No severe complications occurred during and after the procedures. All the patient wer

关 键 词：气道阻塞 冷冻疗法 支气管镜检查 

分 类 号：R725.6[医药卫生—儿科]