支气管镜下球囊扩张治疗儿童气道狭窄156例临床回顾分析

摘要

目的 探讨支气管镜下球囊扩张治疗气道狭窄的疗效和安全性.方法 对山东大学齐鲁儿童医院呼吸介入科2008年10月至2011年8月收治的156例气道狭窄患儿,实施支气管镜介导下球囊扩张治疗,其中146例肺炎致气道炎性狭窄、4例结核感染引起的气道狭窄、1例异物肉芽组织增生致气道狭窄并肺不张；5例气管插管引起的气道疤痕性狭窄.结果 (1)156例气道狭窄的患儿分别接受支气管镜下球囊扩张1～3次.139例显效,其中134例狭窄段管径增大,肺不张复张2/3以上；5例主气道狭窄经球囊扩张治疗呼吸通畅.12例有效,肺不张经球囊扩张后肺组织复张1/3 ～2/3.5例无效,虽扩张后局部狭窄解除,但胸部CT肺不张无改善.总有效率96.8％.(2)经1～6个月随访,气管镜下扩张部位气道未再次狭窄,胸片或胸部CT肺不张无复发.(3)26例扩张时扩张部位的支气管黏膜轻微出血,止血效果好,9例术后轻微胸痛未作处理很快缓解,无其他并发症.结论 支气管镜下球囊扩张治疗儿童气道狭窄是有效、安全、简便的方法.%Objective To discuss the effect and security of balloon dilatation using a bronchoscope in the management of benign tracheobronchial stenosis. Methods A total of 156 child patients with proximal benign tracheobronchial stenosis were managed by balloon using the flexible electronic bronchoscope. Of these patients, 146 were with pneumonia, 4 patients with tuberculosis infection, 1 patient with granulation tissue by airway extraneous material, 5 patients after tra-cheal intubation. Results The 156 patients obtained 1-3 times of balloon dilatation. In these patients, the curative effects of 139 patients were excellent, 12 patients effective, and 5 patients invalid. In 139 excellent patients, the airway average diameter in narrow segmental bronchus was increased and the ventilatory capacity of closed lung was increased above two-thirds in 134 patients and the dyspneic respiration with main bronchus stenosis disappeared in 5 excellent patients. In 12 effective patients, the ventilatory capacity of closed lung was increased from one-third to two-thirds after therapy with balloon dilatation. In 5 invalid patients, the ventilatory capacity of closed lung was not changed, although the partial airway stenosis was removed. So, the total effect rate was 96.8% after therapy with balloon dilatation. After follow-up periods of 1-6 months, the airway dilated by balloon did not become narrow again and closed lung did not appear again through chest X-ray or CT. No severe complication was found in any patient.Conclusion Airway plasty with high pressure balloon dilatation using flexible electronic bronchoscope is an effective, safe, simple and rapid method for treatment of proximal benign tracheobronchial stenosis in child.