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1.
目的:探讨电子支气管镜在中央型肺癌诊断中的价值。方法:对1717例中央型肺癌作电子支气管镜检查及结果分析。结果:该组病例以老年人多见,肿瘤多位于叶支气管,右肺58.5%,左肺41.5%,病理类型为鳞癌50.4%,小细胞癌24.6%,腺癌12.3%.低分化癌11.3%,腺鳞癌0.8%。电子支气管镜下主要特征:鳞癌和低分化癌以管内增殖型改变为主.小细胞癌和腺癌以浸润型为主。结论:电子支气管镜检查对中央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。  相似文献   

2.
中央型肺癌纤维支气管镜检查分析   总被引:1,自引:0,他引:1  
对423例中央型肺癌作纤维支气管镜检查,结果显示:该组病例以中年人多见,占56%。肿瘤多位于叶支气管占76.8%,右肺55.3%,左肺41.4%,气管隆突癌3.3%。病理类型为鳞癌52.2%,低分化癌19.8%,腺癌13%,小细胞癌10.7%。纤维支气管镜下主要特征:鳞癌和低分化癌以管内增殖型改变为主,小细胞癌和腺癌以浸润型为主。  相似文献   

3.
921例经支气管镜确诊肺癌的临床特点分析   总被引:8,自引:4,他引:4  
目的 对921例经支气管镜确诊肺癌的临床特点进行分析。方法 采用常规支气管镜检查,镜下直视、盲目活检组织病理检查和刷检细胞学检查的方法,确定诊断和病理类型。结果 肺癌的发病率在40岁以下显著增加,50-69岁为发病高峰,70岁以下开始下降。921例肺癌中,鳞癌占38.5%,腺癌和低分化癌分别占27.4%和21.9%,小细胞癌占8.7%,其他占3.5%。男性鳞癌的发病率最高,女性腺癌发病率最高。结论 50-69岁是肺癌的高发年龄段,发病率最高的是鳞癌,其次是腺癌、低分化癌和小细胞癌。男女性别的病理类型分布有差别。重视支气管镜检查和提高活检技术,可显著提高诊断率。为临床治疗提供依据。  相似文献   

4.
陈丽萍  杨晓红  陈颖  邬超 《华西医学》2009,(9):2328-2330
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。  相似文献   

5.
196例老年人肺癌纤维支气管镜检查分析   总被引:2,自引:0,他引:2  
目的 探讨老年肺癌纤维支气管镜下的特点,评价老年肺癌患者纤维支气管镜检查的诊断价值及安全性。方法回顾性分析196例60岁以上老年肺癌临床特点和纤维支气管镜下改变。结果该组老年肺癌病理组织学明确者129例中鳞癌居首位(73.6%).其次为小细胞癌(8.5%)和腺癌(5.4%):纤维支气管镜下以直接征象为主(87.2%),间接征象占12.2%.病变部位右肺多于左肺。双上叶最常见;刷检细胞学诊断阳性率77.0%(151/196),病理组织学诊断阳性率为83.2%(129/155)。X线表现以肺部团块影为主,占69.9%(137/196)。结论纤维支气管镜检查是诊断老年肺癌安全而可靠的重要手段。  相似文献   

6.
熊亮  陶晓南 《中国内镜杂志》2005,11(11):1121-1124
目的探讨纤维支气管镜诊断青年肺癌的临床特点以及组织学类型与年龄段、性别、部位和镜下表现间的关系。方法对104例40岁以下青年肺癌纤维支气管镜检查资料进行回顾性分析。结果男女比例为1.6/1.0,女性比例较中老年患者高(P〈0.005)。组织学分型明确的88例中鳞癌居首位39.8%,其次为小细胞癌26.1%和腺癌22.7%;104例青年肺癌镜下改变以直接征象为主(75.0%),间接征象占25.0%,鳞癌多呈菜花样新生物,小细胞癌主要呈息肉样新生物和浸润性改变,腺癌则以息肉样新生物和外压及充血水肿兼有为主。病变部位在左右肺的发生率无明显区别(P〉0.05),但鳞癌多发于右肺(P〈0.005)。结论纤维支气管镜检查是诊断青年肺癌的重要手段,提高对青年肺癌认识和警惕,借助纤维支气管镜检查有助于早期诊断。  相似文献   

7.
323例肺癌临床特点及纤维支气管镜检查结果分析   总被引:3,自引:3,他引:3  
目的:进一步探讨纤维支气管镜在肺癌诊断及治疗中的作用。方法:对1993年1月-1999年12月经纤维支气管镜检查下活检或刷检并经病理或细胞学诊断为肺癌的323例患者进行临床特点及结果分析。结果:管内增生型占45.8%,管壁浸润型25.7%,增生伴浸润型占2.2%,管外压迫型占1.5%,正常型占24.8%;经病理检查证实,管内增生型及管壁浸润型均以鳞癌多见,分别占79.1%及56.6%,而正常型以腺癌稍多,占45.0%,其次为鳞癌,占30.0%。与手术病理检查符合率为85.5%(218/255)。结论:纤维支气管镜检查对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。  相似文献   

8.
目的探讨电子支气管镜替代胸腔镜检查对胸腔积液的诊断价值。方法对56例不明原因胸腔积液患者的电子支气管镜检查结果进行分析。结果56例胸腔积液中,结核32例、间皮瘤2例、腺癌8例、鳞癌3例、低分化癌3例、乳腺癌胸膜转移2例、未明确病因6例,阳性率89%。结论电子支气管镜替代胸腔镜进行胸膜活检术操作简单、安全。  相似文献   

9.
151例老年人肺癌纤维支气管镜检查的临床与病理分析   总被引:7,自引:3,他引:7  
目的观察老年肺癌患者纤维支气管镜检查时镜下表现,病理类型,评价纤维支气管镜检查对老年肺癌的诊断价值及安全性。方法对151例老年肺癌患者纤维支气管镜检查,分析镜下表现,并在直视下获取组织标本进行病理学检查:结果151例老年肺癌镜下表现为管内增殖型91例,管壁浸润型40例,非特异性改变20例;病理分型为:鳞癌95例,小细胞未分化癌28例,腺癌15例,肺泡细胞癌9例,腺鳞癌4例。结论纤维支气管镜检查对老年肺癌的诊断有重要的临床价值,相对安全。  相似文献   

10.
经纤维支气管镜确诊的567例中心性肺癌分析   总被引:13,自引:7,他引:6  
对经纤维支气管镜确诊的567例中心性肺癌分析如下:病变分布于双肺,以左侧偏多,占50.8%,右侧为47.4%,气管隆突部位占1.8%;镜下可见病变以肿块和浸润性生长者占多数,病理类型中鳞癌最多,占46.7%,小细胞未分化癌次之,占34.2%,腺癌占17.5%;该组肺癌患者以男性居多、占81.7%,女性占18.3%,男性患者中鳞癌占多数,共258例,占男性患者的55.8%,其次为小细胞未分化癌,占31.1%;女性患者以小细胞未分化癌和腺癌为主,分别占女性患者的45.2%和32.7%,40-69岁之间的肺癌高发年龄,占患者总数的82.4%,鳞癌患者年龄偏高,以50-60岁居多,占鳞癌总数的72.2%,小细胞未分化癌患者年龄偏低,39岁以下者共29例,占该年龄段肺癌总数的63.0%。  相似文献   

11.
This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.  相似文献   

12.
目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高<20%视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P<0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P<0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P<0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.  相似文献   

13.
The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.  相似文献   

14.
15.
Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.  相似文献   

16.
目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4%(55/72)]明显高于成功组[31.7%(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3%(42/72)]高于成功组[38.1% (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9% (28/72)]高于成功组[23.8%(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大<6 cm、胎头位于坐骨棘上及宫口开大8~10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1%(44/72)]高于成功组[38.9%(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2%(52/72)]明显高于成功组[34.1 %(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.  相似文献   

17.
18.
Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.  相似文献   

19.
ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.  相似文献   

20.
ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.  相似文献   

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