de Blic J, Azevedo I, Burren C P, Le Bourgeois M, Lallemand D, Scheinmann P
Service de Pneumologie et d'Allergologie Infantiles, Hôpital des Enfants, Malades, Paris, France.
Chest. 1991 Sep;100(3):688-92. doi: 10.1378/chest.100.3.688.
The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary tuberculosis.
对54名年龄在3个月至14岁之间疑似患有肺结核的儿童进行了121次柔性支气管镜检查（FB），并对其价值进行了评估。在13例经细菌学确诊的病例中，有7例FB标本结核分枝杆菌培养呈阳性。54例中有31例发现了与诊断相符的支气管异常。初次FB时单独或并存的发现包括气道受压（20例）、肉芽组织（10例）和阻塞性干酪样物质（4例）。胸部X线片低估了14名儿童的支气管受累情况。进一步的FB监测记录了疾病的进展。FB在患者管理中很重要，因为它（1）指导泼尼松治疗的使用，特别是对于胸部X线片未提示支气管受累的儿童；（2）表明需要通过硬质支气管镜切除肉芽组织（3例）；（3）指导手术决策（2例持续性支气管阻塞患儿）。因此，FB是儿童肺结核管理中一种安全且有价值的检查方法。
