儿童原发塑型性支气管炎的临床及影像学分析
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摘要
目的探析儿童原发塑型性支气管炎的临床及影像学特点。方法回顾性分析2015年1月-2017年12月我院确诊为原发塑型性支气管炎患儿27例,统计患者基本资料、临床症状、实验室检查结果、纤维支气管镜检查特征及CT影像学资料,总结分析原发塑型性支气管炎的临床及影像学特点。结果患者均伴有不同程度的咳嗽、高热、气促、进行性呼吸困难等症状;金黄色葡萄球菌感染7例,肺炎支原体感染者19例,腺病毒抗原检测阳性者5例,白假丝酵母菌感染者2例,混合感染者8例;血常规、血清生化检查主要表现为白细胞计数升高,血沉增快;塑型黏液栓病理学镜下呈纤维素样改变,可见大量中性粒细胞及淋巴细胞等炎性细胞浸润;胸部CT呈肺部感染、肺实变征象,示支气管部分或完全阻塞,节段性肺不张5例,胸腔积液者9例,包裹性气胸2例,支气管黏液嵌塞症10例,累及胸膜病变者4例。患儿均行纤支镜取出塑型黏液栓并反复灌洗支气管,同时予以祛痰、抗感染、免疫支持治疗后,患儿呼吸功能均明显恢复,病情显著改善。结论根据临床表现疑诊为原发塑型性支气管炎的患儿,均应及时采用胸部CT与病理学检查进行诊断,予以支持对症治疗的基础上早期行纤维支气管镜取出内生异物以解除呼吸阻塞,降低患儿死亡风险。
Objective To explore the clinical and imaging features of primary plastic bronchitis in children. Methods A retrospective analysis was performed on 27 children with primary plastic bronchitis diagnosed in the hospital during the period from January2015 to December 2017. The general data, clinical symptoms, laboratory examination results, features of fiberoptic bronchoscopy and CT images were statistically analyzed. The clinical and imaging features of primary bronchitis were summarized and analyzed. Results All patients had different degrees of symptoms such as cough, high fever, shortness of breath and progressive dyspnea. There were 7 cases with Staphylococcus aureus infection,19 cases with Mycoplasma pneumoniae infection, 5 cases with positive adenovirus antigen,2 cases with Candida albicans infection and 8 cases with mixed infection. Blood routine and serum biochemical tests mainly showed elevated white blood cell count and increased erythrocyte sedimentation rate(ESR). Plastic mucus plugs showed fibrinoid changes under pathological microscope, showing large number of neutrophils and lymphocytes and other inflammatory cell infiltration. Chest CT showed lung infection, lung consolidation signs,partial or complete obstruction of the bronchus, segmental pulmonary atelectasis in 5 cases,pleural effusion in 9 cases, parcel pneumothorax in 2 cases, bronchial mucous impaction in 10 cases and pleural lesions in 4 cases. Plastic mucus plugs in all children were removed under bronchofiberscope and the bronchus was rinsed repeatedly. The respiratory function of children was significantly restored after sputum-removal, anti-infection and immune supportive therapies, and the condition was significantly improved. Conclusion For children with suspected primary plastic bronchitis, chest CT and pathological examination should be used for diagnosis in time. Supportive symptomatic treatment combined with early removal of endogenous foreign body under bronchofiberscope can relieve respiratory obstruction and reduce the risk of death.
Objective To explore the clinical and imaging features of primary plastic bronchitis in children. Methods A retrospective analysis was performed on 27 children with primary plastic bronchitis diagnosed in the hospital during the period from January2015 to December 2017. The general data, clinical symptoms, laboratory examination results, features of fiberoptic bronchoscopy and CT images were statistically analyzed. The clinical and imaging features of primary bronchitis were summarized and analyzed. Results All patients had different degrees of symptoms such as cough, high fever, shortness of breath and progressive dyspnea. There were 7 cases with Staphylococcus aureus infection,19 cases with Mycoplasma pneumoniae infection, 5 cases with positive adenovirus antigen,2 cases with Candida albicans infection and 8 cases with mixed infection. Blood routine and serum biochemical tests mainly showed elevated white blood cell count and increased erythrocyte sedimentation rate(ESR). Plastic mucus plugs showed fibrinoid changes under pathological microscope, showing large number of neutrophils and lymphocytes and other inflammatory cell infiltration. Chest CT showed lung infection, lung consolidation signs,partial or complete obstruction of the bronchus, segmental pulmonary atelectasis in 5 cases,pleural effusion in 9 cases, parcel pneumothorax in 2 cases, bronchial mucous impaction in 10 cases and pleural lesions in 4 cases. Plastic mucus plugs in all children were removed under bronchofiberscope and the bronchus was rinsed repeatedly. The respiratory function of children was significantly restored after sputum-removal, anti-infection and immune supportive therapies, and the condition was significantly improved. Conclusion For children with suspected primary plastic bronchitis, chest CT and pathological examination should be used for diagnosis in time. Supportive symptomatic treatment combined with early removal of endogenous foreign body under bronchofiberscope can relieve respiratory obstruction and reduce the risk of death.
引文
[1]辛毅,王郜,刘靖,等.儿童肺炎致塑形性支气管炎36例[J].中华实用儿科临床杂志,2 01 5, 30(22):1 746-1747.
[2]Cajaiba M M,Borralho P, Reyesm u gica M. The potentially lethal nature of bronchial casts:plastic bronchitis[J]. Int J Surg Pathol,2016, 16(2):230-232.
[3]徐文淼,纪健,方伯梁,等.小儿重症甲型H1N1流感合并塑型性支气管炎四例分析并文献复习[J].中国小儿急救医学,2017,24(2):158-161.
[4]Soyer T,Sule Yalcin, Emiralioglu N,et a l.Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children[J].J Pediatr Surg, 2016, 51(10):1640-1643.
[5]Schumacher K R,Singh T P,Kuebler J, e t a l.Risk Factors andOutcome of Fontan-Associa ted Plastic Bronchitis:A CaseControl Study[J]. J Am Heart Assoc,2014, 3(2):e000865.
[6]曾其毅,刘大波,罗仁忠,等.儿童塑型性支气管炎的诊断与治疗[J].中国实用儿科杂志,2004,19(2):81-83.
[7]李文荣,孟繁峥,梁航,等.儿童塑型性支气管炎临床分析[J].中国妇幼保健,2014, 29(33):5428-5429.
[8]施璐.16例儿童原发型塑型性支气管炎的实验室指标及CT影像学分析[J].中国CT和MRI杂志,2018, 16(1):66-68.
[9]翟嘉,邹映雪,张文双,等.儿童塑型性支气管炎5 3例临床回顾分析[J].中国实用儿科杂志,2016, 31(3):211-214.
[10]丁小芳,钟礼立,张兵,等.儿童塑型性支气管炎9例临床特征及病原学分析[J].中国当代儿科杂志,2014, 16(7):729-733.
[11] Bruce K Rubin. Plastic Bronchitis[J]. Clin Chest Med, 2016, 37(3):405-408.
[12] Seear M,Hui H,Magee F, et al.Bronchial casts in children:a proposedclassification based on nine eases and a review of the l i terature[J]. Am J Respir Cr i t Care Med,1997, 155(1):364-370
[13]肖飞鹰.儿童原发塑型性支气管炎的临床和CT表现[J].临床肺科杂志,2016, 21(5):943-944.
[14]许勤晖,罗霄,樊树峰.炎症渗出型塑型性支气管炎的CT表现(2例报告并文献复习)[J].临床放射学杂志,2016, 35(3):490-491.
[15]王业军,黄咏梅.儿童塑型性支气管炎误诊临床分析[J].临床误诊误治,2016,29(12):10-12.
[16]宋殿行,郭鹏,杨新国,等.小儿塑形性支气管炎一例[J].临床放射学杂志,2015, 34(11):1855-1856.
[17]梁桂明,黄晓雯.儿童塑型性支气管炎5 0例临床分析[J].临床肺科杂志,2016, 21(9):1571-1574.
[2]Cajaiba M M,Borralho P, Reyesm u gica M. The potentially lethal nature of bronchial casts:plastic bronchitis[J]. Int J Surg Pathol,2016, 16(2):230-232.
[3]徐文淼,纪健,方伯梁,等.小儿重症甲型H1N1流感合并塑型性支气管炎四例分析并文献复习[J].中国小儿急救医学,2017,24(2):158-161.
[4]Soyer T,Sule Yalcin, Emiralioglu N,et a l.Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children[J].J Pediatr Surg, 2016, 51(10):1640-1643.
[5]Schumacher K R,Singh T P,Kuebler J, e t a l.Risk Factors andOutcome of Fontan-Associa ted Plastic Bronchitis:A CaseControl Study[J]. J Am Heart Assoc,2014, 3(2):e000865.
[6]曾其毅,刘大波,罗仁忠,等.儿童塑型性支气管炎的诊断与治疗[J].中国实用儿科杂志,2004,19(2):81-83.
[7]李文荣,孟繁峥,梁航,等.儿童塑型性支气管炎临床分析[J].中国妇幼保健,2014, 29(33):5428-5429.
[8]施璐.16例儿童原发型塑型性支气管炎的实验室指标及CT影像学分析[J].中国CT和MRI杂志,2018, 16(1):66-68.
[9]翟嘉,邹映雪,张文双,等.儿童塑型性支气管炎5 3例临床回顾分析[J].中国实用儿科杂志,2016, 31(3):211-214.
[10]丁小芳,钟礼立,张兵,等.儿童塑型性支气管炎9例临床特征及病原学分析[J].中国当代儿科杂志,2014, 16(7):729-733.
[11] Bruce K Rubin. Plastic Bronchitis[J]. Clin Chest Med, 2016, 37(3):405-408.
[12] Seear M,Hui H,Magee F, et al.Bronchial casts in children:a proposedclassification based on nine eases and a review of the l i terature[J]. Am J Respir Cr i t Care Med,1997, 155(1):364-370
[13]肖飞鹰.儿童原发塑型性支气管炎的临床和CT表现[J].临床肺科杂志,2016, 21(5):943-944.
[14]许勤晖,罗霄,樊树峰.炎症渗出型塑型性支气管炎的CT表现(2例报告并文献复习)[J].临床放射学杂志,2016, 35(3):490-491.
[15]王业军,黄咏梅.儿童塑型性支气管炎误诊临床分析[J].临床误诊误治,2016,29(12):10-12.
[16]宋殿行,郭鹏,杨新国,等.小儿塑形性支气管炎一例[J].临床放射学杂志,2015, 34(11):1855-1856.
[17]梁桂明,黄晓雯.儿童塑型性支气管炎5 0例临床分析[J].临床肺科杂志,2016, 21(9):1571-1574.