Zhang Jiyan,Zhang Xi,Liu Teng,et al.Bronchoscopy interventional diagnosis and treatment of primary airway tumors in children:a clinical analysis[J].Journal of Clinical Pediatric Surgery,2025,(03):265-270.[doi:10.3760/cma.j.cn101785-202312034-012]
经支气管镜介入诊疗在儿童原发性气道肿瘤中的应用
- Title:
- Bronchoscopy interventional diagnosis and treatment of primary airway tumors in children:a clinical analysis
- 摘要:
- 目的 总结儿童原发性气道肿瘤的临床特征,探讨支气管镜介入诊疗在儿童原发性气道肿瘤中应用的有效性和安全性。方法 本研究为回顾性研究,以2019年1月至2023年9月在湖南省儿童医院接受住院治疗的10例原发性气道肿瘤患儿为研究对象,收集患儿临床症状、影像、病理、支气管镜介入诊疗方法及转归资料。结果 男6例、女4例,起病年龄1个月16天至12岁5个月;病程15~180天;临床症状:咳嗽7例,声嘶4例,喉鸣3例,喘息3例,发热2例,咯血1例;肿瘤部位:喉部6例(声门上及会厌部4例,声门下2例),气管及支气管4例(气管1例,左主支气管1例,右主支气管1例,右中叶支气管1例);肿瘤性质:声门下血管瘤2例,喉乳头状瘤4例,腺瘤1例,粘液表皮样癌2例,炎性肌纤维母细胞瘤1例。10例均经支气管镜诊治,2例声门下血管瘤经口服普萘洛尔好转,4例喉乳头状瘤经多次手术治疗、1例腺瘤支气管镜介入治疗后随访30个月无反复,2例黏液表皮样癌和1例炎性肌纤维母细胞瘤患儿支气管镜下活检及清除部分肿块后行外科根治手术治疗,3例患儿分别随访18个月、30个月和36个月,术中、术后均未出现大出血、气胸等严重并发症。结论 儿童原发性气道肿瘤症状缺乏特异性,易误诊及漏诊;支气管镜介入不仅可获取病理活检明确诊断,亦可为气道内恶性肿瘤根治手术创造条件。
- Abstract:
- Objective To summarize the clinical characteristics of primary airway tumors in children and to evaluate the effectiveness and safety of bronchoscopic interventional diagnosis and treatment for these tumors.Methods This retrospective study included 10 pediatric patients diagnosed with primary airway tumors who were hospitalized at Hunan Children’s Hospital between January 2019 and September 2023.Clinical symptoms,imaging findings,pathological results,bronchoscopic interventional treatment methods,and patient outcomes were collected and analyzed.Results Among the 10 patients,there were 6 males and 4 females,with an onset age ranging from 1 month and 16 days to 12 years and 5 months.The duration of symptoms varied from 15 to 180 days.Clinical symptoms included cough (n=7),hoarseness (n=4),stridor (n=3),wheezing (n=3),fever (n=2),and hemoptysis (n=1).The tumor locations were:larynx (n=6,including 4 in supraglottic and epiglottic regions,and 2 in the subglottic region),trachea and bronchi (n=4,including 1 in the trachea,1 in the left main bronchus,1 in the right main bronchus,and 1 in the right middle lobe bronchus).Tumor pathology included subglottic hemangioma (n=2),laryngeal papilloma (n=4),adenoma (n=1),mucoepidermoid carcinoma (n=2),and inflammatory myofibroblastic tumor (n=1).All patients underwent bronchoscopic diagnosis and treatment.The 2 cases of subglottic hemangioma showed improvement with oral propranolol therapy.The 4 cases of laryngeal papilloma required multiple surgical treatments.One patient with adenoma underwent bronchoscopic intervention and remained recurrence-free during 30 months of follow-up.The 2 cases of mucoepidermoid carcinoma and 1 case of inflammatory myofibroblastic biopsy and partial tumor resection,followed by surgical resection.The three patients who underwent surgical treatment were followed up for 18,30,and 36 months,respectively,with no severe intraoperative or postoperative complications such as massive hemorrhage and pneumothorax.Conclusions Primary airway tumors in children present with non-specific symptoms,leading to frequent misdiagnoses and missed diagnoses.Bronchoscopic intervention plays a crucial role in obtaining pathological confirmation and serves as a valuable tool in preparing for definitive surgical treatment in cases of malignant airway tumors.
参考文献/References:
[1] Girvin F,Phan A,Steinberger S,et al.Malignant and benign tracheobronchial neoplasms:comprehensive review with radiologic,bronchoscopic,and pathologic correlation[J].Radiographics,2023,43(9):e230045.DOI:10.1148/rg.230045.
[2] Neville HL,Hogan AR,Zhuge Y,et al.Incidence and outcomes of malignant pediatric lung neoplasms[J].J Surg Res,2009,156(2):224-230.DOI:10.1016/j.jss.2009.03.100.
[3] Varela P,Pio L,Brandigi E,et al.Tracheal and bronchial tumors[J].J Thorac Dis,2016,8(12):3781-3786.DOI:10.21037/jtd.2016.12.67.
[4] Pio LC,Varela P,Eliott MJ,et al.Pediatric airway tumors:a report from the International Network of Pediatric Airway Teams (INPAT)[J].Laryngoscope,2020,130(4):E243-E251.DOI:10.1002/lary.28062.
[5] Cho HJ,Yoon J,Lee E,et al.The different clinical aspects of pediatric primary airway tumors in the larynx,trachea,and bronchi[J].J Korean Med Sci,2017,32(8):1304-1311.DOI:10.3346/jkms.2017.32.8.1304.
[6] Lee EY,Zucker EJ,Restrepo R,et al.Advanced large airway CT imaging in children:evolution from axial to 4-D assessment[J].Pediatr Radiol,2013,43(3):285-297.DOI:10.1007/s00247-012-2470-7.
[7] 王洪琴,黄敏,胡彬雅,等.儿童喉乳头状瘤临床特征及手术疗效分析[J].临床小儿外科杂志,2023,22(10):966-970.DOI:10.3760/cma.j.cn101785-202301017-012. Wang HQ,Huang M,Hu BY,et al.Clinical features and operative efficacies of juvenile onset laryngeal papilloma[J].DOI:10.3760/cma.j.cn101785-202301017-012.
[8] 高星,占小俊,谷庆隆.婴幼儿喉部血管瘤治疗进展[J].临床耳鼻咽喉头颈外科杂志,2023,37(12):972-976.DOI:10.13201/j.issn.2096-7993.2023.12.009. Gao X,Zhan XJ,Gu QL.Advances in the treatment of infantile hemangiomas of the larynx[J].J Clin Otorhinolaryngol Head Neck Surg,2023,37(12):972-976.DOI:10.13201/j.issn.2096-7993.2023.12.009.
[9] 黄莉,刘鸿圣,田金生.儿童原发性大气道肿瘤的CT表现[J].影像诊断与介入放射学,2021,30(3):206-211.DOI:10.3969/j.issn.1005-8001.2021.03.007. Huang L,Liu HS,Tian JS.Clinical and CT features of primary airway tumors in children[J].Diagn Imaging Interv Radiol,2021,30(3):206-211.DOI:10.3969/j.issn.1005-8001.2021.03.007.
[10] Hetzel J,Hetzel M,Hasel C,et al.Old meets modern:the use of traditional cryoprobes in the age of molecular biology[J].Respiration,2008,76(2):193-197.DOI:10.1159/000135934.
[11] Piccione J,Hysinger EB,Vicencio AG.Pediatric advanced diagnostic and interventional bronchoscopy[J].Semin Pediatr Surg,2021,30(3):151065.DOI:10.1016/j.sempedsurg.2021.151065.
[12] 张慧珊,陈熙泼,叶乐平,等.经支气管镜冷冻介入在儿童气管支气管结核诊疗中的临床应用[J].中华儿科杂志,2021,59(11):963-967.DOI:10.3760/cma.j.cn112140-20210504-00378. Zhang HS,Chen XP,Ye LP,et al.Clinical application of transbronchial cryotherapy in the diagnosis and treatment of tracheobronchial tuberculosis in children[J].Chin J Pediatr,2021,59(11):963-967.DOI:10.3760/cma.j.cn112140-20210504-00378.
[13] Tan JHY,Takano AM,Hsu AAL.Resection with preserved histologic morphology of a rare tumour via bronchoscopic cryosurgery[J].J Thorac Dis,2016,8(10):2964-2967.DOI:10.21037/jtd.2016.10.08.
[14] Hetzel J,Eberhardt R,Herth FJF,et al.Cryobiopsy increases the diagnostic yield of endobronchial biopsy:a multicentre trial[J].Eur Respir J,2012,39(3):685-690.DOI:10.1183/09031936.00033011.
[15] 陶红艳,马甜甜,万毅新,等.儿童支气管黏液表皮样癌一例并误诊分析[J].中国医学科学院学报,2020,42(5):706-710.DOI:10.3881/j.issn.1000-503X.11876. Tao HY,Ma TT,Wan YX,et al.Bronchial mucoepidermoid carcinoma in children and its misdiagnosis:report of one case[J].Acta Acad Med Sin,2020,42(5):706-710.DOI:10.3881/j.issn.1000-503X.11876.
[16] Dhochak N,Mittal S,Jain D,et al.The first report of pediatric endobronchial cryobiopsy:expanding horizon of bronchoscopic cryotherapy for airway tumors[J].Pediatr Pulmonol,2021,56(9):3051-3053.DOI:10.1002/ppul.25542.
[17] 吴上志,陈德晖.经支气管镜冷冻技术在儿科呼吸系统疾病中的应用[J].中国小儿急救医学,2024,31(8):566-570.DOI:10.3760/cma.j.issn.1673-4912.2024.08.002. Wu SZ,Chen DH.Application of transbronchoscopic freezing technique in pediatric respiratory diseases[J].Chin Pediatr Emerg Med,2024,31(8):566-570.DOI:10.3760/cma.j.issn.1673-4912.2024.08.002.
[18] 焦安夏.现代儿科呼吸介入技术在呼吸系统肿瘤的应用进展[J].中国实用儿科杂志,2020,35(10):776-778.DOI:10.19538/j.ek2020100608. Jiao AX.Application progress of modern pediatric respiratory intervention techniques in respiratory system tumor[J].Chin J Pract Pediatr,2020,35(10):776-778.DOI:10.19538/j.ek2020100608.
[19] Bertino G,Pedretti F,Mauramati S,et al.Recurrent laryngeal papillomatosis:multimodal therapeutic strategies.Literature review and multicentre retrospective study[J].Acta Otorhinolaryngol Ital,2023,43(S1):S111-S122.DOI:10.14639/0392-100X-suppl.1-43-2023-14.
[20] Hao F,Yue LY,Yin XY,et al.Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis[J].Biosci Rep,2020,40(5):BSR20192005.DOI:10.1042/BSR20192005.
[21] Bowles PF,Liu A,Harries ML.CO2 laser "Ablation Suction" technique for treatment of laryngeal recurrent respiratory papillomatosis[J].Clin Otolaryngol,2019,44(5):884-885.DOI:10.1111/coa.13278.
[22] U?ur Chousein EG,Turan D,?zgül MA,et al.Secondary pulmonary malignancies requiring interventional bronchoscopic procedures[J].Turk Gogus Kalp Damar Cerrahisi Derg,2021,29(3):360-369.DOI:10.5606/tgkdc.dergisi.2021.19927.
[23] Elleuch R.Bronchoscopic treatment of malignant central airway obstruction:a cohort study,long-term survival and complications[J].Rev Mal Respir,2022,39(6):505-515.DOI:10.1016/j.rmr.2022.04.004.
[24] Inomata M,Kuroki S,Oguri N,et al.Pleomorphic adenoma of the trachea:a case report[J].Int J Surg Case Rep,2023,109:108499.DOI:10.1016/j.ijscr.2023.108499.
[25] Yang HM,Yin J,Tang XL,et al.Clinical significance of interventional therapeutic bronchoscopy combined with bronchial arterial embolization in the treatment of hypervascular primary airway tumors in children[J].Pediatr Investig,2021,5(2):130-135.DOI:10.1002/ped4.12256.
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备注/Memo
收稿日期:2023-12-15。
基金项目:儿童急救医学湖南省重点实验室(2018TP1028);湖南省卫生健康委科研计划课题(202206013971)
通讯作者:段效军,Email:dxj801010@126.com