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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 evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis. Methods: We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room, The First Affiliated Hospital of Bengbu Medical College. We analyzed the patients' general data, diagnosis results, clinical manifestations, imaging and interventional treatment. The severity, type and distribution of stenosis were evaluated. The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index (MRC DI) and Karnofsky Performance Score (KPS). Through regular follow-up, dynamic observation and evaluation of clinical efficacy, according to the occurrence of intraoperative and postoperative complications, safety assessment was carried out to evaluate the postoperative outcome. The clinical efficacy, safety evaluation and prognosis were observed. Results: The average age of 46 patients was (62.43±12.34) years old. 36 (78.26%) had tracheal stenosis, 6 (13.04%) had stenosis in the left main bronchus, 10 (21.74%) in the right main bronchus, and 2 (4.35%) in the right middle bronchus. Among them, 33 patients (71.74%) had malignant central airway stenosis and 13 (28.26%) had benign lesions. Forty-six patients underwent 58 interventional therapies, including stent placement, cryotherapy and balloon dilatation. Endoscopic estimation of the degree of tracheal stenosis was (85.42±7.81)% before the first intervention and (24.17±5.79)% after operation. The degree of stenosis in the right main bronchus was improved from (81.00±17.13)% to (20.50±6.43)%. The degree of left main bronchus stenosis (24.17±9.14)% was significantly improved compared with preoperative (77.50±16.66)%. The difference was statistically significant (t=42.73, t=22.43, t=19.02, P<0.001). The degree of dyspnea was relieved in all the patients. Postoperative MRC DI was 0.98±0.62, significantly lower than the preoperative one 3.42±0.57(t=19.65, P<0.001). KPS was 34.01±13.14 and 83.91±8.96 before and after interventional therapy, and KPS increased significantly after operation (t=21.28, P<0.001). The main complications were local hemorrhage, hypoxemia in 4 cases (8.70%, 4/46), transient ventricular premature rupture in 1 case (2.17%, 1/46), and tooth loss in 2 cases(4.35%, 2/46). Most patients had sore throat of varying degrees after operation. The 1-year survival rate of patients with malignant central airway stenosis was 13.79% (4/29), and 4 patients with malignant tumor were followed up; 13 patients with benign airway stenosis had good quality of life. Conclusion: For central airway stenosis, especially complex central airway stenosis, rigid bronchoscopy combined with electronic bronchoscopy shows immediate improvement of dyspnea and causes rare severe complications; thus it is safe and effective. It can improve the patients' quality of life.
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Objective To evaluate the value of the electron bronchoscopy in diagnosis of carcinothoracic fluid in the case of replacing medical thoracoscopy and combining narrow-band imaging (NBI). Methods 89 cases of suspected cancerous pleural effusion patients, used electronic bronchoscope Olympus BF-1T 260 in place of medical thoracoscopy to enter pleural cavity in the usual way. First observed by white light bronchoscopy (WLB), then by narrow-band imaging (NBI) and take 5 pieces of tissue out respectively on the pleura of the lesion for pathological examination. Then compare the sensitivity and specificity of WLB and NBI methods, and the bleeding after biopsy. Result Among 89 cases of suspected cancerous pleural effusion patients, 85 cases found positive by white light bronchoscopy (WLB) , negative in 4 cases, 6 cases bleeding after biopsy (6.70%). Compared with the pathological results, WLB sensitivity 97.50%, specificity 22.22%. 68 cases found positive by NBI, negative 21 cases, no active bleeding after biopsy. Compared with the pathological results, the sensitivity of the NBI 86.67%, specificity 78.57%. Compared WLB with NBI, the former's sensitivity is superior to the latter, the latter's specificity is superior to the former. Both comparisons about sensitivity diagnosis of the and specificity are statistically significant (P < 0.05). Conclusion Electronic bronchial in place of medical thoracoscopy has high diagnostic rate in the carcinothoracic fluid, and the combination of NBI can improve the accuracy and security of the biopsy.
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Objective To investigate the application of electronic bronchoscopy in diagnosis of recurrent tracheoe-sophageal fistula of type Ⅲ esophageal atresia. Methods 5 patients were reviewed who were suspected postopera-tive tracheoesophageal fistula recurrence of type Ⅲ esophageal atresia and examined through electronic bron-choscopy combined with injecting Methylene blue into stomach tube from Jan 2010 to Aug 2014. Male to female ra-tio was 4:1. The age was 2~15 months, median age was 7.4 months. Results The 5 cases were found trachea mem-brane fistula by electronic bronchoscope, recurrent tracheoesophageal fistula was diagnosed with Methylene blue in-jected into stomach tube and overflowed from trachea membrane fistula. Examination time is 3~7 minutes, the aver-age is 4.2 minutes. The 5 cases were confirmed by operation. Conclusion Electronic bronchoscopy combined with injecting Methylene blue into stomach tube to diagnose recurrent tracheoesophageal fistula is safe and feasible, the time is short and the diagnosis rate is high.
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Objectives To investigate the significance of electronic bronchoscopy and bronchoalveolar lavage in diagno-sis and treatment in children with pulmonary mass lesion. Methods A total of 74 hospitalized children from January 2011 to June 2012 whose imaging examinations showed massive patchy shadow were examined and treated by electronic bronchoscopy and bronchoalveolar lavage. Their clinical data were retrospectively analyzed. Results The major cause for the massive shadow was infection according to electronic bronchoscopy examination (68/74, 91.89%), 65 cases of them were lobar pneumonia, 3 cas-es were pulmonary tuberculosis followed by 5 cases of foreign body (6.76%) and one case of pneumorrhagia (1.35%).The lower left lung was the most frequently seen site of infection, followed by lower right lung. The agreement between infection sites and imaging examination was 97.30%. Bronchoalveolar lavage fluid showed that the primary pathogen of lobar pneumonia infection is Mycoplasma pneumoniae (MP) (42/65, 64.62%). The highest detection rate of MP was found in preschool group and the detec-tion rate between different age groups indicated statistically significant difference (P3 weeks, 35.71%) (P<0.05). Conclusions Electronic bronchoscopy and bronchoalveolar lavage play dual roles in etiological diagnosis and therapy in children with pulmo-nary mass lesion.