CAJ | 학술논문

目的对支气管镜介导下球囊扩张气道成形术治疗支原体肺炎肺不张患儿4～5级气道炎性狭窄的疗效和安全性进行评价.方法对30例支原体肺炎所致的气道炎性狭窄并肺不张患儿,实施支气管镜介导下球囊扩张气道成形术.分别于术前和最后一次球囊扩张术后胸部CT检查,对肺不张的情况进行评价.所有患儿均接受了1～6个月的随访.结果(1)30例气道狭窄的患儿分别接受球囊扩张1～3次.经过球囊扩张气道成形术后,25例患儿狭窄段管径增大,球囊扩张部位远端肺组织复张;5例狭窄段扩开不明显,其中3例病变部位有肉芽组织形成,经球囊联合冷冻治疗后,球囊扩张部位远端肺组织复张;另2例患儿病程超过3个月,扩张治疗无效.(2)经1～6个月随访,肺复张的28例患儿胸部CT显示扩张治疗部位影像正常,2例扩张治疗无效的患儿胸部CT显示的肺不张范围较前无变化.(3)30例接受此方法治疗的患儿,20例扩张时出现扩张部位的支气管黏膜轻微出血,5例术后轻微胸痛,没有其他严重并发症发生.结论支气管镜介导下的球囊扩张气道成形术治疗儿童肺部感染后气道狭窄有效、安全.
목적 대지기관경개도하구낭확장기도성형술치료지원체폐염폐불장환인4～5급기도염성협착적료효화안전성진행평개.방법 대30례지원체폐염소치적기도염성협착병폐불장환인,실시지기관경개도하구낭확장기도성형술.분별우술전화최후일차구낭확장술후흉부CT검사,대폐불장적정황진행평개.소유환인균접수료1～6개월적수방.결과(1)30례기도협착적환인분별접수구낭확장1～3차.경과구낭확장기도성형술후,25례환인협착단관경증대,구낭확장부위원단폐조직복장;5례협착단확개불명현,기중3례병변부위유육아조직형성,경구낭연합냉동치료후,구낭확장부위원단폐조직복장;령2례환인병정초과3개월,확장치료무효.(2)경1～6개월수방,폐복장적28례환인흉부CT현시확장치료부위영상정상,2례확장치료무효적환인흉부CT현시적폐불장범위교전무변화.(3)30례접수차방법 치료적환인,20례확장시출현확장부위적지기관점막경미출혈,5례술후경미흉통,몰유기타엄중병발증발생.결론지기관경개도하적구낭확장기도성형술치료인동폐부감염후기도협착유효、안전.
Objective To assess the efficacy and safety of balloon dilatation through flexible bronchoscopy in the management of inflammatory stenosis of grade 4-5 bronchus.Method Thirty patients with inflammatory bronchial stenosis caused by mycoplasmal pneumonia complicated with pulmonary atelectasis were treated with balloon dilatation through fiberoptic bronchoscopy.Before the procedure and after the last operation,therapeutic effect on pulmonary atelectasis were evaluated with CT and all of the patients were followed-up for 1-6 months.Result One to three operations were required to achieve satisfactory dilatation.After balloon dilatation,the average airway diameter increased obviously and the farther airways were opened after the therapy with irrigation.In 25 of 30 cases satisfactory immediate effects were obtained,a narrow airway diameter above expansion significantly increased as compared with preoperative diameter.In 5 children treated with balloon dilatation,the stenosis could not be improvedsignificantly.In 3 patients with hyperplasia of granulation tissue,cryotherapy had to be applied.The operations were ineffective in the other two patiens whose course of disease exeeded 3 months.After followup periods of 1-6 months,chest CT manifestation of expanded sites was improved in 28 patients and atelectasis disappeared.No severe complication was found in any patients.Conclusion Brenchoplasty by balloon dilatation through flexible fiberoptic bronchoscopy is a simple,effective and safe method to treat childhood tracheobronehial stenosis after pulmonary infections.