He Shao-ru, Sun Yun-xia, Liu Yu-mei, Zhuang Jian, Zhong Jin, Liang Sui-xin, Sun Xin, Lai Jing-ni
Department of Neonatology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China.
Zhonghua Er Ke Za Zhi. 2009 Oct;47(10):726-9.
To evaluate the diagnostic value and safety of flexible bronchoscopy in congenital great vessel diseases complicated with airway compression.
The medical records of patients with great vessels abnormalities who were admitted to the neonatal intensive care unit (NICU) from October 2005 to June 2009 were retrospectively reviewed; 34 cases were diagnosed as airway compression by flexible bronchoscopy, 10 cases as vascular ring, 24 cases as aortal arch obstruction. The age of the patients was 6 d - 11 m, body weight 2.2 - 8.7 kg [(4.6 +/- 1.4) kg]. Recorded airway abnormalities detected by bronchoscopy and CT, cardiac vascular defects and airway compression were consistent with the findings on operation. The relation between the airway compression and cardiac vascular abnormalities, treatment of the airway compression and outcome were analysed.
Bronchoscopic assessment was successfully performed in NICU or operating room for all the patients. (1) Initial presentation of the 34 cases were tachypnea, stridor, refractory lung infection and prolonged mechanical ventilation. (2) Extrinsic compression was found in all the 10 cases with vascular ring by bronchoscopy initially which indicated vascular ring, airway compression was mainly of lower part of trachea. Diagnosis of 9 cases was consistent with CT diagnosis and in 1 case the diagnosis was confirmed by surgery; among these cases, 7 had congenital tracheal stenosis. (3) In the 24 cases with aortic obstructive lesion, 5 were detected to have tracheal stenosis by CT before correction of vascular abnormality, among whom one case was indicated to have tracheal stenosis by bronchoscopy, the other 19 cases were found with airway compression by bronchoscopy during or after vascular correction. Among the 24 cases, 21 had left main bronchial stenosis, 2 had congenital tracheal stenosis. Airway compression diagnosed by bronchoscopy agreed with the findings of CT. Two cases developed transient decrease of oxygen saturation, 5 cases developed transient tachycardia.
Flexible bronchoscopy plays an important role in assessment of the airway compression complicated with great vessel abnormalities. Bronchoscopy is an accurate, convenient, safe and rapid way for airway assessment, but further examination of the peripheral structure and vascular malformation need combined examination with CT.
评估可弯曲支气管镜检查在先天性大血管疾病合并气道受压中的诊断价值及安全性。
回顾性分析2005年10月至2009年6月入住新生儿重症监护病房（NICU）的大血管异常患儿的病历资料；34例经可弯曲支气管镜检查诊断为气道受压，其中10例为血管环，24例为主动脉弓梗阻。患儿年龄6天至11个月，体重2.2至8.7千克[（4.6±1.4）千克]。记录支气管镜及CT检查发现的气道异常情况，心脏血管缺陷及气道受压情况与手术所见相符。分析气道受压与心脏血管异常的关系、气道受压的治疗及预后。
所有患儿均在NICU或手术室成功完成支气管镜评估。（1）34例患儿的首发症状为呼吸急促、喘鸣、难治性肺部感染及机械通气时间延长。（2）10例血管环患儿经支气管镜检查均发现外部压迫，提示血管环，气道受压主要位于气管下段。9例诊断与CT诊断一致，1例经手术证实；其中7例合并先天性气管狭窄。（3）24例主动脉梗阻性病变患儿中，5例在血管异常矫治前CT检查发现气管狭窄，其中1例经支气管镜检查提示气管狭窄，另外19例在血管矫治期间或之后经支气管镜检查发现气道受压。24例中，21例合并左主支气管狭窄，2例合并先天性气管狭窄。支气管镜诊断的气道受压情况与CT检查结果相符。2例出现血氧饱和度短暂下降，5例出现短暂心动过速。
可弯曲支气管镜检查在评估大血管异常合并气道受压中起重要作用。支气管镜检查是气道评估准确、便捷、安全且快速的方法，但对于外周结构及血管畸形的进一步检查需与CT联合进行。
