Nicolai T
Universität Kinderklinik München, Dr. von Haunerschen Kinderspital, Munich, Germany.
Pediatr Pulmonol. 2001 Feb;31(2):150-64. doi: 10.1002/1099-0496(200102)31:2<150::aid-ppul1024>3.0.co;2-6.
Diagnostic flexible endoscopy for pediatric respiratory diseases is performed in many centers. Technical advances have resulted in performance of interventional bronchoscopies, and new diagnostic indications are being explored. Indications with documented clinical benefit include congenital or acquired progressive or unexplained airway obstruction. Pulmonary infections in immunodeficient children who do not respond to empirical antibiotic treatment may be diagnosed by bronchoscopy and bronchoalveolar lavage (BAL). The potential usefulness of bronchoscopy and BAL for managing chronic cough, wheeze, or selected cases with asthma or cystic fibrosis requires further study. The use of transbronchial biopsies (TBB) is established in pediatric lung transplantation. The role of TBB in the diagnosis of chronic interstitial lung disease in children remains to be determined. For a number of interventional applications, rigid endoscopy is required, and pediatric bronchoscopists should be trained in its use. Complications in pediatric bronchoscopy are rare, but severe nosocomial infection or overdosing with local anesthetics has occurred. The issues of quality control, video documentation, interobserver variability of findings, and educational standards will have to be addressed in the future as bronchoscopy use becomes less restricted to only large pediatric pulmonary units.
许多中心都开展了用于诊断小儿呼吸道疾病的可弯曲诊断性内镜检查。技术进步使得介入性支气管镜检查得以开展，并且正在探索新的诊断适应证。有文献记载具有临床益处的适应证包括先天性或后天性进行性或不明原因的气道阻塞。对于经验性抗生素治疗无效的免疫功能低下儿童的肺部感染，可通过支气管镜检查和支气管肺泡灌洗（BAL）进行诊断。支气管镜检查和BAL在处理慢性咳嗽、喘息或某些哮喘或囊性纤维化病例中的潜在用途需要进一步研究。经支气管活检（TBB）在小儿肺移植中已确立其应用。TBB在儿童慢性间质性肺疾病诊断中的作用仍有待确定。对于许多介入性应用，需要使用硬质内镜，小儿支气管镜检查医师应接受相关培训。小儿支气管镜检查的并发症很少见，但曾发生过严重的医院感染或局部麻醉药过量的情况。随着支气管镜检查的应用不再局限于大型小儿肺病科，未来必须解决质量控制、视频记录、观察者间检查结果的差异以及教育标准等问题。
