本文選題：先天性氣管支氣管狹窄　切入點(diǎn)：小兒　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：對先天性氣管支氣管狹窄(CTS)病例臨床資料進(jìn)行回顧性分析,探討該病的的臨床特點(diǎn)及診療措施,旨在提高臨床醫(yī)生對該病的診治水平。 方法：收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院兒科2005年1月至2012年3月間收住的16例先天性氣管支氣管狹窄(CTS)患兒的臨床資料,總結(jié)該病的臨床特點(diǎn),觀察其治療轉(zhuǎn)歸。 結(jié)果：1、16例病例中,男11例,女5例。2、起病年齡1歲者10例,1-2歲者4例,3-4歲者2例,最小者為1天,最大者3.5歲。3、13例(81.2%)有反復(fù)或持續(xù)性咳嗽,12例(75%)有雙相性喘鳴,8例(50%)有氣促,6例(37.5%)呼吸困難,5例(31.3%)有喉鳴,4例(25%)聲嘶,嗆奶窒息、插管困難各2例(12.5%),呼吸暫停及撤機(jī)困難各1例(6.25%)；10例(62.5%)肺部可聞及雙相濕Up音,6例(40.0%)可見紫紺、吸凹征,3例(18.8%)合并先天性心臟病患兒可聞及心臟雜音。4、10例(62.5%)患兒曾被誤診,誤診為先天性喉喘鳴者3例、支氣管異物者2例、支氣管哮喘者2例、反復(fù)呼吸道感染者2例、喘息性肺炎者1例：誤診時間最短者達(dá)半月,最長者達(dá)12月。5、5例單獨(dú)行胸部CT+氣道三維重建檢查,2例單獨(dú)行支氣管鏡檢查,9例經(jīng)胸部CT氣道三維重建+支氣管鏡聯(lián)合檢查,通過對比經(jīng)二者聯(lián)合檢查的9例患兒發(fā)現(xiàn),胸部CT+氣道三維重建及支氣管鏡檢查在氣道狹窄診斷上具有良好一致性,且可互補(bǔ),協(xié)助診斷。6、8(50%)例合并其它先天畸形或異常,其中合心臟畸形4例(25.0%)、其它呼吸系統(tǒng)異常及畸形4例(25%)、先天性肥厚性幽門狹窄2例(12.5%)。7、16例患兒均僅予內(nèi)科治療,13例輕、中度狹窄患兒均癥狀緩解,病情好轉(zhuǎn),予出院；3例重度狹窄患兒中2例合并肺部感染治療無效死亡,1例病情好轉(zhuǎn),但家屬放棄,主動出院。8、對14例患兒進(jìn)行隨訪,隨訪時間2月-5年,13例輕、中度狹窄患兒中有4例患兒呼吸道癥狀完全消失,9例癥狀較前明顯減輕。1例重度左主支氣管狹窄并先天性心臟病患兒在外院行先心病修補(bǔ)術(shù),術(shù)后仍有反復(fù)咳嗽、喘鳴及呼吸道感染,病情無明顯改善。 結(jié)論：1、CTS患兒臨床表現(xiàn)缺乏特異性,易出現(xiàn)誤診。對于嬰幼兒期出現(xiàn)的反復(fù)咳嗽、喘鳴、呼吸困難等表現(xiàn)的患兒應(yīng)考慮到的CTS可能。2、CTS常合并其它先天畸形或異常,其中以心臟畸形最為多見。3、胸部CT+氣道三維重建及支氣管鏡檢查對于CTS診斷具有重要意義,二者聯(lián)合檢查可明確氣管的內(nèi)部和外部因素,結(jié)合病史、臨床表現(xiàn)等可明確診斷。4、輕、中度狹窄患兒可予內(nèi)科保守治療,呼吸道癥狀可隨年齡增長逐漸緩解甚至消失,但重度狹窄患兒僅內(nèi)科治療效果差,可能需外科治療。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.6

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相關(guān)期刊論文 前2條

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本文編號：1666721