| Objection:the bronchofibroscope's application in the diagnosis of Pediatric endobronchial tuberculosis(EBTB) and its therapeutic effect of bronchoalveolar lavage,drug injection, Argon beam Coagulator, balloon dilatation and cryoherapy for tuberculosis under bronchofibroscope.Methods:According to the diagnostic criteria of《Zhu Futang Textbook Pediatrics》,we enroll 9 patients ,who were definitely diagnosed as EBTB excluding other inspriational infection diseases, admitted in our department from Aug,2008 to Feb,2011. Among 9 patients, there are 3 boys and 6 girls, aging from 8 month to 15 years old. The first symptom of all patients are coughing with persistent low-grade fever,1 case accompaning with wheeze,1 case with pulmonary tuberculosis and 3 cases with dyspnea. The course of disease is various from 20 days to 2.5 years.Diagnose the disease through the lesion of local tissue observing under bronchofibroscope.and pathological bioposy. As for mild EBTB, bronchoalveolar lavage and topical antitubercular agent are given. Patients with repeated granulation hyperplasia and airway stenosis will be given Argon beam Coagulator(APC), balloon dilatation and cryoherapy. Pulmonary function are tested both before and after the treatment. Recheck bronchofibroscope in 1-3 months.Results: On the basis of conventional therapy, bronchofibroscope and interventional therapy are applicated in the treatment of definite EBTB patients. The observing results shows that caseous necrosis can be seen in 9 cases ,granulation hyperplasia in 2 cases and airway stenosis in 7 cases.Among 7 stenosis airway cases including 3 severe cases,the stenosis location of 3 cases are left primary bronchus, 2 cases are subsegmental bronchus in left lobus superior pulmonis,2 cases are subsegmental bronchus in middle lobe of right lung. There is no difference with lung function between preoperation and postoperation in 6 mild EBTB cases.We know through follow-up telephone interview that 4 of 6 cases are in recovery period with one month treatment of BAL, local drug injection and inhalation as well as antitubercular agent intravenously. Airway stenosis of one case is aggravated under the treatment of BAL ,local drug injection. Later he was given cytotherapy for many times in Qi Lu hospital and he is now in convalescence. One case lost follow up. As for 3 severe airway stenosis cases with apparent dyspnea, the treatment schedule of bronchoalveolar lavage and topical antitubercular agent combined APC or balloon dilatation have a significant effect. The lung function preoperation of all cases was moderate combined ventilation function failure mainly presenting obstruction, while the lung function postoperation was mild.The indice of FVC,PEF,FEV1 in one case treated with APC were significant enhanced respectively from preoperation 42%,4.12L/S,37.59L/min to 72%,4.68L/S, 55.64L/min postoperation. The patient got a good recovery through 9 times APC therapy, with no granulation and stenosis airway under bronchofibroscope. Also the indice of FVC,PEF,FEV1 in two case treated with balloon dilatation were significant enhanced respectively from preoperation 40-50%,less than 4.10L/S,36.55L/min to 70-80%, more than 4.62L/S, more than 55.58L/min postoperation. The two cases are now in good recovery with no caseous necrosis , granulation hyperplasia and stenosis airway observed under bronchofibroscope 3 months aftero peration.Conclusion:1. bronchofibroscope is an effective method for the EBTB diagnosis.2. bronchofibroscope and interventional therapy are effective on the treatment of EBTB.
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