Abstract:

Objective: To evaluate the efficacy and safety of CO₂ cryotherapy combined with forceps in the treatment of infants with lymph node fistula tracheobronchial tuberculosis (TBTB). Methods: The clinical data, including age, gender, clinical symptoms, diagnosis, imaging features, and characteristics of lesions under bronchoscope, of seven children with lymph node fistula TBTB were retrospectively analyzed. All the patients underwent fiberoptic bronchoscope interventional therapy in the Respiratory Department of Tianjin Children’s Hospital from July 2012 to July 2020. The cough grade, CT and bronchoscopic lesion changes before and after the intervention were analyzed by descriptive summary. Results: Among the 7 patients, 6 were male and 1 was female, aged from 8 months to 3 years, and the duration of the disease ranged from 5 to 70 d. All the children were treated mainly with bronchoscopic CO₂ cryotherapy combined with forceps, and the number of interventions was 1 to 3 times. Three months after intervention, the cough scores of decreased from 2 to 0 in 5 patients, which was dramatic effective, and decreased from 3 to 1 in 2 patients, which was mild effective. It was showed by the CT reexamination that the manifestations of enlarged and calcified lymph nodes in the hilum and mediastinum, bronchial obstruction, emphysema, and pulmonary atelectasis of the five patients were significantly improved compared with those before the intervention. Among the five patients,≥1/2 of the lung lesions absorbed was found in four, the treatment was dramatic effective; and the other one had <1/2 of the lung lesions absorbed, the treatment was mild effective. Reexamination of fiberoptic bronchoscopy in 7 children showed that the the fistula was basically closed, the bronchial lesions were significantly absorbed and improved, the lumen stenosis or obstruction was reduced, and the bronchial mucosa was relatively smooth. Among the 7 patients, 5 of them had bronchial lesion absorption of ≥2/3, which was dramatic effective, and 2 of them had improved bronchial lesion absorption but <2/3, which was mild effective. No patients had intraoperative respiratory distress or decrease in oxygen saturation. None of the patients had any serious postoperative complications such as pneumothorax, mediastinal emphysema, airway spasm, luminal edema, or hemorrhage. They were followed up for 3-6 months with the application of fiberoptic bronchoscope intervention, except for one, and no recurrence of lesions was observed in any of the 6 patients. Conclusion: CO₂ cryotherapy combined with forceps intervention for infant with lymph node fistula TBTB achieved good therapeutic results, and no complications such as tracheobronchial stenosis, softening, obstructive pneumonia, or pulmonary atelectasis were observed, therefore, this treatment is safe and effective.

Key words: Tuberculosis, Bronchi, Child, Treatment outcome