OBJECTIVE:Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children. METHODS:In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT. RESULTS:The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days). CONCLUSION:Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value.

Background The purpose of this article is to explore the efficacy and safety of bronchoalveolar lavage with levofloxacin combined with intravenous infusion in the treatment of refractory drug-resistant mycoplasma pneumonia. Methods 120 children with refractory mycoplasma pneumoniae pneumonia (RMPP) were studied and divided into the control group (60 cases) and the observation group (60 cases) based on different treatment methods. The control group was received levofloxacin treatment and control supportive treatment, while the observation group was received bronchoscopy for alveolar lavage on the lesion side in addition to the control group, and local drug retention of levofloxacin was performed. Observe for 7 days after treatment and compare the improvement of clinical symptoms, C-reactive protein (CRP), serum ferritin (SF), lactate dehydrogenase (LDH), and inflammatory factors interleukin-6 (IL-6) and interferon -γ (IFN-γ) between two groups of patients. Results Compared with the control group, the observation group had a shorter time in the symptom improvement and hospital stay. After treatment, the serum CRP, SF, LDH, IL-6, and IFN-γ levels in both groups were significantly decreased, and the observation group was lower than the control group, and the difference between two groups was statistical significance (P < 0.05). Conclusion Bronchoscopic alveolar lavage combined with levofloxacin can help alleviate the inflammatory response of children with severe mycoplasma pneumonia, improve clinical symptoms, accelerate treatment progress, and shorten hospital stay. This indicates that bronchoalveolar lavage with levofloxacin is a treatment method with definite efficacy and worthy of clinical promotion in children.

Objective:To study the diagnostic value of non-enhanced lesions on enhanced CT in lung consolidation for necrotizing pneumonia in children.Methods:A total of 101 cases of necrotizing pneumonia with air sacs on CT scan who were hospitalized in the Department of Respiratory Intervention, Qilu Children′s Hospital of Shandong University from August 2016 to September 2018 were enrolled in this study(group with air lucency). Besides, another 75 cases of lobar pneumonia with non-enhanced lesions in lung consolidation but without air sacs on enhanced CT were also included from the same hospital over the same period(group without air lucency). Clinical data of these patients were retrospectively collected and statistically analyzed.Results:The white blood cell count was (12.5±5.5)×10 9/L in group with air sacs and (10.8±4.1)×10 9/L in group without air sacs, and the difference was statistically significant( t=-2.161, P=0.032). There was no statistical difference between the group with and without air sacs in age, gender distribution, the course prior to admission, duration of fever after admission, length of hospital stay, medical expense, the neutrophils percentage in peripheral blood, C-reactive protein, the erythrocyte sedimentation rate, serum procalcitonin, serum D-Dimer, serum lactate dehydrogenase, serum albumin, bronchoscopy times, the bronchial mucosal erosion ratio, the mucus plug score, the lavage purulent lavage ratio, and the ratio of luminal stricture or atresia in late bronchoscopy(all P>0.05). Conclusions:The clinical course of patients with non-enhanced lesions in lung consolidation but without air sacs is almost identical to that of patients with air sacs on CT scan.The presence of non-enhanced lesions in lung consolidation can be used as diagnostic basis of necrotizing pneumonia in children.

患儿 男，5月龄，因“生后反复撤机失败、气管切开1个月余”就诊，临床表现有发育迟缓、Robin序列征（腭裂、小下颌、舌后坠）、房间隔缺损、指趾端发育畸形、听力缺失、睡眠呼吸障碍、喂养困难。经医学外显子疾病筛查检测到患儿X染色体编码RBM10基因的（chrX）47044937位点存在c.2263G>A（p.D755N）半合变异，确诊为以马蹄内翻足、房间隔缺损、Robin序列征（小下颌、腭裂、舌后坠）、永存左上腔静脉等畸形的一组综合征，简称为TARP综合征。

RATIONALE:Broncholithiasis is a rare disease and is characterized by calcification in the tracheobronchial tree. This disease has a predilection in the adult and occurrence is rare in children. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnosis and treatment procedures.PATIENT CONCERNS:We report a 9-year- and 6-month-old girl who complained of chronic cough and recurrent wheeze for 2 months.DIAGNOSIS:Bronchialithiasis were found under bronchoscope. Pathologic examination revealed aspergillosis.INTERVENTIONS:The stone and surrounding granulation tissue were removed using a bronchoscope and the patient was treated with antifungal therapy.OUTCOMES:The patient was in good general health without any clinical symptoms during the follow-up period.LESSONS:Pulmonary Aspergillus infection can cause bronchiolithiasis. Stones were removed under bronchoscope, and anti-Aspergillus therapy was effective.

目的 探讨干扰素基因刺激蛋白(STING)相关婴儿期发病血管病变(SAVI)的临床特点、诊断和治疗.方法 对1例SAVI患儿的临床表型及基因型进行分析,并通过复习相关文献,分析和总结有关国内外SAVI的文献报道,总结SAVI的临床特征及遗传学特点.结果 男,11岁4个月,为反复呼吸道感染、咳嗽、活动耐力下降,查体可见杵状指(趾),实验室检查提示ESR异常升高、ANA及抗心磷脂抗体阳性,肺部高分辨CT提示间质性病变.全外显子测序提示患儿TMEM173基因新生杂合突变:c.463G＞A,p.V155M.予托法替尼(每次5 mg,每天2次)治疗有效.文献复习目前国内外已报道SAVI病例31例(包括本文1例),SAVI男性多发,以婴幼儿为主.首发症状以皮疹(58.0％)、呼吸急促(41.9％)及活动受限(48.3％)为主.实验室检查64.5％伴有ESR增快或CRP升高,64.5％出现自身抗体阳性.70.9％患儿肺部影像学提示为间质性肺炎改变.基因检查可明确诊断,SAVI相关的基因突变位于第5号染色体上的TMEM173基因,74.1％为新发突变.Janus激酶抑制剂治疗有效.结论 SAVI为一种罕见的自身炎症性疾病,为TMEM173基因变异,临床上以活动耐力下降、生长受限及间质性肺疾病为主要表现.Janus激酶抑制剂对该病治疗有效.

目的 探讨儿童咯血的诊断思路及临床治疗效果.方法 收集2013年1月至2016年6月在济南市儿童医院呼吸介入科住院治疗的25例咯血患儿临床表现、实验室、影像学、支气管镜检查、数字减影血管造影(DSA)检查资料,对其发病特点、病因、治疗、预后进行回顾性分析.结果 25例患儿中男16例,女9例.年龄7个月至16岁,其中＜3岁2例,3～10岁15例,＞10～ 18岁8例.少量咯血17例,中量7例,大量1例.病因为支气管肺血管发育异常者16例,呼吸道感染6例,支气管扩张3例,支气管异物2例,肺外伤1例.21例(84.0％)应用抗菌药物,21例(84.0％)应用止血药物,其中8例应用垂体后叶素.8例行支气管动脉介入栓塞治疗,2例行支气管镜下异物取出术,1例行肺叶切除手术.25例患儿临床治疗效果明显,随访无反复咯血.结论 儿童咯血病因复杂,综合病史、实验室检查、影像学、支气管镜检查、DSA检查,支气管肺血管发育异常诊断率可明显提高,支气管动脉栓塞治疗效果较好.

Previously, the main treatment options for tracheoesophageal fistula included surgery and conservative treatment. Herein, we report a child suffering from severe tracheoesophageal fistula due to button battery ingestion. The child relapsed soon after a repair surgery. Then, he was endotracheally implanted with a fully-covered metallic stent combined with a jejunal tube feeding. He recovered soon and the stent was removed five months later. The fistula was healed with no relapse during a 25-month follow-up. Therefore, endotracheal implantation of fully-covered metallic stent is an alternative treatment for tracheoesophageal fistula due to button battery ingestion, especially in cases with severe respiratory disorders.

喉喘鸣是儿科常见症状之一,最常见的病因是喉软骨软化症,此外还有喉部占位性病变、声带麻痹、气管支气管软化或狭窄等 [1].家长通常会带患儿就诊于儿科,而儿科医师对本病认识不足,常常诊断喉软骨软化症,而忽视其他病因的寻找.我院自开展儿童支气管镜技术以来,喉喘鸣的误诊率明显降低,但由于舌甲状舌管囊肿临床罕见,对本病认识不足导致误诊.现报道如下:

Objective To discuss the effect of electronic bronchoscopy comprehensive therapy in the diagnosis and treatment of glottis and subglottic stenosis after intubation in children.Methods The records of 28 children diagnosed as glottis and subglottic stenosis after intubation by bronchoscopy in Qilu Children's Hospital of Shandong University from January 2012 to January 2015 were reviewed.They all had the neck and chest CT,bronchoscopic diagnostics,and received comprehensive treatment of laser,forceps,balloon angioplasty under electronic bronchoscopy,preoperative and postoperative evaluation was performed according to the improvement of respiratory status and endoscopic findings.All patients were followed up for 6-12 months.Results These 28 children were successfully extubated,and inspiratory dyspnea,hoarseness,and other symptoms were improved,endoscopic narrowest part was widened by 6-12 months of follow-up,including 17 cases reached clinical cure,about 6 times per patient;7 cases were successfully extubated and still in follow-up currently;2 cases of neonatal infants were extubated successfully,but they had vocal congestion,edema,glottis narrow fissure without special intervention,and were under clinical observation currently;2 cases gave up treatment because of the other problems.All patients had no serious bleeding,respiratory insufficiency or other complications.Conclusions Electronic bronchoscopic comprehensive treatment is an effective and safe method to treat glottis and subglottic stenosis after intubation in children.

Objective To discuss the diagnosis,curative effect evaluation of infantile subglottic hemangioma through bronchoscopy,and oral Propranolol curative effect.Methods Twenty-four cases of subglottic hemangioma were retrospectively analyzed from April 2012 to March 2015 in Shandong University Qilu Children's Hospital,all cases were diagnosised by neck enhanced CT or magnetic resonance,receiving oral Propranolol treatment.Starting dose was 0.5 mg/(kg · d),3 times per day,monitored in terms of blood pressure,blood sugar and heart rate,etc.with no bad reaction after 3 days of dosage,increased to 2.0 mg/(kg · d),6 days later to maintain the dose for at least 6 months,with bronchoscopy follow-up visit on a regular basis.All the children received 3 to 15 months of follow-up.Results Clear diagnosis of subglottic hemangioma was made in 24 cases who received oral Propranolol treatment,and after 5-7 days symptoms such as laryngeal stridor and dyspnea were relieved to different extent.Under the bronchoscope tumors could be observed to shrink.After 6 months of oral Propranolol,11 cases of tumors had completely faded,13 cases of tumors had significantly reduced,laryngeal stridor and breathing difficulties were relieved.One patient with parotid gland hemangioma was also improved,3 cases had mild bradycardia during hospital treatment,but during hospitalization and after discharge low blood pressure,hypoglycemia and other side effects were not observed.Conclusions Bronchoscopy in the diagnosis and treatment of infantile subglottic hemangioma plays an important role in the judgment of curative effect as it is both safe and reliable.Taking oral Propranolol can help to shrink tumors in a short period of time,improve the symptoms of respiratory tract obstruction,with distinct curative effect and little side effect.

Objective To investigate the efficacy and safety of integrated interventional treatment for children with endobronchial tuberculosis by electronic bronchoscopy.Methods From January of 2011 to August of 2014,45 cases(31 boys and14 girls)were enrolled,their age ranged from 4 months to 12 years old.On the basis of the conventional anti-tuberculosis treatment in all the patients,electrocoagulation under the bronchoscopy was performed,together with laser,refrigerant or balloon expansion.The tracking observation of curative effect and adverse reaction were observed.Based on the main symptoms of patients after treatment,and the conditions of chest imaging,bronchoscopy,the lesion repair,airway mucosa,lumen patency,therapy efficacy were evaluated.All patients underwent 6-12 months follow-ups.Results Among 45 cases of endobronchial tuberculosis in children,there were 9 cases suffering from ulcers and cheese necrotic changes (20.0％),granulation proliferative changes in 8 cases,accounting for 17.8％,stenosis scar changes in 7 cases(15.5％);44 mixed cases (97.8％) were observed under the microscope,of which 20 cases had tuberculosis lesions by bronchial biopsy,and of them acid-fast staining was positive in 12 cases (60.8％) confirmed by bronchoscopy combined with anti-tuberculosis treatment,and they received 8 to 13 times of treatment,32 cases were markedly effective,accounting for 71.1％,10 cases were effective,accounting for 22.2％;3 cases lost follow-up,and the total efficiency was 93.3％;all patients had no pneumothorax,pulmonary secondary infection,hemoptysis and other adverse reactions.Conclusions In addition to conventional anti-tuberculosis treatment,local comprehensive interventional treatment under the bronchoscopy can effectively remove cheese-like necrosis and reduce granulation hyperplasia and relieve the airway obstruction,promote the absorption of lesions and atelectasis recovery.The therapy is safe and reliable and worth of clinical application.

目的 支气管肺泡灌洗液(BALF)培养及微生物敏感性试验(简称药敏)调查儿童重症肺炎的病原菌及耐药率.方法 对山东大学齐鲁儿童医院2009年1月至201 1年12月收治的2044例重症肺炎住院患儿行支气管镜下肺泡灌洗术,并对支气管肺泡灌洗液进行细菌培养及药敏分析.结果 肺泡灌洗液培养出病原菌247例,感染优势菌为肺炎克雷伯菌49例、大肠埃希菌44例、阴沟肠杆菌23例、铜绿假单胞菌17例;肺炎链球菌21例;金黄色葡萄球菌11例;溶血葡萄球菌9例.药敏试验结果显示:青霉素G、氨苄西林、阿莫西林克拉维酸、头孢呋辛、红霉素、苯唑西林耐药率均超过50％.所测菌株对头胞哌酮舒巴坦未见耐药发生.结论 支气管镜下肺泡灌洗液细菌培养为较好的下呼吸道病原菌检测方式,该组重症肺炎以革兰阴性菌感染为主,早期检测病原菌和耐药性对提高疗效和改善预后是非常重要的.

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.

Objective To discuss the effect of electric coagulation through bronchoscopy in diagnosis and treatment of congenital vallecular cyst in children.Method Ten cases of congenital vallecular cyst in the study with age ranged from 21 days to 4 years and 10 months were treated with electric coagulation through bronchoscopy.The therapeutic effect was evaluated by endoscopic and clinical manifestation.And all the patients were followed-up for 6-12 months.Result All the patients obtained 3-5 times electric coagulation.After the operation,the cyst decreased in size,epiglottis softening was subsided,uplift uncompression,dyspnea and laryngeal stridor were improved obviously.After follow-up periods of 6-12 months,no capsule wall were left,and the activity of the epiglottis resumed.No severe complication was found in any patient.Conclusion Electric coagulation through bronchoscopy is a simple,effective and safe method to treat congenital vallecular cyst in children.

<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 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.