Clinical Experience in Airway Endoscopy in Children: An Emphasis on the Comparison between Flexible and Rigid Endoscopy

小兒呼吸道內視鏡之臨床經驗:可屈式及硬式內視鏡之比較

林嘉德(Chia-Der Lin) ； 鄭元凱(Yeng-Kai Cheng) ； 譚慶鼎(Ching-Ting Tan) ； 陳建銓(Jiann-Chyuan Chen) ； 鄒國英(Kuo-Inn Tsou Yau) ； 李憲彥(Shiann-Yann Lee)

《Acta Paediatrica Sinica》 39卷2期 (1998/04) Pp. 103-108

https://doi.org/10.7097/APS.199804.0103

摘要

相對於成人，小兒呼吸道顯得十分狹小，以往小兒特別是嬰幼兒呼吸道異常只能藉助臨床症狀來診斷，結果常常誤判或忽略許多其他呼吸道異常。近二十歲年以來，小而精緻的內視鏡器具，不論是可屈式纖維內視鏡或硬式通氣式支氣管鏡，配合高解析度攝影錄影機，應用在小兒特別是嬰幼兒呼吸道的診斷與治療，可以早期診斷及治療異常呼吸道病變。臺大醫院耳鼻喉部收集自民國83年4月到民國86年5月間小兒呼吸道之內視鏡檢查，共296名 病患接受509次內視鏡檢查；292次爲可屈式纖維內視鏡檢查，217次爲硬式通氣式支氣管鏡檢查；其中僅一例因硬式支氣管鏡治療而死亡，可屈式纖維內視鏡檢查則幾乎無重大併發症。一般以可屈式纖維內視鏡作爲初步呼吸道評估，檢查時應包括整個上呼吸道並儘可能檢查到氣管與支氣管，若可屈式纖維內視鏡無法作出確切診斷或需手術治療時，則進行硬式內視鏡檢查。檢查之適應症以呼吸喘鳴聲、呼吸困難、追蹤內視鏡檢查或氣管造口評估、餵食困難聲音嘶啞或微弱、及懷疑氣道異物居多。常見之呼吸道異常依次爲軟喉症、聲門下狹窄、氣管支氣管軟化及呼吸道異物；近20%同時有兩種以上呼吸道異常。我們認爲在充分術前評估及與家屬良好之溝通，適當助手及設備、熟練操作技巧之下，內視鏡是檢查小兒呼吸道最佳的利器。

關鍵字

內視鏡 ； 呼吸道 ； 小兒

並列摘要

Congenital and acquired lesions of the pediatric airway frequently pose perplexing problems in children, infants and newborns. Prompt investigation into the etiology and early intervention are essential to decrease the morbidity and to prevent some tragic events. Endoscopy grants access to the lesion sites for either diagnostic or therapeutic purposes. From April 1994 to May 1997, totally 509 endoscopic procedures, including 292 flexible and 217 rigid endoscopic procedures were performed in 296 pediatric patients at National Taiwan University Hospital. For routin diagnostic procedures, the flexible fiberscope is the instrument of choice which should include a detailed examination of entire upper airway, as farther to tracheobronchi as possible. When flexible endoscopy fails to demonstrate the exact airway lesion or certain surgical maipulation is demanded, rigid endoscopy is favored. The indications for endoscopy were:stridor, respiratory distress, follow-up endoscopy or tracheostoma evaluation, feeding difficulty, hoarseness or weak voice, and suspicious airway foreigh body. Common airway problems in serial orders were:laryngomalacia, subglottic stenosis, tracheo/bronchomalacia and airway foreign body. Nearly 20% of patients in this series had multiple synchronous airway lesions. There was no major complication in our 292 flexible endoscopic procedures. Two major complications attributed to endoscopic manipulations occurred in 271 rigid endoscopic procedures.

並列關鍵字

endoscopy ； airway ； pediatric