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Clinical Analysis of 5 Children Patients with Mesocolon Lymphangioma

目的　探讨小儿结肠系膜淋巴管瘤的诊断与治疗方法。方法　回顾性分析我院2006年1月至2011年12月期间手术治疗的5例小儿结肠系膜淋巴管瘤的临床资料。结果　3例诊断为腹腔包块性质待查的患儿，术中发现腹腔肿块来源于乙状结肠系膜，其中1例肿块侵犯到降结肠系膜达结肠脾曲而行左半结肠切除＋肠吻合术，另外2例行乙状结肠系膜淋巴管瘤切除＋部分乙状结肠切除＋肠吻合术；1例患儿诊断为急性化脓性阑尾炎合并乙状结肠系膜淋巴管瘤，行阑尾切除＋乙状结肠系膜淋巴管瘤切除＋肠吻合术，1例患儿诊断为乙状结肠系膜淋巴管瘤破裂并弥漫性腹膜炎，行乙状结肠系膜淋巴管瘤切除＋乙状结肠造瘘术，术后6个月后再行二期手术。5例患儿手术后恢复良好，未发生吻合口漏等并发症。术后随访5个月～5年， （2.3±1.1）年，1例失访，余均存活，仍在随访中，所有病例均未复发。结论　日常行阑尾手术中，应常规探查小肠、结肠；未进行肠道准备的结肠一期吻合手术中结肠灌洗可减少吻合口漏等并发症的发生率；腹腔感染严重的患儿结肠一期吻合不可取，结肠造瘘安全；小儿结肠系膜淋巴管瘤术前确诊困难，反复出现腹痛、腹部包块的患儿应想到结肠系膜淋巴管瘤的可能性，行充分的肠道准备后择期手术，手术是肠系膜淋巴管瘤唯一的治疗方法。

Mile’s术后行瘘口灌洗加束带加压处理临床应用20例体会

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。

Multivariate Statistical Analysis: Significant Factors Causing Free Malignant Cells in Rectum During Radical Resection of Rectal Cancer

Objective　To analyze the risk factors inducing tumor cells exfoliating during radical resection of rectal cancer. Methods　Sixty patients who were diagnosed as rectal cancer from May 2006 to November 2007 and given radical operations were assigned prospectively in this study. Before cutting the rectal stump below the tumor, saline was instilled into rectum to irrigate the stump. Collected irrigating fluids were sent to pathology laboratory, and the exfoliated malignant cells were tested by HE （haematoxylin and eosin） dyeing and common smear technique. The results of examines were collected and statistical analysis, including a Logistic regression model, was performed. Results　Exfoliated malignant cells were found in 27 samples. By univariate analysis, the statistically significant factors defining a high risk of exfoliating were age, tumor size, TNM stage, operation time and operation method (Plt;0.05). Only TNM stage， operation time and operation method were confirmed by Logistic regression analysis to independently result in a statistically significant increased risk of exfoliating. Conclusion　Irrigating the rectal stump before cutting down the tumor is essential to avoid local recurrence. The effects of TNM stage, tumor size and operation time are important. Although the laparoscopic surgery is more predominant than conventional surgery for non-neoplasma technology, irrigating is an important process.

关节腔灌洗配合超声波导入依托芬那酯凝胶治疗膝关节骨关节炎的临床研究

目的　探讨关节腔灌洗配合超声波导入依托芬那酯凝胶治疗膝关节骨关节炎患者的临床疗效。 方法　将2011年11月－2012年7月收治的90例膝关节骨关节炎患者随机分为3组，观察组30例采用关节腔灌洗配合超声波导入依托芬那酯凝胶治疗，对照A组30例只采用关节腔灌洗治疗，对照B组30例采用关节腔灌洗配合外用依托芬那酯凝胶治疗。分别记录观察组与对照组患者的临床疗效并予以统计学分析。 结果　观察组患者的显效率明显高于对照组，两者之间的差异有统计学意义（P＜0.05）。 结论　采用关节腔灌洗配合超声波导入依托芬那酯凝胶治疗膝关节骨关节炎，取得良好的临床疗效。

局部肺叶灌洗治疗合并呼吸衰竭的重症肺泡蛋白沉积症三例并文献复习

目的探讨局部肺叶灌洗治疗合并呼吸衰竭的重症肺泡蛋白沉积症（pulmonary alveolar proteinosis，PAP）的可行性及安全性。方法回顾3例合并呼吸衰竭的PAP患者通过局部肺叶灌洗后逐渐自愈的诊治经过，并复习相关中外文献进行总结分析。结果3例患者均为男性，年龄50～55岁，有长期的粉尘、生物燃料或者消毒物质的密切接触史，以“咳嗽、呼吸困难”入院。入院时呼吸空气动脉血气分析均提示I型呼吸衰竭，胸部高分辨率CT（high-resolution computed tomography，HRCT）呈“铺路石征”；1例患者取支气管肺泡灌洗液、2例患者取支气管镜肺活检行过碘酸–雪夫染色结果均为阳性而确诊PAP。2例患者接受了1次局部肺叶灌洗，1例患者接受了2次局部肺叶灌洗，灌洗后1～5 d复查胸部HRCT与灌洗前相仿，但呼吸困难症状均较前明显改善，动脉血气分析提示呼吸衰竭纠正。出院后密切随诊1～6个月，患者均无呼吸困难复发，胸部HRCT提示双肺弥漫性斑片影几乎全部吸收。截止到2021年1月，在中国知网、维普、万方等数据库以“肺泡蛋白沉积症”和“支气管肺泡灌洗”为检索词，在PubMed数据库以“pulmonary alveolar proteinosis”和“lobar lavage”为关键词，共检索到相关中英文文献64篇，其中合并呼吸衰竭的重症PAP患者43例。大部分报道是利用反复、多次的局部肺叶灌洗，将双肺的所有肺叶逐一进行灌洗，最多者局部肺叶灌洗次数多达20次，时间跨度达4个月；一些研究是将局部肺叶、肺段灌洗作为“预洗”或者“桥梁”，改善临床症状后再进行全肺灌洗；一些研究对比了接受全肺灌洗或肺叶灌洗患者的治疗效果，认为两者疗效相仿，大部分患者仅需要1次灌洗，临床症状即有明显改善。结论肺叶局部灌洗治疗合并呼吸衰竭的重症PAP是安全有效的，同时在1～2次局部肺叶灌洗后，1～6个月随访PAP患者病情呈自愈倾向，短时间内反复、多次灌洗可能是不必要的。

Diagnostic value of soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid for Acinetobacter baumannii infection and colonization in the lungs

ObjectiveTo evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in bronchoalveolar lavage fluid (BALF) for discrimination of Acinetobacter baumannii (A. baumannii) colonization from infection.MethodsSixty patients with tracheal intubation or tracheotomy who were admitted in intensive care unit from July 2016 to July 2018, were divided into an infection group (n=20), a colonization group (n=20) and a control group (n=20). The serum and BALF samples were collected from the patients on the day when lower respiratory tract sample culture was positive so as to detect sTREM-1, serum procalcitonin (PCT) and interleukin-6 (IL-6). The value of serum PCT, IL-6, sTREM-1 and BALF sTREM-1 in differentiation of infection or colonization for A. baumannii was analyzed by mean of receiver operating characteristic (ROC) curve.ResultsThere were no significant differences in gender composition, age or Glasgow coma score among the three groups (P>0.05). The clinical pulmonary infection score (CPIS) of the infection group was higher than that in the control group (P<0.05). Compared with the control group, while the sTREM-1 concentration of BALF with A. baumannii colonization increased significantly but levels of PCT, IL-6 and sTREM-1 remained unchanged in serum. The levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.001). Compared with the colonization group, the levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.05). The area under the ROC curve (AUC) of serum PCT was 0.67 with the sensitivity of 0.55 and the specificity of 0.90 (95%CI 0.52 - 0.82). AUC of serum IL-6 was 0.72 with the sensitivity of 0.60 and the specificity of 0.95 (95%CI 0.58 - 0.85). AUC of serum sTREM-1 was 0.72 with the sensitivity of 0.75 and the specificity of 0.60 (95%CI 0.55 - 0.85). AUC of sTREM-1 in BALF was 0.92 with the sensitivity of 0.95 and the specificity of 0.70 (95%CI 0.79 - 0.98). The diagnostic accuracy of sTREM-1 in BALF was higher than that of PCT, IL-6 and sTREM-1 in serum (P<0.05).ConclusionssTREM-1 in BALF has good diagnostic performance in differentiating patients with infection of colonization for A. baumannii. Its sensitivity and specificity are higher than serum PCT, IL-6 and sTREM-1.

Selective Large Volume Broncholavage for Acute Exacerbation of Bronchiectasis by Bronchonscopy

ObjectiveTo evaluate the efficacy and safety of selective large volume broncholavage by bronchonscopy in treatment of patients with acute exacerbation of bronchiectasis. MethodsA single-center randomized control,non-blind clinical trial was conducted.A total of 65 patients were randomly divided into Group A(large volume broncholavage group,n=21),Group B (mini- large volume broncholavage group,n=22) and Group C (control group,n=22).All patients received routine therapy of acute exacerbation of bronchiectasis while additional broncholavage was administered in the treatment groups for only once.Warm normal saline solution was instilled for Group A at volume of 500 to 2 000 mL and for Group B at volume of 100 to 200 mL.The baseline characteristics,Simplified Clinical Pulmonary Infection Score(CPIS) and C-reactive protein (CRP) were recorded at the first and on 7th day.The duration of antibiotic use,the length of hospital stay and total effective rate were compared among three groups. ResultsThe lavage volume was (1 250.0±403.3)mL for Group A and (141.0±41.2)mL for Group B.The length of hospital stay and duration of antibiotic use were (8.4±1.0)d and (7.9±1.1)d respectively,shorter than those in Group B[(13.5±1.6)d,(11.6±2.4)d] and Group C[(15.3±3.2)d,(13.3±2.6)d] with significant difference between three groups(all P<0.05).The total effective rates was 95.23% in Group A,higher than those in Group B (81.82%) and Group C (68.19%)(all P<0.05).The CPIS on the 7th day of Group A was 1.9±1.4,lower than that in Group B (2.7±0.8) and Group C (3.7±0.9)(P<0.05).The CRP of Group A decreased more quickly than Group B and Group C.The adverse events occurred in Group A and Group B including transient hypoxemia (23.81%,9.09%, respectively),tarchycardia(100%,68.18%, respectively),airway mucosal injury(38.09%,13.64%, respectively) and elevated blood pressure (19.05%,13.64%, respectively). ConclusionSelective large volume broncholavage through bronchonscopy is an effective and safe treatment for patients with acute exacerbation or bronchiectasis.

Clinical practice guidelines of bronchoalveolar lavage: a methodological quality study

ObjectiveTo assess the methodological quality of guidelines for bronchoscopic alveolar lavage. MethodsCNKI, VIP, WanFang Data, CBM, Web of Science, PubMed, EMbase databases and medlive.cn, the National Guideline Clearinghouse (NGC), the National Guideline International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Clinical Excellence (NICE), and the World Health Organization (WHO) websites were electronically searched to collect guidelines of bronchoscopic alveolar lavage from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the guidelines by using AGREE Ⅱ tool. ResultsA total of 19 guidelines were included, with 5 from China, 5 from the USA, 3 from Europe, 2 from the UK, 1 from Australia, 1 from Israel, 1 from Spain, and 1 from India. The average standard score rates of the 19 guidelines in the six fields were 50.73% for scope and purpose, 20.02% for participants, 15.13% for formulation rigor, 36.40% for clarity of presentation, 3.51% for applicability, and 22.37% for editorial independence.ConclusionsThe quality of bronchoalveolar lavage guidelines remains relatively low.

特发性肺纤维化支气管肺泡灌洗后急性加重四例报告并文献复习

目的探讨支气管肺泡灌洗和特发性肺纤维化急性加重之间的联系。 方法收集2000年1月至2014年4月期间在中国医科大学附属第一医院呼吸内科住院并接受支气管肺泡灌洗的特发性肺纤维化患者, 对出现急性加重患者的临床特点进行分析总结。 结果在153例接受支气管肺泡灌洗的特发性肺纤维化患者中, 有4例发生急性加重。其中男3例, 女1例; 年龄均大于50岁; 吸烟者2例; 肺功能用力肺活量＜预计值的60%和/或肺一氧化碳弥散量＜预计值的50%;支气管肺泡灌洗液细胞分类中中性粒细胞比例升高。大剂量糖皮质激素冲击治疗仍作为治疗特发性肺纤维化急性加重的首选。 结论支气管肺泡灌洗可能诱发特发性肺纤维化急性加重, 激素冲击治疗有可能缓解特发性肺纤维化急性加重。