良性中央呼吸道狭窄12例病因分析及气管镜介入治疗疗效分析  

Etiological analysis of 12 cases with benign central airway stenosis and therapeutic effect of endotracheal endoscopic intervention

作　　者：马兰红 贾莉[2] 王晓雯 Ma Lanhong;Jia Li;Wang Xiaowen(Department of Respiratory and Digestive Cardiovascular,Children′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Department of Pharmacy,the People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区儿童医院呼吸消化心血管科,乌鲁木齐830000 [2]新疆维吾尔自治区人民医院药学部,乌鲁木齐830001

出　　处：《中华实用儿科临床杂志》2020年第22期1727-1730,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：新疆维吾尔自治区人民医院科技引进创新项目(20180311)。

摘　　要：目的分析12例良性中央呼吸道狭窄病因,探讨气管镜介入治疗的疗效。方法回顾性收集2018年1月至2019年12月新疆维吾尔自治区人民医院良性中央呼吸道狭窄患儿的临床资料,分析其一般临床资料、CT呼吸道三维重建影像资料及支气管镜直视下气管狭窄特点。采取多种、联合的气管镜介入(高频灼烧、球囊扩张术、冷冻疗法)治疗。结果共收集12例良性中央呼吸道狭窄患儿的临床资料,男7例,女5例;其主要病因构成依次为插管后气管狭窄(9例,75.00%)、气管食管瘘(1例,8.33%)、气管切开术后蹼样狭窄(1例,8.33%)、异物后右主支气管上端靠近隆突处狭窄(1例,8.33%)。治疗后患儿狭窄段呼吸道的直径与治疗前[(1.98±0.48)mm]相比均显著增加,且随着随访时间延长,患儿狭窄段呼吸道的直径[治疗后4周(4.48±0.61)mm,治疗后6个月(5.49±0.52)mm,治疗后1年(6.13±0.26)mm]逐渐增加,差异均有统计学意义(t=12.871、9.302、6.737,均P<0.001);治疗后改良英国医学研究委员会呼吸困难量表(MMRC)评分与治疗前[(3.17±0.58)分]相比均显著下降,且随着随访时间延长,患儿MMRC评分[治疗后4周(1.17±0.94)分,治疗后6个月(0.58±0.67)分,治疗后1年(0.25±0.45)分]逐渐下降,差异均有统计学意义(t=11.489,3.924、2.345,均P<0.05)。结论儿童良性中央呼吸道狭窄病因构成以气管插管或气管切开后所致呼吸道狭窄最为常见,采取多种、联合的气管镜介入治疗(高频灼烧、球囊扩张术、冷冻疗法)疗效显著。Objective To explore the causes of 12 cases with benign central airway stenosis,and to discuss the therapeutic effect of endotracheal intubation.Methods Children with benign central airway stenosis in the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were selected.Their general cli-nical data,CT airway 3D reconstruction image data and the characteristics of tracheostenosis under bronchoscope were analyzed.A variety of combined bronchoscopic interventions(high-frequency cauterization,balloon dilatation,cryotherapy)were performed.Results The clinical data of 12 children with benign central airway stenosis were collected,including 7 males and 5 females.The main causes of benign central airway stenosis in 12 cases were tracheal stenosis after intubation(9 cases,75.00%),tracheoesophageal fistula(1 case,8.33%),webbed stenosis(1 case,8.33%)after tracheotomy,and right main bronchus stenosis after foreign body entrance(1 case,8.33%).After treatment for 4 weeks[(4.48±0.61)mm],6 months[(5.49±0.52)mm]and 1 year[(6.13±0.26)mm],the diameter of stenotic airways increased significantly compared with that before treatment[(1.98±0.48)mm],and the diameter of stenotic airways increased gradually with the time of follow-up(t=12.871,9.302,6.737,all P<0.001);the modified British Medical Research Council scale(MMRC)score decreased significantly after treatment[4 weeks(1.17±0.94)scores,6 months(0.58±0.67)scores,1 year(0.25±0.45)scores]compared with that before treatment[(3.17±0.58)scores],and the MMRC score decreased gradually with the increase of follow-up time(t=11.489,3.924,2.345,all P<0.05).Conclusions The most common causes of benign central airway stenosis in children are tra-cheal intubation or tracheotomy.The combination of a variety of endotracheal endoscopic interventions(high-frequency cauterization,balloon dilatation,cryotherapy)is effective in the treatment of this disease.

关 键 词：良性呼吸道狭窄 支气管镜 介入治疗 儿童 

分 类 号：R725.6[医药卫生—儿科]