论文部分内容阅读
目的评价纤维支气管镜(简称纤支镜)结合胸部多排螺旋CT(MDCT)在先天性大血管病变并呼吸道狭窄中的诊断价值及安全性。方法回顾性分析经纤支镜检查和(或)MDCT确诊呼吸道狭窄的先天性大血管病变患儿34例,记录及分析首发临床表现,纤支镜下见到的呼吸道狭窄情况、胸部CT结果及经手术确诊的心血管畸形及呼吸道狭窄情况,记录纤支镜及MDCT检查中的不良事件,呼吸道狭窄的处理及转归。结果 (1)共34例纳入研究。其中主动脉梗阻性病变24例,血管环10例;均在NICU或术中完成纤支镜检查,34例术前(33例)和(或)术后(5例)完成CT检查。(2)血管环10例患儿均先经纤支镜检查发现呼吸道外压性狭窄或严重发育不良,提示血管环,呼吸道狭窄以气管中、下段为主,9例经CT证实,1例经手术证实。其中7例为先天性气管狭窄。(3)主动脉病变24例中仅5例术前CT提示呼吸道狭窄,其中1例术前纤支镜显示呼吸道狭窄,余19例均在术中或术后经纤支镜发现呼吸道外压性狭窄;21例有左主支气管狭窄,右主支气管狭窄2例,右下支气管狭窄1例。(4)纤支镜检查34例中2例出现一过性血氧饱和度下降,5例出现一过性心动过速,余患儿无不良反应;10例上呼吸机患儿带气管插管外出监护室行MDCT检查;4例外出检查后病情加重,需上呼吸机治疗,余20例外出CT检查无严重不良事件发生。(5)转归:血管环患儿中8例行外科手术治疗,7例单纯血管移植解除呼吸道压迫,其中2例死亡,1例同时行气管重建术,死于气管吻合口肉芽形成的再狭窄;主动脉病变组死亡4例,主动脉矫治术后呼吸道狭窄19例,4例行主动脉悬挂固定术解除狭窄。结论纤支镜检查在先天性大血管畸形伴呼吸道狭窄的诊断及治疗中起重要作用,具有准确、安全、经济及方便快捷的优点,结合MDCT检查可对呼吸道周围结构组织及血管畸形提供更多的信息,危重患儿外出行CT检查存在风险,需评估风险,并由有丰富急救经验的团队陪同外出检查。
Objective To evaluate the diagnostic value and safety of bronchofiberscope combined with chest multi-slice spiral CT (MDCT) in the diagnosis of congenital large vessel disease and airway stenosis. Methods A retrospective analysis of 34 cases of congenital macrovascular complications confirmed by bronchoscopy and / or MDCT in children with respiratory tract stenosis was performed. The first clinical manifestations, airway stenosis under bronchofibroscopy, chest CT findings and Surgical diagnosis of cardiovascular malformations and respiratory stenosis, recording bronchoscopy and MDCT examination of adverse events, respiratory tract stenosis and outcome. Results (1) A total of 34 cases were included in the study. Among them, 24 cases were aortic obstruction and 10 cases were vascular rings. All of them were examined by fiberoptic bronchoscopy in NICU or intraoperatively, 34 cases were performed preoperatively and / or postoperatively (5 cases). (2) 10 cases of vascular ring were detected by fiberoptic bronchoscopy, airway pressure stenosis or severe dysplasia, suggesting that the vascular ring, respiratory tract tracheal middle and lower main, 9 cases confirmed by CT, 1 case of Surgery confirmed. Seven of them were congenital tracheal stenosis. (3) Of the 24 cases with aortic lesions, only 5 cases of preoperative CT suggestive of respiratory tract stenosis, including 1 case of preoperative bronchoscopy showed respiratory tract stenosis, the remaining 19 cases were found during surgery or postoperative bronchoscopy were respiratory pressure 21 cases of left main bronchus stenosis, right main bronchus stenosis in 2 cases, right lower bronchus stenosis in 1 case. (4) Bronchofibroscopy showed transient oxygen saturation decreased in 2 of the 34 cases, transient tachycardia in 5 cases, and no adverse reactions in the other cases. In 10 cases of upper ventilator with tracheal intubation Out of the custody room MDCT examination; 4 cases out of the examination after exacerbations, need to ventilator treatment, more than 20 cases of CT examination without serious adverse events. (5) Outcomes: 8 cases of children with vascular ring underwent surgical treatment, 7 cases of simple vascular graft relieve respiratory pressure, of which 2 died, 1 case of simultaneous tracheal reconstructive surgery, died of tracheal anastomosis granulation restenosis ; 4 cases died of aortic lesions, 19 cases of aortic stenosis after restenosis, 4 cases of aortic suspension fixation to relieve stenosis. Conclusion Fiberoptic bronchoscopy plays an important role in the diagnosis and treatment of congenital macrovascular malformations and airway stenosis. It has the advantages of accuracy, safety, economy and convenience. Combined with MDCT, it can provide more information on the structure and vascular malformations around the airway Of the information, critically ill children traveling CT examination of the risk, need to assess the risk, and by a team with rich first-aid experience go out to check.