Zhang H S, Chen X P, Ye L P, Wang G F, Zheng Y M, Zhang H L, Li C C, Xia X D
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Department of Pediatric Respiratory Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
Zhonghua Er Ke Za Zhi. 2021 Nov 2;59(11):963-967. doi: 10.3760/cma.j.cn112140-20210504-00378.
To explore the clinical utility of bronchoscopy and transbronchial cryotherapy in children with tracheobronchial tuberculosis (TBTB). Retrospective study was conducted to collect the clinical data of 10 hospitalized children who underwent bronchoscopy and were diagnosed as TBTB and in the Department of Pediatrics of Peking University First Hospital and the Department of Pediatric Respiratory Medicine of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2011 to October 2019. The clinical characteristics of TBTB in children, and the efficacy and safety of bronchoscopy and transbronchial cryotherapy were summarized through descriptive analysis. The onset age of 10 children (6 males and 4 females) ranged from 1-14 years. The clinical manifestations included fever (8/10), cough (7/10) and hemoptysis (2/10). Purified protein derivative test and interferon-γ release assay were performed in 9 and 10 patients respectively, the results were all positive. Chest CT examination was performed in all patients, and 8 patients had hilar and mediastinal lymphadenopathy. All patients underwent pediatric bronchoscopy in time, in 9 patients bronchus was found to be blocked in varying degrees by granulation tissue and caseous necrosis and in the remaining patient, obvious congestion and edema in bronchial mucosa. The bronchoscopic manifestations included 8 cases of lymph node fistula type, 1 case of granulation proliferative type and 1 case of inflammatory infiltration type. Pathological biopsies were performed in 7 cases, the findings were consistent with the pathological characteristics of tuberculosis. Nine patients were treated by pediatric bronchoscopic intervention, with 8 transbronchial cryotherapy by flexible bronchoscopy, and among them, 2 patients were treated by simultaneous rigid bronchoscopy. After 1-3 times of transbronchial cryotherapy, the blocked bronchial lumina in 8 cases were all recanalized, and the curative effect was significant without any serious complications. Bronchoscopy plays an important role in the diagnosis of TBTB in children and is helpful for its classification. Also, transbronchial cryotherapy has good efficacy and safety for TBTB in children, especially for the granuloproliferative type or lymph node fistula type.
探讨支气管镜检查及经支气管冷冻治疗在儿童气管支气管结核（TBTB）中的临床应用价值。回顾性研究收集了2011年1月至2019年10月期间在北京大学生第一医院儿科、温州医科大学附属第二医院育英儿童医院小儿呼吸内科住院的10例接受支气管镜检查并诊断为TBTB的儿童的临床资料。通过描述性分析总结儿童TBTB的临床特征以及支气管镜检查和经支气管冷冻治疗的疗效及安全性。10例患儿（男6例，女4例）发病年龄1～14岁。临床表现包括发热（8/10）、咳嗽（7/10）、咯血（2/10）。分别对9例和10例患儿进行结核菌素纯蛋白衍化物试验及γ-干扰素释放试验，结果均为阳性。所有患儿均行胸部CT检查，8例有肺门及纵隔淋巴结肿大。所有患儿均及时行小儿支气管镜检查，9例见支气管不同程度被肉芽组织及干酪样坏死阻塞，余1例支气管黏膜明显充血水肿。支气管镜表现为淋巴结瘘型8例、肉芽增生型1例、炎症浸润型1例。7例行病理活检，结果符合结核病理特征。9例患儿行小儿支气管镜介入治疗，其中8例行可弯曲支气管镜下经支气管冷冻治疗，2例同时行硬质支气管镜治疗。经1～3次经支气管冷冻治疗后，8例阻塞支气管腔均再通，疗效显著，无严重并发症发生。支气管镜检查在儿童TBTB诊断中起重要作用，有助于其分型。经支气管冷冻治疗对儿童TBTB尤其是肉芽增生型或淋巴结瘘型疗效及安全性良好。
