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纤维支气管镜代胸腔镜诊断不明原因胸腔积液28例临床分析

目的探讨纤维支气管镜代胸腔镜检查在诊断胸腔积液中的临床应用价值。 方法以我院2013年5月至2014年8月收治的不明原因胸腔积液患者28例为研究对象, 对其行纤维支气管镜代胸腔镜检查, 获取胸腔积液及病变组织行病理学检查。 结果28例患者中, 2例脓胸患者未行病理检查, 其余26例患者均行病理检查并明确诊断, 确诊率为92.86%。其中, 18例为恶性肿瘤病变, 包括腺癌10例, 鳞癌8例; 8例为肉芽肿样改变, 诊断为结核性胸腔积液, 经正规抗结核治疗胸腔积液消失。27例患者的人工气胸在术后1~3 d内完全吸收拔管, 无术中术后大出血、伤口感染以及胸腔积液新发感染等并发症发生。 结论纤维支气管镜代胸腔镜在检查胸腔积液病因中是一种安全有效、检出率高的检查方法, 值得临床大范围应用与推广。

The Clinical Application of Bronchoalveolar Lavage by Way of Fibrobronchoscopy on Patients with Pulmonary Infection

目的:探讨纤维支气管镜(简称纤支镜)肺泡灌洗术在治疗肺部感染性疾病的疗效。方法:共从内科系统中入选社区获得性肺炎和医院获得性肺炎患者122例,将其分为二组,治疗组:传统治疗加纤支镜肺泡灌洗术治疗肺部感染,共52例;对照组:传统方法治疗肺部感染,共70例。结果:两组病例在发热时间,咳嗽,咳痰及肺部罗音消失时间,住院日,抗生素使用时间,治愈率和死亡率方面对比均有显著性差异(Plt;0.05)。结论:纤支镜肺泡灌洗术在治疗肺部感染性疾病的疗效确切,且术中危险性小,值得推广。

Application and prospect of lung biopsy in acute respiratory distress syndrome

Acute respiratory distress syndrome is a clinical syndrome caused by many reasons, which is characterized by intractable hypoxemia. Its etiology is complex and its mortality is high. Lung biopsy techniques can give accurate histopathological diagnosis to such patients to guide treatment and improve prognosis. At present, lung biopsy techniques include surgical lung biopsy, transbronchial lung cryobiopsy, transbronchial lung biopsy and percutaneous lung biopsy. The diagnostic rate of surgical lung biopsy is high, but it is traumatic and difficult to implement. The diagnostic rate of transbronchial cryobiopsy is relatively high, and the complications are acceptable. Transbronchial lung biopsy is minimally invasive but the diagnostic rate is low. The diagnostic rate of percutaneous lung biopsy is relatively high, and the complications are relatively few. For patients with acute respiratory distress syndrome who need lung biopsy, it is very important to choose different surgical procedures according to their effectiveness, safety and applicability.

The role of rapid on-site evaluation in the diagnosis of lung space-occupying lesions

ObjectiveTo evaluate the role of rapid on-site evaluation (ROSE) in the diagnosis of lung space-occupying lesions.MethodsFrom June 1, 2017 to December 30, 2017, transbronchial biopsies were performed in patients with lung space-occupying lesions on chest CT, and biopsies were taken for ROSE and subsequent routine pathological examination. ROSE interpretation was performed by a pulmonologist who had been trained in cytopathology for 3 months. The interpretation was correlated with the follow-up routine pathological examination. The contemporary cases with lung space-occupying lesions who underwent transbronchial biopsies without ROSE were retrospectively reviewed. The quality assessment of biopsy specimens recorded in pathological reports were compared between cases with and without ROSE.ResultsA total of 101 patients underwent transbronchial biopsies in parallel with ROSE. The interpretation results of the pulmonologist were compared with the follow-up routine pathology, which showed that the consistency rate of malignant lesions was 84.1% and the consistency rate of benign lesions was 93.8%. Consistency test showed good agreement between the ROSE conducted by the pulmonologist and the routine pathological examination by pathologists (κ=0.66, P<0.01). The quality assessment of biopsy specimens showed that there was no significant difference on rate of satisfied biopsy specimens between cases with and without ROSE (98.0%vs 94.5%, P=0.14).ConclusionsThe use of ROSE combining with bronchoscopy allows good preliminary assessment of lung space-occupying lesions. Pulmonologists trained in short-term formal cytopathology are fully capable of performing ROSE, thereby obviating the need for cytopathologists to participate in on-site evaluation.

支气管镜联合胸腔镜手术治疗大咯血32例临床体会

目的探讨支气管镜联合胸腔镜手术治疗大咯血的可行性、安全性和有效性。 方法回顾性分析九江市第一人民医院胸外科自2009年5月至2013年4月完成的32例经支气管镜联合胸腔镜手术治疗大咯血患者的临床资料。其中男19例、女13例，年龄24～60（40.2±9.1）岁；因支气管扩张致大咯血24例，肺癌合并咯血6例，肺结核咯血2例。 结果2例（6%）因胸腔粘连严重而中转开胸。1例因气管内出血量大，纤维支气管镜无法准确定位，终止手术，最终死亡。余29例在全胸腔镜下完成肺叶切除术，包括右肺上叶切除4例，右肺下叶12例，左肺下叶10例，左肺上叶3例。其中6例术中冰冻病理检查提示癌，加做淋巴结清扫术；1例右肺上叶支气管扩张行右肺上叶切除术后第3 d再次出现大咯血，手术证实为右肺中叶再次出血，行右肺中叶切除术；其余22例术后均无咯血。 结论支气管镜联合胸腔镜手术治疗大咯血是一种安全有效的方法。

The Value of CT Virtual Endoscopy and Three Dimensional Imaging in Fiberoptic Bronchoscopic Balloon Dilatation

Objective To evaluate the application value of spiral CT virtual endoscopy and three dimensional imaging in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis. Methods Thirty-three cases of benign tracheobronchial stenosis from June 2004 to November 2008 were checked by spiral CT with airway tracheobronchial reconstruction. For the patients with indications, balloon dilatation was performed under fiberoptic bronchoscope. The three-dimensional reconstruction images were compared with the findings under bronchoscopy. And the preoperative and postoperative three-dimensional reconstruction images were compared for airway diameter. Results Three cases were found stenosis of middle lobe by CT virtual endoscopy and did not undergo balloon dilatation. The remaining 30 cases were confirmed by bronchoscopy findings similar to the images by tracheobronchial reconstruction with CT, with consistent rate of 100% . Immediate postoperative three-dimensional CTreconstruction of tracheal bronchus revealed that diameter of stenotic bronchus increased from ( 2. 7 ±1. 3) mm to ( 6. 9 ±1. 6) mmafter operation. Conclusion Multislice spiral CT virtual endoscopy is helpful in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis and postoperative follow-up.

Research progress of robotic bronchoscopy system and prospect of the combination with artificial intelligence

The robotic bronchoscopy system is a new technology for lung lesion location, biopsy and interventional therapy. Its safety and effectiveness have been clinically proven. Based on many advanced technologies carried by the robotic bronchoscopy system, it is more intelligent, convenient and stable when clinicians perform bronchoscopy operations. It has higher accuracy and diagnostic rates, and less complications than bronchoscopy with the assistance of magnetic navigation and ordinary bronchoscopy. This article gave a review of the progress of robotic bronchoscopy systems, and a prospect of the combination with artificial intelligence.

Clinical evaluation of endoscopic bronchial closure of Peripheral Bronchopleural Fistula with customized silicone plug

ObjectiveTo explore the safety and efficacy of the treatment of peripheral bronchopleural fistula with customized silicone plug through bronchoscope. MethodsA total of 19 patients with BPF admitted to Hunan Provincial People’s Hospital from July 2017 to May 2023 were included. Detailed medical records of the patients were collected, including etiology, fistula location, treatment methods, complications, and effective rates, to assess the safety and efficacy of customized silicone plug occlusion. ResultsThe average age of the 19 patients was 61.58 years (range from 42～84 years). The fistulas were located at the right upper lobe in 8 cases, the right middle lobe in 2 cases, the right lower lobe in 2 cases, the left upper lobe in 2 cases, and the left lower lobe in 5 cases. Causes included 9 cases after pneumonectomy, 6 cases of spontaneous pneumothorax, 1 case post Microwave Ablation Therapy for lung nodule, 1 case of advanced lung cancer under radiotherapy and chemotherapy, 1 case of candidal pneumonia, and 1 case of pulmonary tuberculosis. 15 patients were successfully occluded for the first time, 1 case failed to place the plug, and 3 cases had silicone plug dislodgement within 1 week after the procedure, with a short-term effective rate of 73.68% (14 cases). A total of 40 customized silicone plugs were placed, with an average of (2.10±0.74), and the mean diameter of the plugs used was 6.4 mm, with a range of 3 to 9 mm. Fifteen patients were recruited for long-term follow-up, with a median follow-up time of 15 months (range from 1.5 to 53 months). One patient developed a new fistula on the 45th day, who was treated with a combined small Y-type single bullet-covered stent for occlusion. One patient died of severe pneumonia 3 months postoperatively, and one died of type II respiratory failure at the 30th month, both deaths were unrelated to the interventional procedure. The long-term effective rate was 68.42% (13 cases). ConclusionPlacing customized silicone plugs through bronchoscopy can rapidly and effectively occlude peripheral BPF, with satisfactory long-term outcome.

存留于右侧中间支气管长达14年的支气管异物一例

支气管乳突状瘤一例并文献复习

目的探讨支气管乳突状瘤的临床表现、病理学特征，诊断要点及治疗方式。方法分析 1 例呼吸道乳头状瘤的临床特征、影像及病理学资料，同时进行文献复习对该病进行分析总结。结果患者男性，73 岁，务农。因“呼吸困难半年”入院。本例患者胸部增强 CT 提示左主支气管起始部内见软组织密度影，支气管镜下行病理活检提示为支气管鳞状上皮乳头状瘤，人乳头状瘤病毒（HPV）阴性，Ki67（MIB-1）阳性。行纤维支气管镜下切除并给予重组人干扰素 α2b 注射液（假单胞菌）300 万 IU 皮下注射，治疗 7 d 后再次行纤维支气管镜下治疗好转后出院。通过以“乳头状瘤”与“支气管、气管、肺”为关键词检索查阅 CNKI、万方、维普等数据库，截止 2019 年 3 月。文献报道 93 例，患者年龄 19～80 岁，表现为咳嗽咳痰 60 例，咯血 38 例，胸闷或呼吸困难 31 例；位于气管、主气管 48 例；外科手术 43 例，支气管镜治疗 32 例；65 例患者有病理分型，其中鳞状细胞乳头状瘤 35 例、腺性乳头状瘤 10 例、混合型乳头状瘤 20 例。结论支气管乳突状瘤好发于中老年男性，与吸烟、HPV 感染相关。临床表现可无特异性，表现为咳嗽、咯血及呼吸困难等，容易误诊，诊断主要依据活组织病理检查，鳞状细胞乳头状瘤相对较多。支气管镜下介入治疗或手术治疗是有效的治疗手段，预后好，但易复发，需长期随访。