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Objective:To explore the value and risk of electronic bronchoscope applied in perioperative management of children with congential tracheoesophageal fistula.Methods:Sixty-five children with congential tracheoesophageal fistula performed electronic bronchoscope examination from September 2014 to November 2020 were enrolled in this study.The results of examination and complications were analyzed.Results:Sixty-three children with congenital tracheoesophageal fistula were diagnosed by electronic bronchoscopy.The diagnosis rate was 96.92%.Fifty-four children with congenital tracheoesophageal fistula were diagnosed by esophagography.The diagnosis rate was 91.53%.Sixty-one children with congenital tracheoesophageal fistula were diagnosed by multislice spiral computed tomography.The diagnosis rate was 93.85%.Airway anatomic abnormity was found in 27 children, including three cases of nasopharyngeal soft tissue collapse, 14 cases of laryngomalacia, five cases of tracheal stenosis, nine cases of tracheobronchomalacia, and nine cases of tracheobronchial and abnormal opening of the bronchus.The incidence was 41.54%.Three children with difficult ventilator weaning were related to tracheobronchial stenosis or tracheobronchomalacia.They were gradually weaning from ventilator after a long period of mechanical ventilation and treatment.Two children with transient decrease in oxygen saturation were noticed as complication.Conclusion:Electronic bronchoscopy is a safe and effective method for the diagnosis of congenital tracheoesophageal fistula and recurrence after operation.It is of great value to the airway management after operation by early detection of respiratory anatomic abnormity.
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Objective:To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children, and improve the diagnosis and treatment of foreign bodies.Methods:A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results:A total of 967 cases were operated by soft electronic bronchoscope, and foreign bodies were removed by means of foreign body forceps or nets.Among them, 19 cases(3 cases with subglottic foreign bodies, one with row of pins, and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed, two cases were spontaneously coughed, and 946 cases (97.8%)were removed.Bronchial foreign bodies in children were more common in boys, with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%). The incidence was slightly higher in rural areas than that in urban areas(46.5% in urban areas, 53.5% in rural areas). Foreign bodies were inhaled most in March and least in June.From the perspective of season, winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body, accounting for 93.0%, among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation, and 196 cases of children with varying degrees of granulomatous hyperplasia, accounting for 39.1% and 20.3% of the total.The foreign body in the right bronchus accounted for 50.0% and the left bronchus for 43.7%.There were 793 cases confirmed by imaging, with a positive rate of 81.9%, and 90.9% confirmed by CT.Conclusion:About 88.8% of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious gender, urban-rural and seasonal distribution characteristics, and more cases were male, in rural and winter as well as spring.
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Objective:To analyze the results of polysomnography(PSG) in 523 children, and explore the sleep monitoring results and related influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The PSG monitoring results of children with OSAHS and non-OSAHS were analyzed for children aging from 0 to 16 years old, who were monitored at Sleep Medicine Center of Gansu Maternal and Child Health Hospital from January 2014 to December 2019.Results:A total of 523 children underwent PSG monitoring during the past 5 years.The male to female ratio was 1∶0.47, of which 66.9%(350/523)were children with OSAHS.The average proportion of rapid eye movement sleep was 1.95%(7.7/394). The height of non-OSAHS group was significantly higher than that of OSAHS group[(108.72±16.39)cm vs.(104.80±16.60)cm, P=0.016]. The incidence of OSAHS decreased with age( P=0.038). The apnea index, hypopnea index, apnea hypopnea index, obstructive apnea index, microarousal index, oxygen desaturation index, mean apnea time, and longest apnea time in the OSAHS group were higher than those in the non-OSAHS group( P<0.05). And the lowest oxygen saturation and the mean oxygen saturation during sleep were lower than those in the non-OSAHS group( P<0.05). Logistic regression analysis on the clinical data of OSAHS children showed that open mouth breathing and snoring at night had significant effects on children′s OSAHS, and the differences were statistically significant( P<0.05). Conclusion:PSG is of great significance for the diagnosis of OSAHS.The more severe the degree of OSAHS, the worse severe the night sleep hypoxemia.PSG should be recommended before taking any treatment for children with sleep disorders.
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Objective To explore the clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy,and to investigate the effectiveness and safety of treatment on it.Methods Data of 29 severe laryngomalacia patients from Gansu Provincial Maternity and Child-Care Hospital diagnosed by flexible bronchoscopy were analyzed from March 2013 to July 2015,retrospectively.Twelve cases of them received laser therapy under balanced intravenous anesthesia.Preoperative and postoperative pulse oxygen saturation(SpO2),pulmonary function,and dyspnea index were analyzed statistically.Results After supraglottoplasty with laser,the findings were as follows:SpO2(94.26 ± 1.30) ％,tidal volume (6.11 ± 0.77) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ±3.51,volume at time of peak expiratory flow/expiratory volume 30.95 ± 5.46,and dyspnea index 1.95 ± 1.05;while preoperative findings were SpO2 (82.45 ± 1.35)％,tidal volume(5.30 ± 1.03) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ± 3.51,volume at time of peak expiratory flow/expiratory volume 21.93 ± 7.23,and dyspnea index 2.75 ± 0.84,respectively,and there were significant differences between the preoperative and postoperative therapy (all P ＜ 0.05).Complications were not observed over the next 6 months after operations.Conclusions Severe infant laryngomalacia has influence on living quality of patients,which can be diagnosed by flexible bronchoscopy.Laser therapy is a safe effective cure for it.
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Objective To investigate the clinical effect of two different anaesthesia methods in removing the tracheobronchial foreign bodies in children.Methods This was a retrospective study with 56 hospitalized children through fiberoptic bronchoscope foreign body removing since September 2010 to July 2013 in Gansu Provincial Maternity and Child-Care Hospital.All of the children whose age from 8 months to 11 years were diagnosed of tracheal-bronchial foreign body.Among 56 cases,30 cases were operated with deep sedation anesthesia(deep sedation anesthesia group),and 26 cases with general anesthesia(general anesthesia group).The clinical effect of the two kinds of anesthesia were compared.Results The success rate of foreign bodies in deep sedation anesthesia group and general anesthesia group were 83.33％ and 96.15％ respectively (P ＞ 0.05),there were no statistical differences in oxygen desaturation (86.67 ％ vs 92.31％),cyanosis(30.00％ vs 26.92％),bleeding (16.67％ vs 15.38％),fever (6.67％ vs 3.85％),voice hoarse (40.00％ vs 34.62％),vomiting (26.67 ％ vs 19.23 ％),and other complications between two groups (P ＞ 0.05,respectively).There were significant differences in the rate of choking cough(11.54％ vs 93.33％) and resistance (0 vs 73.33％) between general anesthesia group and deep sedation anesthesia group (P ＜ 0.05).Compared with the deep sedation anesthesia group,the average hospitalization cost[(4 718.73 ± 1 012.61) (￥) vs (4 050.25 ± 1 176.75) (￥)] was bigger,and the average setup time [(18.54 ± 3.46) min vs (6.50-± 1.70) min] was longer,but the average removal of foreign body time [(13.32 ± 6.38) min vs (39.52 ± 15.68) min] was smaller in general anesthesia group,there were significant differences between two groups(P ＜ 0.05,respectively),while there was no statistical difference in the average hospitalization days [(5.46 ± 1.65) d vs (5.67 ± 1.65) d] between two groups (P ＞ 0.05).Conclusion Compared with the deep sedation anesthesia,the success rate of removal foreign bodies is higher,and the removal foreign body time as well as comfort are all significantly improved through general anesthesia,but the average hospitalization cost and average preparation time of general anesthesia are bigger than those of deep sedation anesthesia.