电子支气管镜在65例先天性气管食管瘘儿童围手术期的应用  

Application of electronic bronchoscope in 65 children with congential tracheoesophageal fistula during perioperative period

作　　者：赵启君 王永军[1] 石永生[1] 李晗怡[1] 王舒颖 王有亮[2] 韩旭东[3] Zhao Qijun;Wang Yongjun;Shi Yongsheng;Li Hanyi;Wang Shuying;Wang Youliang;Han Xudong(Department of Pediatric Respiratory,Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China;Department of Pediatric Surgery,Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China;Department of Anesthesiology,Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院小儿呼吸科,兰州730050 [2]甘肃省妇幼保健院小儿外科,兰州730050 [3]甘肃省妇幼保健院麻醉手术科,兰州730050

出　　处：《中国小儿急救医学》2022年第2期119-122,共4页Chinese Pediatric Emergency Medicine

基　　金：甘肃省科技计划项目(18JR2FA004)。

摘　　要：目的探讨电子支气管镜在先天性气管食管瘘围手术期的应用价值及风险。方法回顾性分析2014年9月至2020年11月甘肃省妇幼保健院收治的65例先天性气管食管瘘围手术期患儿的一般情况、临床表现、影像学资料、电子支气管镜检查和治疗转归等临床资料。结果63例患儿经电子支气管镜检查后确诊为先天性气管食管瘘,确诊率为96.92%;54例患儿经食管造影确诊,确诊率91.53%;61例患儿经多层螺旋CT确诊,确诊率93.85%。27例电子支气管镜检查发现呼吸道结构异常,发生率为41.54%,其中包括鼻咽软组织塌陷3例、喉软化14例、气管狭窄5例、气管软化9例、气管支气管及支气管异常开口9例。3例术后出现撤机困难主要与气管狭窄、气管软化有关,经过长时间机械通气及治疗后逐步撤机。2例患儿术中出现一过性缺氧。结论电子支气管镜是诊断先天性气管食管瘘及术后复发的安全、有效方法,可以早期发现呼吸道解剖结构异常,对术后的气道管理具有重要的价值。Objective To explore the value and risk of electronic bronchoscope applied in perioperative management of children with congential tracheoesophageal fistula.Methods Sixty-five children with congential tracheoesophageal fistula performed electronic bronchoscope examination from September 2014 to November 2020 were enrolled in this study.The results of examination and complications were analyzed.Results Sixty-three children with congenital tracheoesophageal fistula were diagnosed by electronic bronchoscopy.The diagnosis rate was 96.92%.Fifty-four children with congenital tracheoesophageal fistula were diagnosed by esophagography.The diagnosis rate was 91.53%.Sixty-one children with congenital tracheoesophageal fistula were diagnosed by multislice spiral computed tomography.The diagnosis rate was 93.85%.Airway anatomic abnormity was found in 27 children,including three cases of nasopharyngeal soft tissue collapse,14 cases of laryngomalacia,five cases of tracheal stenosis,nine cases of tracheobronchomalacia,and nine cases of tracheobronchial and abnormal opening of the bronchus.The incidence was 41.54%.Three children with difficult ventilator weaning were related to tracheobronchial stenosis or tracheobronchomalacia.They were gradually weaning from ventilator after a long period of mechanical ventilation and treatment.Two children with transient decrease in oxygen saturation were noticed as complication.Conclusion Electronic bronchoscopy is a safe and effective method for the diagnosis of congenital tracheoesophageal fistula and recurrence after operation.It is of great value to the airway management after operation by early detection of respiratory anatomic abnormity.

关 键 词：电子支气管镜 气管食管瘘 围手术期 

分 类 号：R726.5[医药卫生—儿科]