CAJ | 학술논문

支气管镜检查在儿科肺疾病的评估和治疗中发挥了很重要的作用.支气管肺泡灌洗、支气管刷检及活检为诊断提供了很多帮助,甚至在很小的患儿中也能安全施行.文章描述了纤维支气管镜检查的经典过程及其在临床中适应证.
지기관경검사재인과폐질병적평고화치료중발휘료흔중요적작용.지기관폐포관세、지기관쇄검급활검위진단제공료흔다방조,심지재흔소적환인중야능안전시행.문장묘술료섬유지기관경검사적경전과정급기재림상중괄응증.
The role of flexible fiberoptic bronchoscopy (FFB) in the evaluation of pediatric lung disease has expanded dramatically since the original description of the procedure by Wood and Fink in 1978.FFB can be used to evaluate airway anatomy, obtain secretions for culture and biochemical analysis and obtain airway cells or parenchymal tissues for evaluation. Both the upper and lower airway can be examined during FFB. Visual examination can diagnose a variety of congenital abnormalities ( Table 1 ). During FFB a dynamic evaluation of the airways, including the movement of the glottis, vocal cords and lower airways during the respiratory cycle can be performed. These observations can diagnose airway collapse due to malacia or obstruction due to external compression. Additionally, the diameter of the airway lumen and character of the airway mucosa can easily be evaluated. FFB can also identify airway obstruction by secretions and mucus plugs, blood, foreign bodies or masses. Bronchoalveolar lavage (BAL) allows collection of airway and alveolar secretions for evaluation of cellular and immunologic components, evidence of infection and cytology. Therapeutic lavage can be used to treat atelectasis by removing secretions obstructing airways. This approach can be helpful in children with inspissated secretions obstructing both large and small airways ( Figure 1 ). Therapeutic lavage has also been used in the treatment of alveolar proteinosis. Bronchial brushing can add information to bronchoscopic examination by obtaining airway epithelial cells for cytology, to identify intracellular pathogens and to evaluate cilia. Studies have demonstrated the utility of bronchial brushings for the isolation, characterization and culture of primary epithelial cells from children with asthma. Endobronchial biopsies are used for histopathological and immunocytochemical analysis and microbiological culture. Biopsies are often performed to assess cilia function and architecture. In addition, primary bronchial epithelial cells can be isolated and cultured from endobronchial mucosal biopsies. Endobronchial biopsies have been utilized extensively to study inflammation and airway remodeling in children with both asthma and cystic fibrosis. Transbronchial biopsies can be used to diagnose a wide variety of infectious, immunologically-mediated and fibrotic pulmonary conditions. This procedure is best utilized for the diagnosis of diffuse lung disease. The biopsies typically contain both airway and alveolar tissue. Transbronchial biopsies are particularly useful in the management of patients following pulmonary transplantation. Common indications for pediatric FFB can be found in Table 2, including stridor,persistent wheezing (Figure 2), chronic cough, atelectasis, pneumonia and suspected infection (Figure 3)and interstitial lung disease. The use of FFB in evaluation of airways abnormities, infections and diffuse lung diseases can provide significant insight into the pathogenesis of pediatric pulmonary symptoms and suggest therapeutic interventions.The diagnostic yield of FFB is greatly enhanced by the careful selection of patients who undergo the procedure.