电子支气管镜在儿童肺部大片阴影病灶性疾病的诊治作用  

Significance of electronic bronchoscopy in diagnosis and treatment of lung diseases with pulmonary mass lesion in children

作　　者：尹芳[1] 周卫芳[1] 黄莉[1] 朱灿红[1] 王美娟[1] 闻芳[1] 严永东[1] 季伟[1] 

机构地区：[1]苏州大学附属儿童医院,江苏苏州215003

出　　处：《临床儿科杂志》2014年第2期131-135,共5页Journal of Clinical Pediatrics

基　　金：江苏省社会发展项目(No.BE2012652)

摘　　要：目的：探讨电子支气管镜及肺泡灌洗术在儿童肺部大片阴影病灶性疾病诊治中的价值。方法回顾性分析2011年1月-2012年6月74例影像学示肺部大片状阴影，并行电子支气管镜检查及肺泡灌洗术的住院患儿的临床资料。结果电子支气管镜检查发现儿童肺部大片阴影以感染最常见（68/74，91.89%），包括大叶性肺炎65例，肺结核3例；其次为支气管异物（5例，6.76%）和肺出血（1例，1.35%）。炎症部位以左下叶最多，其次为右下叶，病变部位与术前影像学检查一致率为97.30%。肺泡灌洗液检测提示，大叶性肺炎以支原体感染为主（42/65，64.62%），支原体感染检出率以学龄前期组最高（70.83%），在不同年龄患儿中的差异有统计学意义（P＆lt;0.01）。第1次电子支气管镜及肺泡灌洗术后1周内复查影像学，61.54%大叶性肺炎患儿肺部病变明显好转。发病后在1~2周内行电子支气管镜检查的短程组患儿的肺部病变好转率（90.91%）高于2~3周的中程组（51.72%）和＆gt;3周的长程组（35.71%），住院时间也短于中程组和长程组，差异均有统计学意义（P＆lt;0.05）。结论电子支气管镜及肺泡灌洗术在儿童肺部大片阴影病灶性疾病中具有病因诊断和治疗的双重作用。Objectives To investigate the significance of electronic bronchoscopy and bronchoalveolar lavage in diagno-sis and treatment in children with pulmonary mass lesion. Methods A total of 74 hospitalized children from January 2011 to June 2012 whose imaging examinations showed massive patchy shadow were examined and treated by electronic bronchoscopy and bronchoalveolar lavage. Their clinical data were retrospectively analyzed. Results The major cause for the massive shadow was infection according to electronic bronchoscopy examination （68/74, 91.89%）, 65 cases of them were lobar pneumonia, 3 cas-es were pulmonary tuberculosis followed by 5 cases of foreign body （6.76%） and one case of pneumorrhagia （1.35%）.The lower left lung was the most frequently seen site of infection, followed by lower right lung. The agreement between infection sites and imaging examination was 97.30%. Bronchoalveolar lavage fluid showed that the primary pathogen of lobar pneumonia infection is Mycoplasma pneumoniae （MP） （42/65, 64.62%）. The highest detection rate of MP was found in preschool group and the detec-tion rate between different age groups indicated statistically significant difference （P＆lt;0.01）. The imaging examination showed pulmonary lesions in 61.54%children with lobar pneumonia improved significantly in one week. The improvement rate of pul-monary lesions was higher in infected children with short duration （1-2 weeks, 90.91%） between disease onset and electronic bronchoscopy inspection than those with longer duration （2-3 weeks, 51.72% and ＆gt;3 weeks, 35.71%） （P＆lt;0.05）. Conclusions Electronic bronchoscopy and bronchoalveolar lavage play dual roles in etiological diagnosis and therapy in children with pulmo-nary mass lesion.

关 键 词：肺部大片阴影 电子支气管镜 肺泡灌洗术 儿童 

分 类 号：R725.6[医药卫生—儿科]