Wong Jackson Y, Westall Glen P, Snell Gregory I
Division of Pediatric Respiratory Medicine, Department of Pediatrics, McMaster University, Ontario, Canada.
Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia.
Pediatr Pulmonol. 2015 Dec;50(12):1406-19. doi: 10.1002/ppul.23203. Epub 2015 May 4.
Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting.
对于接受肺移植（LTx）的儿科患者，支气管镜检查仍然是一项关键的诊断和治疗干预措施。无论是作为监测方案的一部分进行，还是在有临床指征时进行，纤维支气管镜检查都能直接观察移植的同种异体移植物，特别是评估支气管吻合口（或心肺移植后的气管吻合口）的通畅情况。此外，支气管镜检查通过收集并随后评估支气管肺泡灌洗（BAL）和经支气管活检（TBBx）样本，有助于区分感染性病变和排斥反应。事实上，急性细胞排斥反应分级的诊断标准取决于支气管镜检查时收集的活检样本的组织病理学评估。支气管镜检查通常在门诊进行，一般来说是一种安全的操作，不过偶尔也会出现与出血和气胸相关的并发症。气道并发症，包括狭窄、软化和裂开，可在支气管镜检查时诊断出来，随后的治疗，包括球囊扩张、激光治疗和支架置入，也可通过支气管镜进行。最后，支气管镜检查一直是且仍然是一项重要的研究工具，通过收集和分析收集到的BAL和TBBx样本，能更好地了解肺同种异体移植物的免疫生物学。虽然新的研究工具不断发展，但通过支气管镜对肺同种异体移植物进行简单的可视化和样本收集，仍然是评估肺同种异体移植物的金标准。本综述描述了儿科环境下肺移植后支气管镜检查的使用情况和经验。
