巨气管支气管症1例并文献复习  

Clinical analysis of one case of trachebronchomegaly and literature review

作　　者：金贝贝[1] 韦秀平[1] 王娟[1] 丁彦[1] 王晓陶[1] 董淑文[1] 党斌温[1] 张杰[1] Jin Beibei;Wei Xiuping;Wang Juan;Ding Yan;Wang Xiaotao;Dong Shuwen;Dang Binwen;Zhang Jie(Department of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院呼吸内科,100050

出　　处：《国际呼吸杂志》2018年第11期849-854,共6页International Journal of Respiration

摘　　要：目的提高对巨气管支气管症的认识,减少漏诊。方法报道1例巨气管支气管症患者,并复习国内已报道的20例巨气管支气管症患者的临床资料。结果21例巨气管支气管症患者中,男20例,平均年龄54岁。主要症状为咳嗽（95.24%）、咳痰（95.24%）、气短（57.14%）,听诊肺内干湿啰音（66.67%）。影像学可见气管、主支气管管腔增大（100.00%）、支气管扩张（4286%）、气管支气管多发憩室（1429%）、肺大疱（23.81%）,其中18例患者气管平均直径361mm,12例患者左主支气管平均直径25.2mm,右主支气管平均直径250mm。气管直径与患者年龄（r=-0.147,P=0.560）及病程（r=0337,P=0.201）无明确相关关系。13例患者进行支气管镜检查,镜下表现主要为气管管腔扩大（10000%）、憩室形成（46.15%）、气道功能障碍（30.77%）。气道功能障碍与气管直径之间无相关关系（χ^2=0.213,P=0.644）。未见置入气道支架治疗者,1例患者死于严重感染。结论该病以男性发病为主,临床表现无特异性,主要依靠影像学测量气管直径确定诊断,气管镜检查可辅助诊断,并可及时发现气管软化。Objective To improve understandings of clinical characteristics of tracheobronchomegaly （TBM） and reduce risks of missed diagnosis in clinical practice. Methods A case of TBM admitted to Beijing Tiantan Hospital was reported and 20 cases previously published in domestic literatures were reviewed. Results Of the total 21 involved patients, 20 cases were male with an average age of 54 years old. The most common clinical symptoms and physical signs were cough （95.24%）, sputum （95.24 % ）, shortness of breath （ 57.14 % ）, bronchial tale and/or wheezing （ 66.67 % ）. Featured imaging changes by chest CT scan were dilatation of the trachea and mainstem bronchi （100.00%）, bronchiectasis （42.86 % ）, tracheal diverticulosis （14.29%）, and pulmonary bulla （23.81 %）. The average diameter of trachea in 18 patients was 36.1 mm, while the average diameters of left and right mainstem bronchus in 12 patients were 25.2 mm and 25.0 mm, respectively. The further analysis showed the diameter of trachea was not associated with age （ r = -0. 147, P =0. 560） or disease duration of patients （r = 0.337, P = 0.201 ）. Among 13 patients with bronchoscopy, increased tracheal diameter （100.00%）,diverticulosis （46.15%） and trachea dysfunction （30.77%） were observed. There was no correlation between the diameter of trachea and trachea dysfunction （ χ^2 =0. 213, P =0. 644）. No patient was treated by trachea stent therapy to sustain their airway stabilization. One patient died of severe infection. Conclusions TBM is more common in male patients without specific clinical manifestations. The diagnosis of TBM is mainly based on measurement of trachea diameter. Broncboscopy can facilitate early diagnosis of TBM and direct verification of tracheobronchomalacia.

关 键 词：巨气管支气管症 回顾性研究 诊断 

分 类 号：R562[医药卫生—呼吸系统]