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.

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 describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children.Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary,Intervention Qilu Children's Hospital of Shandong University from no vember 2013 to June 2015.Pleural biopsy was performed under direct visual guidance to obtain tissues,and pleural adhesion and cellulose exudation had been cleaned out in 7 cases.Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy.Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion,thickened heart capsule was found in the operation,then continuous cardiac ultrasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure.The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti-infective therapy,the pleural adhesion was reduced.One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion.Medium bleeding was found in 1 case during the procedure.Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation.There were no severe complications in the other 7 patients.Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease,thoracoscopy is a safe and effective technique for pediatric patients.

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.