Background: The aim of this study was to investigate the efficacy and safety of bronchoscopic cryotherapy for pediatric poor ventilation.Methods: A total of 156 pediatric patients with airway stenosis and obstruction as well as pulmonary atelectasis received bronchoscopic cryotherapy. Treatment efficacy was evaluated on bronchoscopy Before cryotherapy and after the last cryotherapy treatment. Pulmonary atelectasis was assessed according to range of atelectasis on chest computed tomography (CT), and tracheobronchial stenosis according to pulmonary function, tidal volume analysis and dyspnea index.Results: The 154 patients with effective treatment had patent airway, smooth mucosa and resolved atelectasis. In the two patients with ineffective treatment, however, the airway was not smooth and the range of pulmonary atelectasis was reduced by < 30%. Among the 156 patients, 136 had markedly effective treatment, with CT pulmonary atelectasis recovery > 70%. The width of the main airway significantly increased approximately 50% and the tidal volume or capacity increased 100%. Effective treatment was identified in 18 patients (18/156), with CT pulmonary atelectasis area reduced 30-70%. Ineffective treatment was noted in two patients, with CT pulmonary atelectasis area reduced by < 30%. No complications were noted in any patients during or after operation. No recurrence was noted on follow up of 2-24 months.Conclusion: Bronchoscopic cryotherapy is effective and safe for dyspnea caused by airway obstruction, and wide application in clinic is recommended.

1 Shandong Medicinal Biotechnology Centre, Key Laboratory for Modern Medicine and Technology of Shandong Province, Key Laboratory for Virology of Shandong Province, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Key Laboratory for Biotech-Drugs, Ministry of Health, Shandong Academy of Medical Sciences, No. 18877 Jingshi Road, Jinan 250062, China 2 School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250200, China 3Department of Laboratory, Qilu Children’s Hospital of Shandong University, Jinan 250022, China 4 School of Dental Medicine, Shandong University, Jinan 250012, China 5 Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China 6Respiratory Department, Qilu Children’s Hospital of Shandong University, Jinan 250022, China

This study is to explore the efficacy and safety of bronchoscopic electrocoagulation treatment for pediatric disease of poor ventilation. Seventy pediatric patients of airway stenosis and obstruction as well as pharyngeal and laryngeal cysts received bronchoscopic electrocoagulation treatment, including 15 cases of epiglottic cyst, 13 cases of cicatricial hyperplasia of fibrous tissue after trachea intubation, 5 cases of foreign body in bronchus and 37 cases of endobronchial tuberculosis. Before and after the last electrocoagulation treatment, treatment efficacy was evaluated by examining the patients' clinical presentations and lesions in airway under bronchoscope, examining chest CT and pulmonary function, and estimating pulmonary atelectasis and ventilation function. Seventy cases of pediatric patients were treated by bronchoscopic electrocoagulation, with the total treatment number of 106 times. Among them, 66 cases were treated with marked efficacy and 4 cases were with effective treatment. There was no invalid treatment. The treatment efficacy was 100% without complications. Bronchoscopic electrocoagulation treatment is a fast, effective and safe therapeutic method in treating airway stenosis and obstruction, such as foreign body in bronchus, granulation tissue hyperplasia, and epiglottic cysts. It is worthy of being widely applied in clinic.

目的 探讨支气管镜下电凝治疗儿科气道管腔内肉芽形成、纤维组织增生导致气道狭窄及咽喉部占位性病变压迫气道引起通气不畅的疗效和安全性.方法 对2009年9月至2011年6月山东大学齐鲁儿童医院呼吸介入科收治的12例气道内增生病变患儿,其中支气管异物后气道内增生3例、支气管内膜结核菌感染引起黏膜肉芽生长阻塞气道所致肺不张2例、气管插管后气管黏膜纤维组织增生导致气管狭窄出现呼吸困难5例、舌根部囊肿压迫会厌致会厌抬起受限而引起呼吸困难2例.实施支气管镜下电凝治疗.分别于术前和最后1次电凝治疗后对病变部位进行支气管镜下评估,胸部CT及肺功能检查,对肺不张及通气功能进行评价.结果 12例患儿分别接受电凝治疗(共13次),其中显效11例、有效1例,有效率100％,未见并发症发生.结论 支气管镜下电凝治疗对于异物、感染后肉芽组织生长阻塞气道形成的肺不张、气管插管后气道内膜纤维组织增生性气管狭窄以及咽喉部占位性病变压迫气道形成的呼吸困难,是快速、有效的治疗方法,但手术操作有风险,需经技术培训.

The viral etiologies of UTRIs and LTRIs in children in Jinan city were investigated between July 2009 and June 2010. Nasal and throat swabs were collected from 397 children with URTIs and bronchoalveolar lavage fluid specimens were collected from 323 children with LRTIs. RT-PCR/PCR was used to examine all samples for IFV, PIV, RSV, RV, hMPV, HBoV, CoV, ADV, RSV, and EV. Viral pathogens were detected in 47.10% of URTI samples and 66.57% samples, and the incidence of viral coinfection was 5.29% and 21.05%, respectively. IFV was the most common virus in URTIs, with a detection rate of 19.40%, followed by PIV (10.83%), RV (10.58%), and EV (6.30%). For LRTIs, PIV and RV were both detected in 27% of samples, followed by RSV (9.91%), HBoV (8.36%), IFV (5.57%), and hMPV (5.57%). RSV and HBoV were more prevalent in the youngest children of no more than six months. Meanwhile, RV, PIV, and RSV were the most frequent viruses combined with bacterial pathogens in LRTIs. In conclusion, the spectrum of respiratory virus infections in URTIs and LRTIs differed in terms of the most common pathogens, seasonal distribution, and coinfection rate.

Objective To discuss the effect and security of balloon dilatation using a bronchoscope in the management of benign tracheobronchial stenosis.Methods A total of 156 child patients with proximal benign tracheobronchial stenosis were managed by balloon using the flexible electronic bronchoscope.Of these patients,146 were with pneumonia,4 patients with tuberculosis infection,1 patient with granulation tissue by airway extraneous material,5 patients after tracheal intubation.Results The 156 patients obtained 1-3 times of balloon dilatation.In these patients,the curative effects of 139 patients were excellent,12 patients effective,and 5 patients invalid.In 139 excellent patients,the airway average diameter in narrow segmental bronchus was increased and the ventilatory capacity of closed lung was increased above two-thirds in 134 patients and the dyspneic respiration with main bronchus stenosis disappeared in 5 excellent patients.In 12 effective patients,the ventilatory capacity of closed lung was increased from one-third to two-thirds after therapy with balloon dilatation.In 5 invalid patients,the ventilatory capacity of closed lung was not changed,although the partial airway stenosis was removed.So,the total effect rate was 96.8% after therapy with balloon dilatation.After follow-up periods of 1-6 months,the airway dilated by balloon did not become narrow again and closed lung did not appear again through chest X-ray or CT.No severe complication was found in any patient.Conclusion Airway plasty with high pressure balloon dilatation using flexible electronic bronchoscope is an effective,safe,simple and rapid method for treatment of proximal benign tracheobronchial stenosis in child.

<正>1病例资料例1女,6岁7个月,因"咳嗽20d,发热15d,左下肢疼痛14d"入山东大学齐鲁儿童医院(我院)。患儿15d前发热,体温最高39.3℃,无寒战及皮疹;咳嗽、咯痰中偶带血丝,右侧胸痛。因左下肢肿胀、疼痛而跛行。在当地医院就诊,予青霉素类、

OBJECTIVE:To analyze the effect and safety of bronchoscopic cryosurgery in children with lower airway stenosis caused by granulation and fiber hyperplasia.METHOD:Twenty-two patients had undergone bronchoscopic examination and cryosurgery, 18 patients with atelectasis caused by Mycoplasma pneumoniae pneumonia, 2 patients with endobronchial tuberculosis (EBTB), 1 patient with atelectasis caused by granulation tissue after bronchial foreign body, and 1 case who had severe dyspnea, with tracheal stenosis after long-term endotracheal intubation during surgery for heart disease. All the patients under went bronchoscopic cryosurgery for several times, 1 case with severe tracheal stenosis was operated by electric coagulation before cryosurgery. Before and after the treatment, all the patients were evaluated based on clinical symptoms, tracheal lumen by bronchoscopy, chest CT for atelectasis and pulmonary function for tracheal stenosis.RESULT:The patients were treated with cryosurgery for 1-4 times. Sixteen cases were markedly improved, clinical symptoms disappeared completely, no granulation and fiber hyperplasia were found during bronchoscopy, and all the atelectasis were cured. After the treatment, the bronchial lumen diameter of the patient with tracheal stenosis was increased from 2 mm to about 5 mm, the tidal volume increased from 3.0 ml/kg to 8.8 ml/kg. Five cases were effectively improved, the clinical symptoms also disappeared, during bronchoscopy and bronchial alveolar lavage (BAL), no granulation and fiber hyperplasia were found, but some distal bronchial tubes were atresia or narrowed, the lumen was patent, the atelectasis recovered partially. In 1 case the treatment was ineffective, as the clinical symptoms and granulation disappeared, but because almost all distal bronchi were atresia or narrow, the lumen was not patent during BAL, there was no change on chest CT. The total effective rate was 21/22 (95.5%). No severe complications occurred during and after the procedures. All the patient were followed up for 1 - 12 months, no case had recurrence.CONCLUSION:Treatment with bronchoscopic cryosurgery is a safe and effective methods to tracheal stenosis caused by granulation tissue and fiber hyperplasia in children.

Objective To detect the concentrations of serum C-reactive protein(CRP)in children during acute asthma attack for investigating its clinical significance.Methods Serum CRP and IgE were detected in 182 asthmatic children in acute phase and 50 healthy children.The asthmatic children were divided into allergen-induced group,viral infection-induced group,bacterial infection-induced group.Allergen specific IgE(sIgE)were detected in asthmatic children.The serum CRPs were compared among subgroups of asthmatic children and healthy children.The relationship of CRP,IgE and sIgE was analyzed.Results The bacterial infection-induced group had the highest serum CRP(19.55 ± 17.61 mg/L),followed by allergen-induced group 5.45 ± 4.32 mg/L and viral infection-induced group(8.61 ± 8.03 mg/L).All of them had a significantly higher serum CRP than healthy children(1.61 ± 1.25)mg/L(P < 0.001).The serum CRP concentration range of healthy group,allergen-induced group,viral infection-induced group and bacterial infection-induced group were 0 ～ 2 mg/L,2 ～ 10 mg/L,5 ～ 16 mg/L,≥ 16 mg/L respectively.If the serum CRP level ≥ 16 mg/L,bacterial infection should be highly suspected.No relationship was observed between serum CRP,IgE and sIgE.Conclusions The concentrations of serum CRP are generally at 2 ～ 10 mg/L,5 ～ 16 mg/L in allergy induced and viral infection-induced asthmatic children.When the acute asthmatic children had a serum CRP level ≥ 16 mg/L,probably had been induced by bacterial infection and combined pneumonia.

OBJECTIVE:To evaluate the effect of bronchoalveolar lavage (BAL) through bronchoscopy in diagnosis and treatment of accidental inhalation of liquid and powdery foreign bodies in children.METHOD:Twenty-one cases of accidental inhalation were classified into the following 4 groups according to the materials inhaled: 3 cases inhaled the lipidic material; 2 cases inhaled chemical material; 15 cases inhaled hydrosoluble materials; 1 case inhaled powdery material. Eighteen cases were hospitalized within 3 days after the accidents, which included 16 cases treated within 1 day in hospital. And 3 cases were hospitalized 3 days after the accident. After hospitalization, all patients were immediately treated with direct aspiration and lavage clearance method through bronchoscopy. The inhaled foreign materials were cleared as soon as possible, which reduced the absorption, stimulation and infection of respiratory mucosa. The therapeutic effect was evaluated by endoscopic findings, clinical manifestation, laboratory examination and chest imaging. At the same time, decision was made on the second BAL and the prognosis was estimated.RESULT:Twenty-one cases had dyspnea of certain degree. The bronchial mucous membrane of all the 21 cases showed hyperemia, edema and exudate attached. Lavage fluid looked like broth and contained much of the inhaled material. After two to five times treatment, 18 cases were cured (86%), but 3 cases died (14%). One of these 3 cases fell into an oil well, 1 into mosquito repellent solution, another into manure pit. The patients who could not survive had severe airway obstruction, which was difficult to clean and made the problem deteriorated progressively. One of the patients was sent to a hospital 3 days after the accident and another case developed fungal infection, pneumothorax and finally respiratory failure.CONCLUSION:BAL through bronchoscopy is necessary for children who accidentally inhaled liquid and powdery materials. This treatment is safe and effective in diagnosis and treatment of such problems in children. The effect of treatment is influenced by types of inhaled material, the time of lavage clearance through bronchoscopy, and certain complications, such as infection etc.

OBJECTIVE:To assess the efficacy and safety of balloon dilatation through flexible bronchoscopy in the management of inflammatory stenosis of grade 4-5 bronchus.METHOD:Thirty patients with inflammatory bronchial stenosis caused by mycoplasmal pneumonia complicated with pulmonary atelectasis were treated with balloon dilatation through fiberoptic bronchoscopy. Before the procedure and after the last operation, therapeutic effect on pulmonary atelectasis were evaluated with CT and all of the patients were followed-up for 1 - 6 months.RESULT:One to three operations were required to achieve satisfactory dilatation. After balloon dilatation, the average airway diameter increased obviously and the farther airways were opened after the therapy with irrigation. In 25 of 30 cases satisfactory immediate effects were obtained, a narrow airway diameter above expansion significantly increased as compared with preoperative diameter. In 5 children treated with balloon dilatation, the stenosis could not be improved significantly. In 3 patients with hyperplasia of granulation tissue, cryotherapy had to be applied. The operations were ineffective in the other two patients whose course of disease exceeded 3 months. After follow-up periods of 1 - 6 months, chest CT manifestation of expanded sites was improved in 28 patients and atelectasis disappeared. No severe complication was found in any patients.CONCLUSION:Bronchoplasty by balloon dilatation through flexible fiberoptic bronchoscopy is a simple, effective and safe method to treat childhood tracheobronchial stenosis after pulmonary infections.