Oliveira-Santos J A, Pereira-da-Silva L, Clington A, Serelha M
Serviço de Pediatria, Hospital de Dona Estefânia, Lisboa.
Acta Med Port. 2004 Sep-Oct;17(5):341-8. Epub 2004 Dec 20.
The availability of newer, more sophisticated and versatile bronchoscopes has expanded the spectrum and scope of the indications for bronchoscopy in the newborn infant both for diagnostic and therapeutic purposes. The aim of this study was to carry out a retrospective analysis of the bronchoscopies performed on newborn infants, and to review the indications of this procedure in this age group. Sixty-three patients were submitted to 67 bronchoscopies in a period of 13 years, allowing the diagnosis of 45 anomalies and malformations of the tracheo-bronchial tree, and the performance of 24 bronchoalveolar lavages. In six cases, endoscopic removal of secretions helped to resolve resistant atelectasia, while in another case, with esophageal atresia, intra-operative definition of the fistula tract was possible through catheterisation of the fistula with the bronchoscope. The flexible bronchoscope was preferred for diagnosis by direct visualisation, and the rigid bronchoscope for some diagnostic and therapeutic procedures. Stridor, unexplained cyanosis, hemoptysis, persistent or recurrent pulmonary images, difficulties in the intubation or extubation, and persistent disturbances in ventilation are among the main indications for bronchoscopy in the newborn infant. Bronchoscopy also allows the performance of subsidiary techniques, such as bronchoalveolar lavage, biopsy and laser therapy.
更新的、更精密且用途广泛的支气管镜的出现，扩大了新生儿支气管镜检查在诊断和治疗方面的适应证范围。本研究的目的是对新生儿进行的支气管镜检查进行回顾性分析，并审视该年龄组这一检查方法的适应证。在13年期间，63例患者接受了67次支气管镜检查，得以诊断出45例气管支气管树的异常和畸形，并进行了24次支气管肺泡灌洗。在6例病例中，内镜下清除分泌物有助于解决难治性肺不张，而在另一例食管闭锁病例中，通过支气管镜经瘘管插入导管，术中明确了瘘管路径。诊断时，柔性支气管镜因可直接观察而更受青睐，而刚性支气管镜则用于一些诊断和治疗程序。喘鸣、不明原因的青紫、咯血、持续或反复出现的肺部影像、插管或拔管困难以及持续的通气障碍是新生儿支气管镜检查的主要适应证。支气管镜检查还可进行辅助技术，如支气管肺泡灌洗、活检和激光治疗。
