可弯曲支气管镜技术在儿童气管支气管结核中的应用：个案报道与文献复习
Application of Flexible Bronchoscopy in Pediatric Tracheobronchial Tuberculosis: A Case Report and Literature Review
DOI: 10.12677/acm.2025.1592545, PDF,   
作者: 陈 鹏：青岛大学医学部，山东 青岛；郯城县第一人民医院儿科，山东 临沂；刘从欣：郯城县第一人民医院儿科，山东 临沂；郝 琴：青岛大学医学部，山东 青岛；李 蕾*：青岛大学附属医院儿童呼吸心血管内科，山东 青岛
关键词: 可弯曲支气管镜；儿童气管支气管结核；诊疗价值；Flexible Bronchoscopy； Pediatric Tracheobronchial Tuberculosis； Diagnostic and Therapeutic Value
摘要: 目的：探讨可弯曲支气管镜技术在儿童气管支气管结核(Tracheobronchial tuberculosis, TBTB)的诊疗过程中的应用价值。方法：选取2023年12月青岛大学附属医院收治的气管支气管结核患儿1例，回顾分析其临床症状、辅助检查及诊疗转归过程。以“气管支气管结核”“支气管内膜结核”“可弯曲支气管镜”“电子支气管镜”“儿童”为中文关键词，检索中国知网、中华医学期刊全文数据库等；再以“Flexible Bronchoscopy”“Tracheobronchial tuberculosis”“TBTB”“children”“child, only”为英文关键词，检索PubMed、Web of Science (WOS)数据库。上述中、英文数据库的检索时间均设定为数据库建库至2025年5月。结果：① 本例患儿为女性，12岁，因“咳嗽1个月，发热4天”于2023年12月首次于青岛大学附属医院就诊，入院后行纤维支气管镜检查显示：气管粘膜结节样隆起，可见肉芽组织增生形成，表面大量白色分泌物及坏死组织覆盖。予局部盐水清洗，钳夹清理。术后肺泡灌洗液送检结果显示：1) 抗酸菌检测：抗酸杆菌阳性2+：1~9条/10视野，连续100个视野；2) 肺泡灌洗液细胞分类检查：中性粒细胞百分比5.00%，淋巴细胞百分比15.00%；3) 呼吸道细菌基因快速检测13项：结核分枝杆菌复合群DNA阳性。4) 外送肺泡灌洗液NGS检查示：高序列数结核分枝杆菌。给予标准抗结核治疗(2HRZE/4HR方案)，1年后回我院复查支气管镜：气管管腔略不规则，粘膜不平整，可见轻微结节样改变。左侧、右主支气管及其段支气管开口通畅，黏膜无异常。② 文献复习结果：根据本研究设定的文献检索策略，检索涉及关于儿童TBTB的相关临床研究文献为22篇，其中中文文献12篇，英文文献10篇，纳入研究的EBTB患儿共计596例，均进行了1次到多次的可弯曲支气管镜检查或治疗。结论：可弯曲支气管镜在儿童TBTB中兼具诊断、治疗与随访三重价值，操作安全、疗效确切，可作为儿童气管支气管结核诊疗中的核心环节予以推广。
Abstract: Objective: To evaluate the diagnostic and therapeutic value of flexible bronchoscopy in pediatric tracheobronchial tuberculosis (TBTB). Methods: A 12-year-old girl with TBTB admitted to the Affiliated Hospital of Qingdao University in December 2023 was retrospectively analyzed with respect to clinical manifestations, ancillary investigations, and treatment outcomes. A systematic literature search was conducted in CNKI, the Full-text Database of Chinese Medical Journals, PubMed, and Web of Science from inception to May 2025. The following terms were employed: “tracheobronchial tuberculosis”, “endobronchial tuberculosis”, “flexible bronchoscopy”, “electronic bronchoscopy”, and “children” in Chinese; and “Flexible Bronchoscopy”, “Tracheobronchial tuberculosis”, “TBTB”, “children”, and “child, only” in English. Results: ① Case summary: The patient presented with a 1-month history of cough and 4 days of fever. Flexible bronchoscopy revealed nodular elevations of the tracheal mucosa with exuberant granulation tissue covered by abundant white secretions and necrotic debris. After saline lavage and forceps debridement, bronchoalveolar lavage fluid (BALF) analyses showed: 1) acid-fast bacilli positive (2+; 1~9 organisms per 10 high-power fields in 100 consecutive fields); 2) differential cytology: 5.00% neutrophils and 15.00% lymphocytes; 3) multiplex PCR panel positive for Mycobacterium tuberculosis complex DNA; and 4) next-generation sequencing of BALF with high-sequence reads of M. tuberculosis. Standard anti-tuberculosis therapy (2HRZE/4HR) was initiated. One year later, repeat bronchoscopy demonstrated mild, irregular nodularity of the tracheal mucosa without significant stenosis; both main bronchi and segmental orifices were patent and macroscopically normal. ② Literature review: 22 eligible studies (12 Chinese, 10 English) comprising 596 pediatric patients with endobronchial tuberculosis were identified. All patients underwent one or more flexible bronchoscopic procedures for diagnostic or therapeutic purposes. Conclusion: Flexible bronchoscopy combined with bronchoalveolar lavage constitutes a central modality for the diagnosis of pediatric TBTB and affords additional therapeutic benefit. The technique is safe and effective and merits broader clinical implementation.
文章引用：陈鹏, 刘从欣, 郝琴, 李蕾. 可弯曲支气管镜技术在儿童气管支气管结核中的应用：个案报道与文献复习[J]. 临床医学进展, 2025, 15(9): 699-707. https://doi.org/10.12677/acm.2025.1592545

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