小儿先天性气管支气管狭窄16例临床分析

发布时间：2018-03-26 06:25

本文选题：先天性气管支气管狭窄　切入点：小儿　出处：《广西医科大学》2012年硕士论文

【摘要】：目的：对先天性气管支气管狭窄(CTS)病例临床资料进行回顾性分析,探讨该病的的临床特点及诊疗措施,旨在提高临床医生对该病的诊治水平。方法：收集广西医科大学第一附属医院儿科2005年1月至2012年3月间收住的16例先天性气管支气管狭窄(CTS)患儿的临床资料,总结该病的临床特点,观察其治疗转归。结果：1、16例病例中,男11例,女5例。2、起病年龄1岁者10例,1-2岁者4例,3-4岁者2例,最小者为1天,最大者3.5岁。3、13例(81.2%)有反复或持续性咳嗽,12例(75%)有双相性喘鸣,8例(50%)有气促,6例(37.5%)呼吸困难,5例(31.3%)有喉鸣,4例(25%)声嘶,呛奶窒息、插管困难各2例(12.5%),呼吸暂停及撤机困难各1例(6.25%)；10例(62.5%)肺部可闻及双相湿Up音,6例(40.0%)可见紫绀、吸凹征,3例(18.8%)合并先天性心脏病患儿可闻及心脏杂音。4、10例(62.5%)患儿曾被误诊,误诊为先天性喉喘鸣者3例、支气管异物者2例、支气管哮喘者2例、反复呼吸道感染者2例、喘息性肺炎者1例：误诊时间最短者达半月,最长者达12月。5、5例单独行胸部CT+气道三维重建检查,2例单独行支气管镜检查,9例经胸部CT气道三维重建+支气管镜联合检查,通过对比经二者联合检查的9例患儿发现,胸部CT+气道三维重建及支气管镜检查在气道狭窄诊断上具有良好一致性,且可互补,协助诊断。6、8(50%)例合并其它先天畸形或异常,其中合心脏畸形4例(25.0%)、其它呼吸系统异常及畸形4例(25%)、先天性肥厚性幽门狭窄2例(12.5%)。7、16例患儿均仅予内科治疗,13例轻、中度狭窄患儿均症状缓解,病情好转,予出院；3例重度狭窄患儿中2例合并肺部感染治疗无效死亡,1例病情好转,但家属放弃,主动出院。8、对14例患儿进行随访,随访时间2月-5年,13例轻、中度狭窄患儿中有4例患儿呼吸道症状完全消失,9例症状较前明显减轻。1例重度左主支气管狭窄并先天性心脏病患儿在外院行先心病修补术,术后仍有反复咳嗽、喘鸣及呼吸道感染,病情无明显改善。结论：1、CTS患儿临床表现缺乏特异性,易出现误诊。对于婴幼儿期出现的反复咳嗽、喘鸣、呼吸困难等表现的患儿应考虑到的CTS可能。2、CTS常合并其它先天畸形或异常,其中以心脏畸形最为多见。3、胸部CT+气道三维重建及支气管镜检查对于CTS诊断具有重要意义,二者联合检查可明确气管的内部和外部因素,结合病史、临床表现等可明确诊断。4、轻、中度狭窄患儿可予内科保守治疗,呼吸道症状可随年龄增长逐渐缓解甚至消失,但重度狭窄患儿仅内科治疗效果差,可能需外科治疗。
[Abstract]:Objective: to analyze retrospectively the clinical data of patients with congenital tracheobronchial stenosis (CTS) and to explore the clinical features and diagnosis and treatment of CTS in order to improve the diagnosis and treatment of the disease. Methods: the clinical data of 16 children with congenital tracheobronchial stenosis (CTS) admitted from January 2005 to March 2012 in the first affiliated Hospital of Guangxi Medical University were collected. Results among the 16 cases, 11 cases were male and 5 cases were female. The onset age of disease was 1 year old, 10 cases, 1-2 years old, 4 cases, 3-4 years old, 2 cases, the smallest case was 1 day. The largest 3.5-year-old (13 cases / 81.2) have recurrent or persistent cough (12 / 75) with bipolar wheezing (8 / 50) with shortness of breath (6 / 37.5) with dyspnea (5 / 31.3) with larynx (4 / 25) with hoarseness, choking and asphyxia, There were 2 cases of difficult intubation, 1 case of apnea and 1 case of dyspnea, 1 case of dyspnea and 1 case of dyspnea in 10 cases (62.5%). The lungs were audible and biphasic wet up sound was found in 6 cases. Cyanosis was seen in 6 cases, and concave sign in 3 cases (18.8%) with congenital heart disease. 410 cases (62.5%) were misdiagnosed. 3 cases were misdiagnosed as congenital laryngeal wheezing, 2 cases as bronchial foreign body, 2 cases as bronchial asthma, 2 cases as recurrent respiratory tract infection, 1 case as wheezing pneumonia. The longest of them was 12 months. 5 cases were examined by CT and 2 cases by bronchoscopy alone. 9 cases were examined by combined bronchoscopy of chest CT, and 9 cases were found by comparing the results of the two combined examinations. Three-dimensional reconstruction of chest CT and bronchoscopy have good consistency in the diagnosis of airway stenosis, and can be complementary to each other. Among them, 4 cases of cardiac malformation, 4 cases of other respiratory system abnormalities and 4 cases of malformation, 2 cases of congenital hypertrophic pyloric stenosis, 2 cases of congenital hypertrophic pyloric stenosis and 716 cases of congenital hypertrophic pyloric stenosis were treated with medical treatment only in 13 cases of mild and moderate stenosis. Of the 3 cases of severe stenosis, 2 cases were treated with pulmonary infection and 1 case died. However, the family gave up and discharged from the hospital voluntarily. 14 cases were followed up. The follow-up time was 2 months to 5 years and 13 cases were mild. In 4 cases of moderate stenosis, respiratory symptoms disappeared completely. 9 cases with severe left main bronchus stenosis and congenital heart disease were treated with repair of congenital heart disease in external hospital, and there was still repeated cough after operation. Wheezing and respiratory tract infection had no obvious improvement. Conclusion the clinical manifestations of children with 1 / 1 CTS are lack of specificity and misdiagnosed easily. For children with recurrent cough, wheezing and dyspnea in infancy, CTS may often be associated with other congenital malformations or abnormalities. Three dimensional reconstruction of chest CT and bronchoscopy are important for the diagnosis of CTS. The combined examination can identify the internal and external factors of trachea, combined with the history of the trachea. The clinical manifestations can be clearly diagnosed. The children with mild or moderate stenosis can be treated conservatively, and the respiratory symptoms can be relieved or even disappeared with the age, but the effect of medical treatment is poor in the children with severe stenosis, which may require surgical treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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