Application Of Fiberoptic Bronchoscopy In The Diagnosis And Treatment Of Pediatric Respiratory Diseases.

Objective To explore the diagnostic and therapeutic value and the safety of fiberoptic bronchoscopy(FB)in children with respiratory diseases.Methods The clinical data of 230 cases performed by FB with pulmonary atelectasis of unknown origin,suspected foreign bodies,chronic cough,recurrent or prolonged wheezing ,refractory pneumonia and so on were retrospectively analysed from March 2002 to March 2007 in Anhui Provincial Children's Hospital.Results Two hundreds and forty-eight times FB procedures were performed in 230 cases.The confirmed diagnosis was obtained in 226 cases,the total diagnostic rate was 98.3%.In all 230 cases,bronchoalveolar lavage(BAL) was performed in 101 times, bacterial culture was performed in 95 bronchoalveolar lavage fluid (BALF)samples and 11 samples were positive(11.6%).Biopsy or brush biopay of bronchial mucosa or neoplasma was performed in 28 cases ,the pathological results revealed acute or chronic information in 20cases,foreign body in3 cases,tumor in 2 cases ,pulmonary hemosiderin cell in 2 cases and tuberculosis in 1 case. Among the 46 pulmonary atelectasis cases confirmed by imageology,inflammatory stricture or mucus plug obstruction,totaling 22 cases (47.8%) ,was the leading causes, which was followed by foreign body (11/46,23.9%). Among the 49 cases with suspected trachobronchial foreign body,foreign bodies were confirmed in 38 cases via FB ,the accordance of clinical diagnosis was 77.6%.Twenty-two cases with atelectasis of unknown origin, chronic cough, wheezing of unknown origin and refractory pneumonia diagnosed by the clinic were confirmed foreign bodies, which shows that misdiagnosis and missed diagnosis usually are caused by tracheobronchial foreign bodies.Besides,tracheobronchial foreign body usually occurred in children less than 3 years (75.0%),and alimentary foreign bodies were most common(93.3%). Although the incidence rate of foreign body was higher in the left lung(48.3%) than in the right one(38.3%), there was not significant difference between them (P>0.05).In 52 cases with chronic cough,35 cases were caused by chronic endobronchitis,7 cases by foreign body,2 cases by abnormal bronchial branch, 2 cases by bronchiectasis,1 case by bronchostenosis,1 case by tracheomalacia,1 case by bronchial tumor,1 case by epiglottis abnormal motion and 1 case with unknown origin. In 33 cases of recurrent or prolonged wheezing,19 cases were confirmed with endobrochitis, 4 cases with tracheobronchomalacia, 3 cases with laryngomalacia, 2 cases with foreign bodies, 2 cases with bronchostenosis, 2 cases with tumor and 1 case with abnormal bronchial branch. In 12 cases of refractory pneumonia, 8 cases were confirmed with inflammation, 2cases with foreign bodies,1 case with bronchostenosis,1 case with vocal cord insufficientia.In 8 cases of congenital heart disease, 5 cases were confirmed with trachea or bronchus compression (62.5%), In addition, the causes of hoarse voice (12 cases), dyspnea (9 cases), hemoptysis (5 cases) were identified via FB. After removal of foreign bodies, BAL and administration of drugs via FB, 35 cases were improved in 41cases with atelectasis (85.4%). Foreign bodies located underâ…¡grade bronchus (17 cases) were removed via FB,furthermore, foreign bodies located in trachea or I grade bronchus (43 cases), which were identified via FB, were removed by rigid tracheoscopy. The curative effect on the children with chronic cough, recurrent or prolonged wheezing and refractory pneumonia was satisfactoried. With the guide of FB, we have helped anesthetists perform endotracheal intubation to one case successfully. Although the complications rate of FB was high (36.5%), all complications were mild and temporal. Conclusion FB plays an important role in diagnosis and treatment of pediatric respiratory diseases with relative safety and reliability, which should be used extensively in paediatrics.