Clinical analysis of 176 children with congenital tracheobronchial malformation / 中华实用儿科临床杂志

ABSTRACT

Objective:To investigate the clinical characteristics of congenital tracheobronchial malformation in children.Methods:Retrospective analysis was performed on the data of 176 children with congenital tracheobronchial malformation who were diagnosed by bronchoscopy at Children′s Hospital of Chongqing Medical University from January 2016 to October 2016, and were followed up by telephone for the presence of dyspnea, operation and death within 3 years after discharge.Results:(1) Among the 176 cases, there were 156 cases less than 3 years old, accounting for 88.64%.(2) Among the 176 cases, there were 54 cases with congenital tracheobronchial stenosis, 42 cases with congenital tracheomalacia, 26 cases with abnormal bronchial openings, 3 cases with airway diverticulum, 1 case with tracheoesophageal fistula, 1 case with bridging bronchus, and 49 cases with mixed type (2 or more malformations). (3) The most common clinical manifestations included recurrent or persistent dyspnea (86 cases), chronic cough (61 cases), and recurrent respiratory infection (34 cases) with the most frequent occurrence.Other manifestations included laryngeal stridor (14 cases), pulmonary atelectasis (29 cases), localized emphysema (6 cases), and difficulty extubation after endotracheal intubation (6 cases). (4) Among the 139 patients who underwent chest CT examination and airway reconstruction, only 44 cases were diagnosed correctly.(5) All 176 patients received routine medical treatment and bronchoscopy during hospitalization, among which 17 cases received surgical treatment.One hundred and seventy cases were improved in their condition and discharged, and 6 cases did not respond well.A total of 47 patients were followed up by telephone for 3 years.The proportion of children with dyspnea after 1 year, 2 years and 3 years were 59.57%, 51.06% and 38.30%, respectively.Among the follow-up patients, 4 patients received surgical treatment and 2 patients died.Conclusions:Congenital tracheobronchial malformation in children often occurs in infants, and their clinical manifestations are not typical.Therefore, suspected patients should receive chest CT and airway reconstruction as early as possible, and bronchoscopy can be employed in time if the diagnosis is unclear.The majority of children can obtain a favorable prognosis, with few death cases.Partial patients would present with a risk of recurrent or persistent dyspnea, and some critically ill children shall receive the airway stent implantation or surgical intervention.