CF Wang, LF Tang, ZM Chen, YY Zhang, YS Wang, YC Xu

Abstract

Objective: To explore the value of flexible bronchoscopy in aetiological diagnosis of paediatric refractory wheezing. Methods: A total of 246 patients with refractory wheezing performed flexible bronchoscopy were analysed. They were 146 males and 100 females with a ratio of male to female 1.5:1. Their age ranged from 1 month to 9 years with a median age of 17 months. Results: Flexible bronchoscopy was performed 269 times. By bronchoscopy, mucus plug was found in 52 patients (21.1%), airway malacia in 76 (30.9%), structural deformity in 32 (13.0%), foreign bodies in 22 (8.9%), tuberculosis in 3 and tumor in one. The aetiology of refractory wheezing varied with different ages. Airway malacia (61.2%) was the main reason in infants, then mucus plug (15.3%). Among toddlers, the most common reason was mucus plug (24.5%), followed by airway malacia (15.1%) and foreign body (14.2%). Bronchoalveolar lavage demonstrated pathogens in 17 (17.3%) of 98 samples. The most common complication was hypoxia during the procedures. They all were transient and alleviated by oxygen supplement or temporary cessation of the procedure. Conclusion: Flexible bronchoscopy is effective in the aetiological diagnosis of childhood refractory wheezing. Mucus plug, airway malacia, structural deformities and foreign body are the main reasons for childhood refractory wheezing.

目的：探討可曲式支氣管鏡在兒童頑固性喘鳴的病因診斷價值。方法：共246名患有頑固性喘鳴的病童接受了可曲式支氣管鏡檢查，並進行數據分析。男孩146人，女孩100人，男女比例為1.5:1。年齡範圍由1個月至9歲，年齡中位數為17個月。結果：合共進行了269次可曲式支氣管鏡檢查，支氣管鏡檢查中發現52人（21.1%）出現粘液塞，76人（30.9%）出現氣道軟化，32人（13.0%）出現結構性缺陷，22人（8.9%）有異物，3人患結核病和1人有腫瘤。頑固性喘鳴的病因隨年齡而改變，嬰兒主要出現氣道軟化（61.2%），其次是粘液塞（15.3%）。小孩多見粘液塞（24.5%），其次是氣道軟化（15.1%）和異物（14.2%）。在98個支氣管肺泡灌洗樣本裡17個（17.3%）發現病原體。手術中最常見的併發症是缺氧，但都是短暫性和給氧氣或暫停操作可緩解。結論：可曲式支氣管鏡能有效診斷兒童頑固性喘鳴的病因，粘液塞，氣道軟化，結構性缺陷和異物是兒童頑固性喘鳴的主要原因。