支气管镜检查在儿科临床中的应用

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1、万方数据·724·支气管镜检查在儿科临床中的应用PeterJ．Mogayzel，Jr．【编者按】PeterJ．Mogayzel，Jr．博士为约翰霍普金斯医院(全美国排名第一)儿童中心呼吸医师，副教授，儿科囊性纤维化中心主任以及儿童专科门诊主任。为美国儿童囊性纤维化治疗指南起草者之一，是美国较早在儿童病例中开展支气管镜检查的学者。PeterJ．Mogayzel，Jr．博士及其所领导的中心在儿童支气管镜技术适应证的掌握、支气管内膜活检、经支气管镜肺活检等方面所开展的工作领先于中国。为此，我们委托我刊编委赵顺英教

2、授，特邀PeterJ．Mogayzel，Jr．博士为我刊撰文，向国内同行介绍支气管镜在美国儿科肺疾病中的应用情况，以加强相互学习、交流和合作。为满足读者阅读英文原文的需要，我刊还将作者的原文“Useofflexiblefiberopticbronchoscopyinpediatricclinicalpractice”印制成单页，随本期赠送。Useofflexiblefiberopficbronchoscopyinpediatricclinicalpracticef，e柳上Mogayzel，Jr．Eudowc

3、odDivisionofPediatricRespiratorySciences，比JohnsHopkinsMedicalInstitutions，Baltimore，Maryland21287．USA【Abstract】，11leroleofflexiblefibempticbrenchoscopy(m)intheevaluationofpediatriclungdiseasehasexpandeddramaticallysincetheoriginaldescriptionoftheprocedureb

4、yWoodandFilll‘in1978．FFBcanbeusedtoevaluateairwayanatomy．obtainsecretionsforcultureandbiochemicalanalysisandobtainairwaycellsorparenchymaltissuesforevaluIation．BoththeupperandlowerairwaycanbeexaminedduringFFB．Visualexaminationcandiagnoseavarietyofcongenita

5、labnormalities(Table1)．DuringFFBadynamicevaluationoftheairways。includingthemovementoftlleglottis．vocalcordsandlowerairwaysduringtherespiratorycycleCallbeperformed．TheseobservationsCalldiagnoseairwaycollapseduetomalaciaoFobstructionduetoexternalcompression．

6、Additionally，thediameteroftheairwaylumenandcharacteroftheairwaymucosacaneasilybeevaluated．FFBcanalsoidentifyairwayobstructionbysocretionsandmucusplugs，blood，foreignbodiesormasses．Bronchoalveolarlavage(BAL)allowscoUectionofairwayand81veolarsecretionsforeval

7、uationofcellularandimmunologiccomponents，evidenceofinfectionandcytology．Therapeuticlavagecanbeusedtotreatatelectasisbyremovingsecretionsobstructingairways．’111isapproachcanbehelpfulinchildrenwithinspissatedsecretionsobstructingbethlargeandsnlallairways(Fig

8、ure1)．Therapeuticlavagehasalsobeenusedinthetreatmentofalveolarproteinosis．Bronchialbrushingcanaddinformationtobmnchoscopicexaminationbyobtainingairwayepithelialcellsforcytology，toidentifyintracellularpathogen