摘要目的 探讨支气管镜在儿童支气管黏液表皮样癌诊断及介入治疗中的应用.方法 回顾性分析2013年4月至2015年6月首都医科大学附属北京儿童医院介入肺科经病理确诊的4例儿童支气管黏液表皮样癌的临床资料,分析其临床特征、胸部CT及支气管镜表现.结果 3例为低度恶性支气管黏液表皮样癌,1例为中度恶性(中分化)支气管黏液表皮样癌.发病年龄4岁11个月～10岁9个月.患儿均无特征性临床表现,以咳嗽、喘息、运动耐受不良为主要症状,2例伴咯血,术前误诊为肺炎、支气管哮喘、支气管异物等.胸部CT提示呼吸道内类圆形肿物,2例发生于左主支气管,1例发生于右支气管中间段,1例发生于右中叶支气管,有阻塞性肺不张或肺气肿.4例患儿均在全身麻醉下行支气管镜下病灶活检,3例行支气管镜下介入治疗切除肿物,1例行肺叶切除+支气管重建术.结论 儿童黏液表皮样癌无特征性表现,常出现咳嗽、喘息等呼吸道症状.支气管镜下组织活检对确诊有重要作用,对不能手术切除的肿瘤,支气管镜下介入治疗是一种有效的姑息治疗方法.

abstractsObjective To explore the application of bronchoscope in diagnosis and treatment of bronchial mucoepidermoid carcinoma in children.Methods The clinical data of 4 cases of bronchial mucoepidermoid carcinoma treated in Department of Interventional Pulmonology,Beijing Children's Hospital Affiliated to Capital Medical University from April 2013 to June 2015,were retrospectively analyzed,and their clinical manifestations,chest computed tomography(CT),bronchoscopic manifestations were analyzed.Results Among the 4 cases of bronchial mucoepidermoid carcinoma,3 cases were low-grade bronchial mucoepidermoid carcinoma,and 1 case was intermediate grade malignant.Onset of clinical manifestations occurred from the ages of 4 years and 11 months old to 10 years and 9 months old.All patients had no characteristic clinical manifestations,only 2 cases had hemoptysis,while the main symptoms were cough,wheezing,and exercise tolerance decreased in 4 the patients,and they were initially misdiagnosed as pneumonia,asthma or bronchial foreign body.Chest CT prompted that there was circular mass in respiratory tract,the lesions located in left main bronchus in 2 patients,in right bronchus intermedius in 1 patient,and in right middle bronchus in 1 case,and atelectases or emphysema occurred in bronchus.The biopsy by bronchoscope under general anesthesia was performed for more enough specimen in all the 4 patients.The lesions were completely removed in 3 patients by interventional bronchoscopy,and 1 patient by lobectomy.Conclusions The children with bronchial mucoepidermoid carcinoma were presented with cough and wheezing without specific manifestations.Biopsy by bronchoscope is a good choice for the diagnosis of bronchial mucoepidermoid carcinoma.Bronchoscopic intervention was effective in the treatment of non-operative carcinoma.