Clinical Application Of Flexible Fiberoptic Bronchoscopy In Infants And Children: Experience With 1392 Patients From 2004～2006

Background:In the 1960s,applied with the technique of light-guide fiber,the flexible fiberoptic bronchoscope(FB)was invented.It was Shigeto Ikeda who first used FB in the clinical area.Because FB is easy to insert,tends to be safe and has a wide view,it was quickly accepted by patients and doctors.Thus the diagnosis, treatment and research on respiratory diseases in adult have made great progress. Meanwhile,the indications of FB had been widened.However,the use of FB was limited in pediatrics,because of narrowness of the children's airways,lack of cooperation,difficulty in anesthesia,worries about complications,and the thin working channel of the FB.The development of freezing and laser treatment is also restricted.Application of pediatric FB can be traced to 1978.At the beginning,FB was used to examine nose,pharynx,larynx,trachea and bronchial tree.With the improvement of related technique,the indications,methods,validity and safety of pediatric FB have been reported in many researchers,but series researches on FB applied in pediatric patients are rare.Our hospital started the new technique in 1999. It was mainly used in diagnosis and removal of airway foreign bodies in the early years,then in diagnosis and treatment in variety of respiratory diseases from 2001. The research on clinical use of FB will result in popularizing pediatric flexible fiberoptic bronchoscopy,improving diagnosis and treatment of respiratory diseases and standardizing FB in pediatric practice.Objective:To explore the clinical value of pediatric flexible fiberoptic bronchoscopy.Methods:1392 cases of pediatric patients were recorded from 2004 to 2006 having flexible fiberoptic bronchoscopy.They are divided into seven groups, including therapy of airway foreign body group,atelectasis group,stridor group, chronic cough group,intensive care unit(ICU)group,other disease group and safety research group.According to different ages and weights,different FB was chosen from the 3 types of BFXP40,BF3C30 and BFP40(Olympus Co.).Results:The 1392 patients underwent 1499 times of flexible fiberoptic bronchoscopy:1.Therapy of airway foreign body group:235 cases,with 210 cases of successfully removal(89.4%),of them 185 cases succeeded in the first attempt (78.7%).Most of the foreign bodies were vegetable origin in nature.109 cases of the foreign bodies were found in the left lung,100 cases in the fight lung,and 7 cases in both lungs.In 123 cases(52.3%),granulation tissues were found around foreign bodies.2.Atelectasis group:387 cases.Obvious lesions were observed in 352 cases,no obvious lesions 35 cases,and inflammation 214 cases(55.3%).All the cases underwent lavages:once in 339 cases,twice in 39 cases,three times in 3 cases,and 4 times in 2 cases.After lavage,chest X-ray or computer tomography showed the atelectasis lungs of 253 patients(71.1%)had completely expanded,74(20.8%) partially expanded within 4 weeks;305(85.7%)completely expanded,42(11.8%) partially expanded,9(2.5%)no progress within 3 months. 3.Stridor group:246 cases.Combined with clinical diagnosis after flexible fiberoptic bronchoscopy,etiologic diagnoses are as follows:airway malacia in 76 cases(29.7%),asthma in 88 cases(27.6%),airway foreign body in 22(8.9%),airway stricture in 15 cases(6.1%).4.Chronic cough group:156 cases:bronchitis in 28 cases(17.9%),asthma 42 cases(27.0%),airway malacia 18 cases(11.5%),airway foreign bodies 28 cases (17,9%),sinusitis 20 cases(12.8%),gastroesophageal reflux 15 cases(9.6%).5.ICU group:48 cases.Most of bronchoscopic diagnoses were obstructive pneumonia caused by abundant purulence secretion and sputum,airway abnormity, and airway obstruction post operation.6.Other disease group:418 cases.In 227 cases(54.3%),the flexible fiberoptic bronchoscopy helped to clear the unclear diagnoses.In 191 cases(45.7%).Among the 191 cases,87 cases were diagnosed as airway foreign bodies.7.Safety research group:335 cases,among them 141 cases(42.1%)had duringor after-bronchoscopic complications,but recovered soon.Cyanosis was most common in during-bronchoscopic complications.Among those cases,infants group was highly tended to have cyanosis,and with age grew,incidence decreased (x~2=23.22,P＜0.001).Cough or aggravation of cough was mostly observed(6.0%). Stridor or aggravation of stridor mostly happened in infants(z~2=25.62,P＜0.001).Conclusions:1.FB can be used safely in the diagnosis and treatment of pediatric respiratory diseases.2.For some ambiguous or refractory cases,such as emphysema,atelectasis, stridor,chronic cough,early flexible fiberoptic bronchoscopy often helps.3.The flexible fiberoptic bronchoscopy can be the gold standard for the diagnosis of congenital airway abnormity and stricture,and combined with biopsy, endobronchial tuberculosis. 4.Early the flexible fiberoptic bronchoscopy can reduce mortality rate in ICU patients with acute obstructive disease.5.The flexible fiberoptic bronchoscopy has high value in the management of equivocal airway foreign body and some special location of foreign bodies,such as left or right upper lobe.But for some large foreign bodies or those with sharp edges, FB is not suitable and rind bronchoscopy should be consulted.