动力性良性中央气道狭窄临床特征分析:附二例报告  

Clinical characteristics of dynamic benign tracheobtonchial stenosis: two cases report

作　　者：孙小富 刘春涛[2] 罗壮[3] 胡良安 SUN Xiaofu;LIU Chuntao;LUO Zhuang;HU Liangan(Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P. R. China)

机构地区：[1]重庆医科大学附属第一医院呼吸内科,重庆400016 [2]四川大学华西医院呼吸与危重症医学科,四川成都610041 [3]昆明医科大学第一附属医院呼吸与危重症医学科,云南昆明650032

出　　处：《中国呼吸与危重监护杂志》2018年第3期275-278,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的通过对2例具有代表性的动力性良性中央气道狭窄病例的临床特征、影像学、支气管镜检查的复习,提高临床医生对该病的认识。方法回顾性分析以气管软骨环病变为主的气管支气管软化症(TBM)病例和以气管膜部受损造成的过度动态气道塌陷(EDAC)病例各1例。结果 2例患者均以中央气道狭窄、肺功能提示明显的"可逆性气道阻塞"为主要表现;TBM主要特点:胸部多层螺旋CT见气管、支气管壁"剑鞘样改变",气道冠状位直径缩短;气管镜见气管、支气管管腔狭窄、黏膜肿胀、软骨环消失。胸部EDAC见气管、支气管壁呼气相气道横截面积明显减少,气道矢状位直径明显缩短。气管镜见软骨环清晰,呼气时膜部向管腔内突出,气道呈新月形改变。结论动力性良性中央气道狭窄是临床少见疾病。CT检查是有效的筛查手段,最终的诊断需要支气管镜直视下观察诊断。Objective To improve the knowledge on dynamic benign central airway stenosis through two typical cases. Methods The clinical features, imaging findings, and bronchial morphologic changes of two cases characterized by dynamic benign central airway stenosis were retrospectively analyzed. The etiologies for the two cases were tracheobronchomalacia（TBM） and excessive dynamic airway collapse（EDAC）, respectively. Results Central airway stenosis and reversible airway obstruction were common clinical characteristics for the two cases. However, there were identifiable differences on imaging findings and bronchial morphologic changes between the two cases. Multidetector computed tomography showed sabre-sheath trachea and narrowed trachea in coronal position for TBM, while small sized trachea in exhalation phase and narrowed trachea in sagittal position for EDAC. Bronchoscopy displayed narrowed airway, swelling mucosa, and the absence of annular cartilage for TBM, while crescent airway with membranacea part protruding to lumen in inspiration phase, and the integrity of annular cartilage for EDAC. Conclusion Multidetector computed tomography and bronchoscopy examinations are valid methods to distinguish TBM and EDAC, which are both characterized by dynamic benign central airway stenosis.

关 键 词：动力性良性中央气道狭窄 气管支气管软化症 过度动态气道塌陷 复发性多软骨炎 支气管镜 

分 类 号：R56[医药卫生—呼吸系统]