儿童淋巴结瘘型气管支气管结核临床特征及疗效分析

doi:10.19871/j.cnki.xfcrbzz.2026.04.007

摘要/Abstract

摘要： 目的总结分析儿童淋巴结瘘型气管支气管结核（tracheobronchial tuberculosis,TBTB）的临床特征、支气管镜下表现和全身药物联合介入治疗的临床疗效,为该病临床诊疗及规范化干预提供参考依据。方法回顾性分析2015年7月至2025年9月于广州市胸科医院确诊的45例淋巴结瘘型TBTB患儿的临床资料,分析其一般情况、临床表现、影像学特征、支气管镜下特点及介入治疗结局。结果所有患儿均经支气管镜活检病理确诊,男17例,女28例,年龄1~15岁,平均（11.24±3.30）岁,病程1周至1年,主要临床表现为发热、咳嗽。影像学检查示肺门或纵隔淋巴结肿大,伴肺实变或肺不张。支气管镜下分型为肉芽/息肉型30例（66.67%）,单纯/溃疡穿孔型15例（33.33%）。共检出90个瘘口,以多发性为主,主要分布于左、右主支气管,右侧居多。单发病灶患儿（22例）介入治疗次数中位数为3.5次,多发病灶患儿（23例）为7次,组间差异有统计学意义（P<0.05）。治疗总有效率为100%,治疗期间及随访中均未出现严重并发症。结论儿童淋巴结瘘型TBTB支气管镜下分型以肉芽/息肉型多见,病灶多呈多发性,以右主支气管为主。全身抗结核药物联合支气管镜下介入治疗其疗效确切且安全性良好。

关键词: 儿童, 淋巴结瘘型, 气管支气管结核, 支气管镜检查, 临床特征, 疗效

Abstract: Objective To summarize and analyze the clinical characteristics, bronchoscopic findings, and clinical efficacy of combined systemic drug therapy and interventional treatment for tracheobronchial tuberculosis (TBTB) with lymph node fistula in children, providing a reference for the clinical diagnosis, treatment, and standardized management of this condition. Method Clinical data of 45 children diagnosed with lymph node fistula type TBTB at Guangzhou Chest Hospital from July 2015 to September 2025 were retrospectively reviewed. General information, clinical manifestations, imaging features, bronchoscopic characteristics, and interventional treatment outcomes were analyzed. Result All 45 pediatric patients were pathologically diagnosed via bronchoscopic biopsy. Among them, 17 were male and 28 were female, ranging in age from 1 to 15 years, with a mean age of (11.24±3.30) years; the duration of illness ranged from 1 week to 1 year. The main clinical manifestations were fever and cough. Imaging studies revealed enlarged hilar or mediastinal lymph nodes, accompanied by pulmonary consolidation or atelectasis. Bronchoscopic classification revealed granulomatous/polypoid type in 30 cases (66.67%) and simple/ulcerative perforation type in 15 cases (33.33%). A total of 90 fistula openings were identified, with multiple lesions being the predominant type; they were mainly distributed in the left and right main bronchi, with a higher prevalence on the right side. The median number of interventional procedures for children with a single lesion (22 cases) was 3.5, while for those with multiple lesions (23 cases) it was 7; the difference between the two groups was statistically significant (P<0.05). The treatment efficacy rate was 100%, and no serious complications occurred either during or after treatment. Conclusion In children with lymph node fistula type TBTB, the bronchoscopic classification is predominantly the granulomatous/polypoid type. Lesions are often multiple and mainly located in the right main bronchus. Systemic anti-tuberculosis drugs combined with bronchoscopic interventional therapy is effective and safe.

Key words: Children, Lymph node fistula, Tracheobronchial tuberculosis, Bronchoscopy, Clinical analysis

中图分类号:

李翠萍, 黄绍梅, 陈品儒, 宋敏, 方伟军. 儿童淋巴结瘘型气管支气管结核临床特征及疗效分析[J]. 新发传染病电子杂志, 2026, 11(4): 44-48.

Li Cuiping, Huang Shaomei, Chen Pinru, Song Min, Fang Weijun. Clinical characteristics and therapeutic efficacy analysis of lymphatic fistula-type tracheobronchial tuberculosis in children[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(4): 44-48.

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