目的:探讨电子支气管镜在肺癌诊断中的价值。方法:对233例支气管镜下诊断肺癌的患者进行分析。结果:电子支气管镜下肺癌的诊断率为63.49%,其中中央型肺癌的诊断率为72.85%,周围型肺癌的诊断率为27.63%,该组病例以老年人多见, 肿瘤多位于叶支气管,右肺57.51%, 左肺42.49%,病理类型为鳞癌45.92%, 小细胞癌22.75%, 腺癌24.03%。电子支气管镜下主要特征:鳞癌以管内增殖型改变为主,表现为新生物形成,阻塞管腔,伴有糜烂、充血、水肿,小细胞癌以增殖型和浸润型为主,可见气管内新生物形成及节结样改变。腺癌以管内增殖型和肿块压迫管腔为主,可见管内新生物形成或支气管呈缝隙样狭窄,甚至闭塞。结论:与周围型肺癌相比电子支气管镜检查对中心型肺癌诊断的准确率较高, 其检查方法简单, 创伤性小, 是正确指导临床医生选择合理治疗方法的一种较好的辅助检查技术。
ObjectiveTo investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. MethodsFrom September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO2), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. ResultsAfter treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO2 [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H2O (1 cm H2O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H2O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO2 (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . ConclusionIn mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.
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(Plt;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。
Objective To evaluate the diagnostic value and utility of flexible bronchoscopy in the preoperative assessment in patients with solitary pulmonary nodules (SPNs). Methods A total of 111 patients with SPNs of unknown origin treated between January and June 2016 were retrospectively enrolled. The clinical characteristics, bronchoscopy findings and surgical strategies were collected. Results In the total 111 cases, malignant and benign SPNs were 79 and 32 cases, respectively. The mean diameter of malignant SPNs was larger than that of benign SPNs [(2.04±0.58) vs. (1.70±0.75) cm, P<0.05]. Bronchoscopy identified 9 cases (8.1%) unsuspected findings. Surgeries were modified or cancelled in 3 patients (2.7%) because of bronchoscopy findings. Transbronchoscopy biopsies were performed in 26 patients, 9 of whom were diagnosed lung cancer preoperatively, with a sensitivity of 45% (9/20) and a specificity of 100% (6/6). Conclusions Flexible bronchoscopy can be contributed to diagnosis of SPN before surgery and determination of surgical strategies. It is suggested that flexible bronchoscopy could be included in the routine preoperative work-up of SPN.
The coming out of electromagnetic navigation bronchoscopy gives exciting solution for diagnosis and even treatment of peripheral pulmonary nodules. It breaks the barriers of traditional bronchoscopy, and gives live visible imaging guidance for operators during biopsy of peripheral pulmonary nodules. The electromagnetic navigation bronchoscopy system can intelligently recognize and reconstruct the bronchial tree of the patients, and generate visible data and virtual guidance for the operators. It can perceive real-time magnetic localization of the signal, so as to precisely guide the navigational or biopsy tools. This review introduced the artificial intelligence configuration of the electromagnetic navigation bronchoscopy system based on the Veran system, and gave some improvement advices based on the defects of the system. In this way, we hope to promote the development and better clinical application of electromagnetic navigation bronchoscopy system.
Objective To compare the diagnostic value of sterile sputumsuction tube with protected specimen brush in mechanically ventilated patients with serious lung infection, and explore the safety and efficacy of bronchofibroscope combining mechanical ventilation in the treatment of severe lung infection.Methods Seventy-four severe lung infection patients with invasive mechanical ventilation support were recruited in the study. Based on the routine treatment, the subjects were randomly divided into a control group received only mechanical ventilation, and a treatment group received sputum aspiration and bronchial lavage by bronchofibroscope combiningmechanical ventilation. Lower respiratory tract secretion was collected to analyze the bacterial etiology with sterile sputum suction tube in the control group, and with protectedspecimen brush in the treatment group. Results The positive rate of sputum suction tube and protected specimen brush was 70. 27% and 75. 68% , respectively, with no statistical difference between the two groups ( P gt; 0. 05) . The PaO2 of the treatment group increased and PaCO2 decreased obviously after sputum aspiration and bronchial lavage by bronchofibroscope ( P lt; 0. 01) . The total effective rate was also highly increased, and the heart rate and respiration were stable in the treatment group. The time of mechanical ventilation and the length of ICU stay were all shortened in the treatment group compared with the control group. Conclusions Sterile sputum suction tube can not only acquire accurate pathogen, but also is a simple and economical method for patients with severe lung infection with mechanical ventilation. Sputum aspiration and bronchial lavage with bronchofibroscope combining mechanical ventilation are effective and safe treatment for patients with severe lung infection.
ObjectiveTo evaluate the safety and efficacy of non-invasive positive pressure ventilation (NIPPV) combined with fiberoptic bronchoscopy(FB) on acute exacerbation of chronic obstructive puhmonary disease (AECOPD) patients with acute respiratory failure. MethodsA prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011.They were randomly divided into a case group and a control group.The case group was administrated FB and lavage after one hour of NIPPV treatment.The control group was administrated NIPPV without FB and lavage.Other treatment regimen was the same in two groups. ResultsThere were 51 subjects recruited in the study, 25 subjects in the case group and 26 subjects in the control group.All variables at baseline were matched (P > 0.05).All variables improved after one hour of NIPPV before FB, without significant difference between two groups (P > 0.05).During the period of FB, heart rate in the case group was faster than that in the control group (P < 0.05), and other variables were not significantly different between two groups (P > 0.05).Both groups received NIPPV for one hour after FB, the variables including heart rate, respiratory rate, pH, PaO2, PaCO2 were statistically significant between two groups(P < 0.05).At the time of 24 hours after FB, the variables including mean arterial pressure, heart rate, respiratory rate, pH, PaO2 and PaCO2 in the case group were nearly recovered, and differences between two groups were significant (P < 0.05).The positive rate of sputum culture was significantly higher in the case group than that in the control group[88.0%(22/25) vs.58.6%(14/26)].Success rate in the case group were obviously superior to that in control group.The cases of failure, death and refusing in the case group were lower than those in the control group.Complications in two groups had no significant difference (P > 0.05).There was not serious complication such as hear arrest, hemoptysis and apnea during the process of NIPPV combined with early FB. Conclusion It deserves to be used in clinic because of the safety, efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.