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頁籤選單縮合
題名 | Clinical Spectrum of Bronchiectasis in Children=支氣管擴張症在兒童的臨床表現 |
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作者 | 曹珮真; 林清淵; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 43:5 民91.09-10 |
頁次 | 頁271-275+303 |
分類號 | 417.5342 |
關鍵詞 | 支氣管擴張症; 反覆性感染; 咳血; 免疫不全; Bronchiectasis; Recurrent infections; Hemoptysis; Congenital immunodeficiency; |
語文 | 英文(English) |
中文摘要 | 在1970年後,由於疫苗的發展和抗生素的進步使得支氣管擴張症的發生率明顯降低。然而,支氣管擴張症在開發中的國家依然是一個問題。爲了瞭解支氣管擴張症在我國兒童族群的情況,我們回溯探討21位從1984年到2001年12月在台北榮民總醫院診斷爲支氣管擴張症之病童其病因,臨床表徵,放射線影像特徵及預後。診斷的工具包括了胸部X光、胸部電腦斷層掃描和支氣管攝影檢查。結果發現最常見造成支氣管擴張症的病因是呼吸道的感染。其中五例(23.8%)是肺結核感染所致。三例(14.3%)爲先天性免疫不全症。有兩例診斷爲原發性機毛運動不良症。而在近幾年來,免疫缺乏症扮演越來越重要的角色。大部分的病人在診斷前已經有三到五年的症狀,例如咳嗽有膿痰。在我們的個案中,咳血是第二常見的症狀,胸部X光片(14.2%的病人)偶爾可見支氣管擴張合併蜂竄狀構造的情形,或是只有發現肺部浸潤增加。近幾年來,高解析度胸部電腦斷層掃描成爲一個更精確且百侵入性的診斷工具。支氣管擴張症的初步治療皆是以內科療法爲主。在我們的個案中只有五個病人因爲內科療法失敗而接受肺部部分切除手術。大部分的病人在長期追蹤時仍偶爾會有肺炎或呼吸道的症狀復發。總結,在我們的研究中發現,支氣管擴張症在兒童並不少見,而且容易被忽略。有長期反覆下呼吸道感染的病史和反覆的咳嗽有膿痰或咳血的臨床 症狀是讓我們考虑到這個疾病的重要線索,早斯的診斷與適當的治療可以肺部之化膿性併發症的産生。 |
英文摘要 | The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectaisis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale. |
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