507例中叶和161例舌叶病变的纤维支气管镜检查和临床分析

目的了解中叶和舌叶纤维支气管镜下病变的特点，为诊断提供依据。方法对经纤维支气管镜检查的161例舌叶病变和507例中叶病变的临床症状、影像学及纤维支气管镜下异常表现进行回顾性分析。结果中叶和舌叶纤维支气管镜下异常病变发生率之比3．1：1，舌叶病变中肺癌居首位，胸片上具有团块影的肺癌征象仅占34．4％，纤维支气管镜检查示支气管壁异常改变和支气管腔内异常均以肺癌多见。中叶病变以肺炎多发，纤维支气管镜检查显示肺炎以支气管壁异常改变常见，肺癌以支气管腔内异常为主。结论舌叶肺癌在胸片和纤维支气管镜下常见的典型表现不明显，纤维支气管镜检查对中、舌叶病变的早期诊断及鉴别诊断有着重要意义。     

高分辨CT扫描对气管、支气管结核的诊断价值及临床意义

目的　探讨HRCT对气管、支气管结核的诊断价值及临床意义。方法 对32例诊断明确的气管、支气管结核住院患者行胸部HRCT扫描,结合纤维支气管镜检查,观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 气管、支气管壁病变检出率为73.9%,其中管壁轻度增厚54.3%,明显增厚19.6%;气道管腔形态改变检出率为67.4%,其中管腔狭窄<50%的41.3%,>50%的19.6%,管腔闭塞6.5%。同时观察到气管、支气管周围及纵隔淋巴结肿大7例,病变支气管远侧管腔内粘液栓12例,管腔局限性扩张5例,小叶性肺气肿18例,肺不张2例,肺内结核病灶39例。结论 HRCT检查观察气道病变部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

支气管镜介入冷冻治疗支气管结核

目的　探讨支气管镜下冷冻治疗支气管结核的疗效。方法 21例支气管结核患者常规抗结核化疗基础上,在支气管镜下行冷冻和镜下注药治疗并追踪观察。结果 21例支气管结核患者行支气管镜下冷冻和镜下注药治疗,平均治疗5±2次/例。18例溃疡坏死型和/或肉芽增殖型患者经治疗后,支气管黏膜光滑、管腔通畅,原有阻塞性肺炎、肺不张消退,症状消退或明显改善,仅3例患者支气管腔内遗留少量瘢痕组织,不影响通气功能。显效83.3%(15/18)、有效16.7%(3/18),总有效率100%(18/18)。而3例瘢痕型经多次冷冻治疗后,病变无变化,症状无改善。结论 肉芽增殖型和/或溃疡坏死型支气管结核采用支气管镜下介入冷冻治疗不仅能迅速缓解病人临床症状、促进病灶吸收,通畅呼吸道,还可有效地控制肉芽增生,避免瘢痕纤维组织形成的气道狭窄或闭锁等不良后果。但对于肉芽增生进入瘢痕纤维组织形成后,冷冻治疗则难以奏效。故对于支气管结核患者应争取尽早诊断、尽早治疗,纤支镜介入冷冻治疗支气管结核是一种无明显并发症和不良反应,安全有效的方法。     

支气管结核微波介入治疗的临床研究

目的　观察微波介入治疗支气管结核的有效性和安全性。方法 92例住院支气管结核患者随机分成治疗组、对照组。治疗组应用微波介入治疗;对照组予局部药物注入治疗。结果 治疗组9月后痰菌阴转率及肺不张治愈率均达到100%,X线胸片病灶有效率88.1%,电子支气管镜复查病变支气管总有效率85.7%,明显高于对照组,疗效较好。结论 通过电子支气管镜微波介入治疗支气管结核是一种安全、有效的方法。     

支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的价值

目的 探讨支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的应用价值。 方法 回顾性分析2015年11月至2017年12月解放军总医院第八医学中心全军结核病研究所确诊的全部气管支气管结核所致中叶综合征118例患者的临床资料,根据是否接受支气管镜介入治疗分为观察组(82例)和对照组(36例),对118例患者的临床症状、影像学表现、支气管镜下表现、气促评级、治疗效果进行对比分析。 结果 观察组和对照组患者出院后6个月时的气促评级分别为(0.74±0.12)和(1.36±0.07),差异有统计学意义(t=2.791,P=0.006)。观察组患者治疗后的总有效率为80.5%(66/82),对照组患者治疗后的总有效率为61.1%(22/36),两组患者治疗疗效比较差异有统计学意义(χ ²=12.743,P=0.002)。 结论 支气管镜介入技术可提高气管支气管结核所致中叶综合征治疗的有效率,是治疗气管支气管结核所致中叶综合征的重要手段。     

纤维支气管镜在肺部疾病诊断和治疗中的价值

<正>纤维支气管镜1967年首次应用于临床。进入20世纪80年代以来,随着现代光学、医用电子、医学影像及生物材料等技术的迅猛发展,纤维支气管镜也取得了长足的发展,在肺部疾病的诊断和治疗中发挥了越来越重要的作用。一、纤维支气管镜在肺部疾病诊断中的价值肺癌是最常见的肺部疾病之一,经纤维支气管镜灌洗、刷检、活检是诊断肺癌最重要的方法。对于部分紧邻支气管壁的腔外病变或淋巴结病变,可通过经支气管针吸活检(transbronchial needle     

1422例荧光支气管镜检查结果回顾性分析

目的探讨和评价荧光支气管镜在肺部疾病尤其是肺癌及支气管结核诊断中的价值。方法选择第四军医大学唐都医院呼吸内科2010年3月至9月支气管镜室使用荧光支气管镜检查的1422例临床资料,其中男性863例（60．69％）,女性559例（39．31％）;年龄最大86岁,最小4岁,平均57．84岁。分析了1422例荧光支气管镜检查的镜下及病理活检结果。结果支气管镜下白光与荧光均呈明显异常改变者,病理活检结果包括恶性病变,支气管结核、肉芽肿病变等改变;白光下异常,荧光镜下正常者,活检未发现1例恶性病变。白光下正常（包括黏膜轻度充血、肿胀者）而荧光镜下异常者,活检发现中一重度不典型增生1例;结论荧光支气管镜对于气管内明显可见并怀疑恶性病变的诊断价值不大,但黏膜荧光改变的程度可能有助于良、恶性病变的镜下鉴别。     

240例肺不张原因及临床治疗分析

目的　探讨肺不张形成原因及临床治疗方法。方法 回顾性总结 2 4 0例肺不张病例 ,分析形成原因、不同疾病肺不张的好发部位、分布及治疗方法。结果 肺不张形成的疾病以结核(6 0 .8% )、肿瘤 (16 .6 % )、炎症 (12 .1% )多见 ,支气管镜对结核、炎症肺不张有较好治疗作用。结论 CT及支气管镜检查是了解不张病因的重要方法 ,应注重基础治疗如鼓励病人咳嗽、翻身拍背、超声雾化、反复吸痰和纤维支气管镜检查等。     

纤维支气管镜诊断小儿支原体肺炎的价值

目的探讨纤维支气管镜诊断小儿支原体肺炎的应用价值。方法对我院收治的170例小儿支原体肺炎患儿的临床资料进行分析。结果 138例(81.18%)支原体肺炎患儿单份血清特异性MP-IgM抗体滴度大于1∶160。151例(88.82%)患儿MP-DNA检测阳性。支气管肺泡灌洗液细菌培养得阳性菌株共23株。170例支原体肺炎患儿均进行纤维支气管镜检查,在镜下均可见支气管内膜炎症表现,病变部位可有黏膜充血水肿并附着分泌物,45例(26.47%)患儿支气管开口处可见痰堵,患儿通气不畅,24例(14.12%)患儿管腔内可见黄脓性痰栓,18例(10.59%)患儿支气管开口出现炎性狭窄,14例(8.24%)患儿支气管分支开口异常,11例(6.47%)患儿管壁黏膜呈现小结节样突起。结论对小儿支原体肺炎早期应用纤维支气管镜检查,提高诊断效率,治疗预后有重要意义。     

纤维支气管镜检查对肺弥漫性疾病的诊断价值

目的　了解纤维支气管镜(FB)检查对肺弥漫性病变的临床诊断价值。方法 总结1993～1999年间,经痰细胞学及细菌学检查均为阴性的肺部弥漫性病变86例行FB,并做活检、灌洗及刷片检查。结果 FB总的阳性率87.2%,镜下直视有病变51例,占59.4%。活检、灌洗液及刷检阳性率分别为69.2%、55.6%和30.8%。确诊肺癌38例中,支气管内新生物及肺活检阳性率分别为100%和84.2%,支气管肺泡灌洗液阳性率仅27.3%。在25例肺结核中,FB总的活检阳性率85.7%,而FB刷检和培养阳性率低16.2%。支气管镜肺活检的阳性率不因取活检次数的增加而增加。结论 FB,特别是活检是一种安全有效简便的方法,对肺弥漫性病变诊断率高,副作用小。     

Spontaneous coughing up of a polyp

We report the case of an 18-year old female with right lower lobe atelectasis, who was admitted to our hospital because of a nonproductive cough. She underwent fiberoptic bronchoscopy that revealed a peduncular polyp in the right truncus intermedius or middle bronchus. Before admission for laser polypectomy, she spontaneously coughed up the tissue mass, and the right lower lobe atelectasis disappeared. We report a rare case of 'autopolypectomy' of a bronchial adenoma.     

A case of endobronchial tuberculosis associated with bronchial asthma treated with high doses of inhaled corticosteroid]

A 46-year-old woman had been treated with 1,600-2,000 micrograms/day of beclomethasone dipropionate (BDP) and oral theophylline on the basis of a diagnosis of bronchial asthma in 1993. Eosinophilic pneumonia was diagnosed in June 1999, and she was then treated with 40 mg/day of oral prednisolone (PSL), which was gradually tapered off, and then stopped in October 1999. She was referred to our hospital because acid-fast bacilli were found in the sputum on January 18, 2000. Her chest radiographs and CT scans showed partial atelectasis of the right upper lobe, and fiberoptic bronchoscopy revealed bronchial inflammatory changes and whitish mucosal nodular lesions in the walls of the lower trachea, the right main bronchus and the orifice of the right upper lobe bronchus. She was found to have endobronchial tuberculosis. Anti-tuberculosis treatment with isoniazid, rifampicin, streptomycin and pyrazinamide was started. Serum levels of interferon-gamma were markedly elevated on admission. Asthma symptoms improved for a period of one month after the beginning of anti-tuberculosis treatment, despite the termination of inhaled corticosteroid. However, as the tuberculosis improved, the frequency and severity of the asthma increased and so corticosteroid inhalation was started again. Four months after administration of the anti-tuberculosis drug, fiberoptic bronchoscopy revealed that the endobronchial lesions had improved without any stenosis or constrictive changes. It was speculated that high doses of inhaled corticosteroid may have the potential to cause endobronchial tuberculosis whilst, ironically, at the same time preventing bronchial stenosis by endobronchial tuberculosis. This is an interesting case in which the asthma symptoms first decreased during the acute phase of endobronchial tuberculosis and then increased again after the tuberculosis improved.     

Coexisting bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe: a case report

The synchronous occurrence of pulmonary tuberculosis and bronchial carcinoid tumor is unusual. Although pulmonary tuberculosis can coexist with all histological types of lung cancer, few coexisting cases of bronchial carcinoid tumor and pulmonary tuberculosis have been reported. We present coexistent bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe. A 39-year-old woman was admitted to our clinic with chest pain for two months. Chest radiograph showed consolidation in the right lower field. Computed tomography of the thorax demonstrated multiple mediastinal lymphadenopathies, infiltration and atelectasis in the right lower lobe. Fiberoptic bronchoscopy showed a mass lesion totally obstructing the proximal right lower lobe bronchus. The pathological diagnosis was typical carcinoid tumor. Right lower lobectomy with mediastinal lymph node dissection was performed. The pathological examination of resected material revealed coexistent tuberculosis and carcinoid tumor in the same lobe and mediastinal tuberculous lymphadenitis.     

支气管色素沉着纤维化的临床特征研究

目的:研究支气管色素沉着纤维化(BAF)患者的临床特征。方法:选取经电子支气管镜检查确诊的支气管色素沉着纤维化病例70例,回顾性分析、总结其肺部高分辨CT、支气管镜镜检、刷检细胞学及活检病理等改变。其中有53例进行了肺功能检查,将其设为实验组,另随机抽取53例非BAF患者为对照组行肺功能检查,比较2组间第1秒钟用力呼气量(FEV_1%)、用力肺活量(FVC%)、第1秒率(FEV_1/FVC%)的不同。结果:支气管镜镜检示管腔扭曲、变形20例,闭塞20例,裂隙样狭窄17例,环形狭窄3例;管腔黏膜类肿瘤样增生3例,肥厚、水肿39例,肉芽肿样改变2例,丘状隆起8例,瘢痕样改变8例、坏死物5例,干酪样坏死物7例;管腔狭窄:左主支气管2例,右主支气管1例;左肺上叶支气管(8例),右肺中叶支气管(22例)及上叶支气管(14例);左、右肺上叶尖后段支气管狭窄多见;其中多叶段管腔狭窄16例。肺部高分辩CT(HRCT):肺间质改变15例,胸腔积液12例,胸膜增厚、粘连10例。肺结核25例,右肺中叶不张27例,右肺上叶不张5例,左肺上叶狭窄并肺不张18例,右肺下叶肺不张2例,左肺上叶上支狭窄1例,增殖、纤维化改变38例,肺部小结节影12例,陈旧性肺结核9例,斑片状阴影4例;纵膈淋巴结增大并钙化20例,肺门淋巴结增大并钙化10例,肺门淋巴结增大10例;BAF组FEV_1%、FVC%、FEV_1/FVC%均低于正常参考值;BAF组FEV_1%、FVC%、FEV_1/FVC%均低于非BAF组(P0.01或P0.05)。慢性黏膜炎20例,玻璃样变2例,尘细胞沉积1例,碳末沉积3例,纤维素渗出4例,间质纤维组织增生4例,干酪样坏死4例,局灶上皮鳞化3例,淀粉样变性1例;T-spot T.B试验阳性20例,PPD试验阳性16例。结论:BAF的支气管镜镜检、病理改变、肺部高分辨CT、肺功能都具有一定特征性改变,与肺结核、慢性阻塞性肺疾病有相关性。     

Abscess of residual lobe after pulmonary resection for lung cancer

Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.     

电子支气管镜下联合取材病理诊断肺癌120例分析

目的探讨电子支气管镜在肺癌诊断中的作用。方法对我院收治的120例肺癌患者行电子支气管镜检查,通过电子支气管镜活检、刷检、术后痰涂片行细胞学检查或病理进行分析。结果病变部位以左肺上叶多见,其次为右肺上叶,左肺下叶、右肺下叶次之。确诊的多为中央型肺癌,肺癌病理类型以鳞癌为主,其次为腺癌,小细胞癌最少。结论经电子支气管镜下联合取材病理诊断肺癌中央型肺癌居多,鳞癌比例最高;肺癌病变部位好发于左右肺上叶;电子支气管镜下联合取材病理诊断肺癌,对提高肺癌诊断率有一定的帮助。     

电磁导航支气管镜联合径向超声对肺外周病变的诊断价值

目的 探讨电磁导航支气管镜(ENB)联合径向超声(EBUS)对肺外周病变的诊断价值.方法 纳入2018年1月至2019年7月就诊唐都医院呼吸科的肺外周病变32例,筛除最终诊断不明确的和未探及活检的6例,对比入选26例诊断率及确诊病例临床特征分层关系和未确诊病例临床特征.结果 ENB+EBUS确诊17例,诊断率65.4％...     

Fiber-optic bronchoscope and detection of lung cancer: a five year study

White light bronchoscopy [WLB] has been used for identification and localization of intra-epithelial pre-neoplastic and neoplastic lesions within the bronchus. Aim of the study was to evaluate the uses of WLB to detect and localize the precancerous and cancerous lesions, and in addition to analyze morphologic presentation, and association to histological type and the variation between genders.A total of 4983 patients were examined by WLB from 2004 to 2009 in a local tertiary teaching hospital. The following parameters were collected: morphological presentation, biopsy sites, histology. The patients' records of age, sex, smoking status, blood-gas, X-RAY/CT, CBC, ECG, PT, and APTT were obtained for analysis. Differences between the patients groups were analyzed using Chi square test.1489 patients who had hyperplasia or neoplasic lesions were further confirmed as having lung cancer pathologically. Lung cancer was more commonly found in the right lung (51.58% vs 42.82%). The upper lobe was more frequently found to have lesions (44.17% vs 22.42%) than the lower lobe. Male patients with squamous cell carcinoma showed more commonly upper lobe involvement, while left main bronchus was more commonly involved in female patients. Adenocarcinoma was mostly involved in lesions of the upper lobe. Proliferative type was found in 80.15% of squamous cell carcinoma cases and in 76.16 % of small cell carcinoma cases.Fiberoptic bronchoscopy is an effective method for the detection of preinvasive neoplasic lesions. The morphological presentation is associated to histological type. There is variation in presentation and histology of cancerous lung lesion between the genders.     

老年肺癌患者的支气管镜表现及临床特点分析

目的 观察老年肺癌患者临床特点及支气管镜表现.方法 分析182例经支气管镜检查确诊肺癌的老年患者（＆gt;60岁）的临床特点及支气管镜下表现、病灶部位、病理学分型等.结果 老年肺癌男女患病比例为3.79：1;病灶主要在右上叶支气管（31.87%）及左上叶支气管（23.08%）;增生型肺癌多见（65.93%）,其中鳞癌最多（65.83%）;其次是浸润型（21.43%）.结论 老年肺癌患者男性发病率高于女性,支气管镜可准确判断病灶部位、病理学类型,在肺癌临床诊治中具有重要价值.