| Objective: To discuss the clinical application values of the broncho- fibroscope (BF) in the lower respiratory tract diseases.Methods: The clinical data of 502 cases performed by bronchofibroscope with unknown etiogenic pulmonary atelectasis, suspected of foreign bodies, recurrent or prolonged wheezing, large lesions pneumonia and so on were retrospectively analyzed from July 2007 to March 2010 in No.1 hospital of Jilin university.Results: Five hundreds and two bronchofibroscope procedures were performed in 404 cases. From the FB, lower respiratory tract diseases were mainly composed of infection, respiratory tract foreign bodies, respiratory tract dysplasia, and airway malacoma. The proportion respectively was 78.2% (393 cases), 13.5% (68 cases), 5.2% (26 cases) and 4.4% (22 cases). However, the proportion of endobronchial tuberculosis, bronchiectasia and tumor were lower and less in children. In bronchofibroscope procedures, 352 pneumonia cases mainly presented mucous hyperemia, edema, mucous pallescence, granulation hyperplasy, suppurative change, phlegm obstruction, longitudinal reductus and so on in morphology. Fifty suppurative change and phlegm obstruction cases were all bacterial infection. Eighty-seven cases presented the longitudinal reductus, and 77.0% cases were mycoplasma antibody positive. In the other mycoplasma negative cases, 10 cases were effective cured by anti-mycoplasma treatment, such as Azithromycin. Those appearance in BF can show the pathogen initially. In all 502 cases, bronchoalveolar lavage(BAL) was performed in 233 times, and 53 samples were positive(22.75%). Among the 53 samples, acute inflammatory changes were 86.8% (46 cases), and chronic changes were 13.2% (7 cases). In the chronic inflammatory cases, the majority of the pathogens were opportunistic pathogens (85.7%), which may initially suggest pathogens. Endoscopic foreign bodies were found with a total of 68 cases in children, most (85.3%) patients had cough symptoms. Only 35 cases had a clear history of foreign bodies inhalation(51.5%). Patients without a clear inhalation history, the average hospital stay was (29±35) days, which was all very long. More foreign bodies were in the right respiratory tract(57.4%, 39 cases), 29.4% (20 cases)in the left respiratory tract, 10.3% (7 cases) in trachea, 1 case in bilateral tracts, and 1 case in the glottis, each accounting for 1.5%. The foreign bodies were mostly in the main bronchus, but there were also 41.1% (28 cases) in the segmental and deeper bronchus. The kind of foreign bodies were mostly the nuts, such as peanuts, melon seeds, which account for 73.5% (53 cases). The children in ~3 years group were the highest proportion of foreign bodies(67.4%). Sixty-six patients successfully removed the foreign bodies by biopsy forceps. The cure rate was 97.1%, and 2 cases did not successfully removed. Seventy-nine cases of atelectasis were performed in the BF. The most common etiological factor was inflammation, accounting for 74.6% (59 cases). The following cause were respiratory tract dysplasia, bronchial foreign bodies, and endobronchial tuberculosis. The proportion respectively was 7.6% (6 cases), 6.3% (5 cases), and 5.0% (4 cases). In addition, bronchomalacia, tumor, external pressure, bronchiectasis, and hemoptysis due to atelectasis were just 1 case. To the diseased region, atelectasis caused by inflammation was mostly in the right upper lobe, accounting for 25% (15.5 cases). Atelectasis caused by foreign bodies was more common in the bronchus principalis dexter, accounting for 60% (5 cases). Bronchial endometrial tuberculosis was mainly in the right upper lobe and right middle lobe. To the age of atelectasis, inflammation was the highest ratio in ~7 years and >7 years group, while the foreign body was the highest ratio in ~3 years group. After the treatment by fiberoptic bronchoscopy, the reexpansion rate of atelectasis in 79 patients was as high as 74.7%, but to the atelectasis caused by external pressure, the curative effect was not satisfactory. To the 48 cases of recurrent or prolonged wheezing and cough, the causes of the disease were more common in foreign bodies, accounting for 41.7%(20 cases). The second is inflammation, accounting for 29.2% (14 cases). The third was the trachea and bronchus malacoma, accounting for 14.6% (7 cases). From the age point of view, foreign bodies were more common cause in ~3 years group, while tracheobronchial malacia mainly occurred in infants and young children. The wheezing caused by the foreign bodies and inflammation were cured effectively by bronchoscopy, but the curative effect of wheezing caused by tracheobronchial malacia and dysplasiahe was not satisfactory. To the effect on shortening the course of disease by bronchoscopy, the average hospital stay was (13.8±9.1) days for the 347 cases of large lesions pneumonia and atelectasis children in bronchoscopy procedure group, while the average hospital stay of previous 200 cases of the diseases above in non- bronchoscopy procedure group was (23.7±10.1) days. Both of them had the significant difference (P<0.05). For large lesions pneumonia cases, the incidence of serious complications such as atelectasis patients, lung abscess, and empyema in bronchoscopy group were markedly reduced than the control group, so with the early diagnosis and treatment of bronchoscopy can prevent the complications above.Conclusion: 1. BAL is an important method of the etiological diagnosis and treatment for large lesions pneumonia. It can reduce the complications incidence and shorten the hospital stay significantly. 2. Bronchoscopy is the golden standard for the children's trachea and pneumono-malformations. 3. BAL is a effective treatment of atelectasis. 4. Bronchoscopy is an important means of diagnosis and treatment for bronchial foreign bodies. It can work with the rigid bronchoscope together, and they can enhance the role mutually. 5. By the special performance of bronchoscopy in morphology, we can get the information of pathogen. For example, the performance of suppurative change and phlegm obstruction bacterial infection. If the performance is the pale mucous membranes, it may suggests the the opportunistic pathogen infection. If the performance is longitudinal fold, it should be noted that mycoplasma infection and so on. 6. If the pedo- wheezing is not soothing after long-term regular asthma therapy, the patient should be advised the bronchoscopy. 7. Bronchoscopy is a safe and effective clinical technology and should be promoted in pediatrics.
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