The value of fiberoptic bronchoscopy in diagnosis and treatment of pulmonary artery sling in infants
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摘要: 目的: 评价纤维支气管镜在诊治婴幼儿肺动脉吊带中的临床价值。方法: 收集2014-05-2017-06期间在我院确诊为肺动脉吊带的患儿11例, 回顾性分析其临床特征、影像学资料、纤维支气管镜检查及支气管肺泡灌洗液病原菌培养资料、治疗及预后。结果: 11例患儿因咳嗽、喘息、气促等不同呼吸道症状入院, 纤维支气管镜检查均发现气道不同部位有不同程度的狭窄, 经心脏彩超和心脏CT增强血管造影 (CTA) 证实为肺动脉吊带, 3例患儿因病情危重放弃死亡, 8例经外科手术及内科保守治疗后恢复良好。结论: 婴幼儿反复出现咳嗽喘息等呼吸道症状者, 应尽快行纤维支气管镜检查, 发现气道狭窄及畸形, 应高度警惕肺动脉吊带可能, 结合心脏彩超和心脏CTA可明确诊断, 早期诊断及手术治疗是治疗成功的关键。Abstract: Objective: To evaluate the clinical value of fiberoptic bronchoscopy in diagnosis and treatment of pulmonary artery sling in infants.Method: To collect 11 cases of infants who were diagnosed as pulmonary artery sling in Hunan Children's Hospital from May 2014 to June 2017, clinical manifestation, imaging examinations, fiberoptic bronchoscopy, the culture of pathogenic bacteria of bronchoalveolar lavage fluid (BALF), treatment and prognosis were retrospectively reviewed.Result: Eleven infants were admitted for respiratory tract symptoms, like coughing, wheezing, short of breath and so on.Examinations using Fiberoptic bronchoscopy discovered tracheal stenosis of various severity in different parts of respiratory tract, which verified to be pulmonary artery sling by echocardiography and cardiac spiral CT angiography (CTA).Three cases gave up treatment and died, while the other 8 cases had surgeries and received conservative medical treatment and recovered well.Conclusion: When infants demonstrate respiratory tract symptoms repeatly, such as couging, wheezing, etc.Fiberoptic bronchoscopy ought to be applied without delay.If tracheal stenosis and deformity are discovered, we should be on high alert for pulmonary artery sling.The combination of echocardiography and CTA can lead to definite diagnosis.Early diagnosis and surgery are key to successful treatment.
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Key words:
- pulmonary artery sling /
- fiberoptic bronchoscopy /
- tracheal stenosis /
- infants
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[1] Yu J M, Liao C P, Ge S, et al.The prevalence and clinical impact of pulmonary artery sling on school-aged children:a large-scale screening study[J].Pediatriculmonol, 2008, 43:656-661.
[2] Wu M H, Wu H Y.Tracheobronchial Stenosis Caused by Complex Sling of Left Pulmonary Artery and Aorta[J].Ann Thoracic Surg, 2016, 102:e59-e59.
[3] Tola H, Ozturk E, Yildiz O, et al.Assessment of children with vascular ring[J].Pediatr Int, 2017, 59:134-140.
[4] 刘金桥, 陈文娟, 彭巧玉, 等.超声心动图对左肺动脉吊带的诊断价值研究[J].临床小儿外科杂志, 2014, 13 (4):325-327.
[5] 李庚武, 王昶, 胡俊, 等.64层螺旋计算机断层摄影术及1.5T磁共振成像对婴幼儿先天性动脉血管环的诊断价值[J].中国循环杂志, 2016, 31 (2):156-160.
[6] Chen S J, Lee W J, Lin M T, et al.Left pulmonary artery sling complex:computed tomography and hypothesis of embryogenesis[J].Ann Thorac Surg, 2007, 84:1645-1650.
[7] Greenberg S B, Dyamenahalli U.Dynamic pulmonary computed tomography angiography:a new standard for evaluation of combined airway and vascular abnormalities in infants[J].Int J Cardiovasc Imaging, 2014, 30:407-414.
[8] Schramm D, Yu Y, Wiemers A, et al.Pediatric flexible and rigid bronchoscopy in European centers-Availability and current practice[J].Pediatr Pulmonol, 2017, 52:1502-1508.
[9] Terada M, Hotoda K, Toma M, et al.Surgical management of congenital tracheal stenosis[J].Gen Thorac Cardiovasc Surg, 2009, 57:175-183.
[10] Atkins M D, Fuller S.Thoracic Surgery Considerations in the Child and Young Adult[J].Thoracic Surg Clin, 2018, 28:43-52.
[11] 李金, 李光.支气管肺泡灌洗液细菌培养分布及耐药性分析[J].天津医科大学学报, 2015, 21 (3):242-244.
[12] 雷元辉.支气管镜肺泡灌洗用于重症肺炎患者的效果分析[J].临床急诊杂志, 2016, 17 (11):841-843.
[13] 焦鹏, 刘鑫, 王生华, 等.床旁纤支镜气管肺泡灌洗在急诊重症监护室机械通气COPD患者救治中的应用[J].临床急诊杂志, 2016, 17 (11):874-876.
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