Ledesma Albarrán J M, Pérez Ruiz E, Fernández V, González Martínez B, Pérez Frías J, Martínez Valverde A
Sección de Neumología Infantil, Facultad de Medicina, Hospital Materno Infantil, Málaga.
Arch Bronconeumol. 1996 Apr;32(4):183-6.
The aim of this study was to determine the role of fiberoptic bronchoscopy (FB) in pulmonary tuberculosis in children. We assessed bronchoscopic findings of 36 procedures performed in 30 children who presented the following abnormalities on chest films: lobular or segmentary atelectasis (17), paratracheal or parahilar adenopathies (14), parenchymatous consolidation (9) and localized hyperinflation (5). Premedication for FB included intravenous atropine and diazepam plus ketamine for sedation, as well as lidocaine 2 and 5% in aerosol form for topical anesthesia. FB results showed that involvement was endobronchial in 29 patients. In the 18 patients with X-rays suggestive of endobronchial tuberculosis (EBT), the diagnosis was confirmed by FB. Significantly, EBT was found by FB in 11 (36.6%) patients with no clinical or radiological signs of such involvement. EBT was in the early stages in 3 (10%) patients and was advanced in 8 (26.6%). M. tuberculosis was isolated in 9 (30%) of the 30 patients. Culture was of bronchoalveolar lavage in three, of gastric lavage in four and of endobronchial biopsy in two. We conclude that FB is a safe, important tool for the confirmation of EBT in the management of pulmonary tuberculosis in children. It serves as a guide for the start of steroid treatment, especially in children with no radiological suggestion of EBT.
本研究的目的是确定纤维支气管镜检查（FB）在儿童肺结核中的作用。我们评估了30名儿童接受的36次支气管镜检查结果，这些儿童胸部X线片呈现以下异常：小叶或节段性肺不张（17例）、气管旁或肺门旁淋巴结肿大（14例）、实质实变（9例）和局限性肺过度充气（5例）。FB的术前用药包括静脉注射阿托品、地西泮加氯胺酮镇静，以及2%和5%利多卡因气雾剂局部麻醉。FB结果显示，29例患者存在支气管内受累。在18例X线提示支气管内膜结核（EBT）的患者中，FB确诊了该诊断。值得注意的是，FB在11例（36.6%）无EBT临床或放射学征象的患者中发现了EBT。3例（10%）患者的EBT处于早期阶段，8例（26.6%）处于晚期阶段。30例患者中有9例（30%）分离出结核分枝杆菌。3例通过支气管肺泡灌洗培养，4例通过洗胃培养，2例通过支气管内膜活检培养。我们得出结论，FB是确诊儿童肺结核中EBT的一种安全且重要的工具。它为开始使用类固醇治疗提供了指导，尤其是在无EBT放射学征象的儿童中。
