Bronchoscopic Nd-YAG laser surgery for tracheobronchial mucoepidermoid carcinoma--a report of two cases

Mucoepidermoid carcinoma (MEC) of the tracheobronchial tree represents 0.2% of all lung tumours. It arises from the excretory ducts of the bronchial mucosa and is classified into low- and high-grade tumours using criteria derived from similar tumours of the major salivary glands. Low-grade MEC behaves in a benign fashion with less parenchymal and hilar lymph nodal invasion. The traditional method of treatment is by thoracotomy. The bronchoscopic approach to this lesion using lasers has rarely been reported. This article reports two cases of low-grade tracheobronchial MEC, which were both managed through bronchoscopic neodymium yttrium aluminium garnet (Nd-YAG) laser surgery. The patients were free from disease, 26 and 36 months after surgery. Bronchoscopic laser surgery promises to be an effective alternative treatment modality for tracheobronchial MEC. It is minimally invasive, results in less hospital stay and does not impair pulmonary functions.     

Nd-YAG laser therapy for tracheobronchial disorders

The neodymium-yttrium aluminum garnet (Nd-YAG) laser has demonstrated its effectiveness in treatment of a number of benign and malignant tracheobronchial disorders. This laser has many advantages over past methods of endobronchial therapy, such as cryosurgery and electrocautery. It is a precise, no-touch method that produces little pain during therapy and little or no edema or infection afterward. Since the laser is a form of nonionizing radiation, therapy may be repeated as often as needed. Unlike the carbon dioxide laser, the Nd-YAG laser may be used with standard flexible endoscopes. Currently, the commonest indication for Nd-YAG laser therapy is obstruction of a large airway by an inoperable neoplasm. Whether this technique can be applied more widely in management of early lung cancer, possibly in combination with radiotherapy, chemotherapy, or surgery, will be determined by further study.     

纤维支气管镜引导下微波组织凝固治疗骨化性气管支气管病1例

1 临床资料患者男性,24岁,教师。以反复咳漱、咳痰1.5年于2003年5月8日来我院就诊。1年半前患者因受凉后开始反复咳漱、咳痰,痰有白黏痰和黄脓痰,痰中带血,多次在外院拍胸片示“正常”,间断抗感染治疗(具体不详),症状时轻时重。病程中无胸痛、气促,无发热、盗汗。既往身体健康。体检:体温36.2℃,脉搏70次/min,呼吸18次/min,血压100/70 mmHg,双肺呼吸音粗糙,无罗音,心、腹无异常。胸部螺旋CT示气管壁可见点状钙化影突入管腔。纤维支气管镜(纤支镜)检查示气管中下段、左右主支气管、右上叶、中叶支气管可见多发大小不等钟乳石样结节突入管…     

多层螺旋CT对儿童气管、支气管异物的诊断价值

目的:探讨多层螺旋CT对儿童气管、支气管异物的诊断价值。方法:20例气管、支气管异物病例行多层螺旋CT检查,结合后处理重建图像分析,全部病例经纤维支气管镜或临床证实。结果:1例位于气管;19例位于支气管,异物有瓜子、花生米碎片18例;小虾及塑料管各1例。结论:多平面重建、CT仿真支气管镜、表面遮盖显示、最小密度投影、容积再现能显示气管、支气管异物的位置、形态、异物与支气管粘膜的关系等。     

小儿气管支气管异物取出术的术中配合及护理

目的探讨无麻醉下经硬质支气管镜小儿气管异物取出术的手术配合和护理要点。方法总结113例小儿气管异物取出术的配合过程。结果 113例手术配合均获成功。结论手术室护士必须做到熟悉手术程序和步骤,及时充分准备用物,掌握特殊物品的使用,术中密切注意患儿的动脉氧饱和度,为手术成功提供保障。     

Indications and contraindications for plasma substitutes in surgery

The indication for the infusion of plasma substitutes has been considerably limited as the result of a series of grave incidents. Prior to each application, differential-therapeutic deliberations must decide on the choice of plasma substitute bringing about the desired success in accordance with its physico-chemical characteristics and clinical values. The type and severity of a probable anaphylactoid incident and its therapy should also be considered.     

General anesthesia and ventilation of the lungs in endoscopic surgery of tumors of the larynx, trachea and bronchi]

Clinical study was carried out during 116 total anesthesias for endoscopic operations on the larynx, trachea, and bronchi. Multicomponent total anesthesia was based on fentanyl, calypsol, diprivane, and dormicum microdoses in combination with local lidocaine anesthesia of the airways and premedication with nonsteroid antiinflammatory drugs. Interventions on the larynx and proximal part of the trachea were carried out with the patients' spontaneous respiration retained; during interventions on the middle part of the trachea, forced ventilation of the lungs (FVL) was carried out through an intubation bronchoscope; and during total anesthesia for operations on the tracheal bifurcation, high-frequency FVL of the intact lung was carried out. Stable hemodynamics and gas exchange, hypercapnia, and moderate respiratory acidosis were observed in patients operated on under both types of FVL. No serious complications during and immediately after surgery and anesthesia were observed. Hence, the choice of the method of total anesthesia and ventilation of the lungs in endoscopic interventions on the airways depends on the level of lesions and degree of airway obstruction.     

A new instrument for pulmonary resection: the bipolar Nd-YAG laser dissector

A bipolar Nd-YAG laser dissector was developed to quickly dissect or resect organs, and the possibility of laser pulmonary dissection without scissors and ligation threads was studied experimentally. Pulmonary tissue was completely and easily divided using a bipolar laser handpiece, and the dissected edge was perfectly sealed. Leakage of air and blood from the edge was not induced and no additional stitching was required. Histological examination of the dissected edge revealed tissue remodeling after laser irradiation. The formation of amorphous layers, including vacuoles, was peculiar to the fusion-coagulation area, and alveolar atelectasis and capillary obstructions were characteristic of the degenerative area. When tissue dissection was performed by laser vaporazation, tissue remodeling seemed to be the most important factor in the prevention of leakage. In conclusion, we can effectively and quickly resect pulmonary tissue using the bipolar Nd-YAG laser dissector without scissors and without ligation threads.     

Indications for surgery for morbid obesity and effectiveness of bariatric surgery

In this paper we describe a history and technical aspects of bariatric surgery. And surgical techniques of Divided Vertical Banded Gastroplasty and perioperative management are presented. Our indications for surgery for morbid obesity are almost equal to the guidelines for obesity surgery adopted by the American Society for Bariatric Surgery October 1986. From 1982 to 2000, 64 bariatric surgical procedures were performed at the author's institution. Vertical banded gastroplasty was performed in 45 patients, Horizontal gastric partitioning in 8 patients, Gastric bypass in 10 patients, and Divided vertical banded gastroplasty in 1 patient. The average weight loss one year after Vertical banded gastroplasty is 1/3 of the patient weight. Most of the preexisting comorbid conditions related to the obesity showed improvement or were completely resolved after surgery. No major complications were observed postoperatively. We concluded that surgical procedures for morbid obesity are very effective therapy.     

Indications and complications of percutaneous endoscopic gastrostomy

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) plays an important role in maintaining enteral nutrition in patients with swallowing disorders of different etiologies. The aim of our study was to record indications and complications of PEG-placement in a one-year period. METHODS: All patients were investigated prospectively regarding indications, wound infections, other complications and mortality between 1999-10-01 and 2000-09-30. The exit site was examined daily, after 30 days a follow-up by telephone was carried out. RESULTS: The PEG-procedure was performed in 93 patients, one patient received a percutaneous endoscopic jejunostomy. The mean age of the patients was 65.4 years (range 7 months--92 years). The most frequent indications were neurological diseases (n = 61, 65%). 21 patients had a PEG-placement because of malignancies (22%), 9 patients following brain injury (10%) and 3 patients (3%) due to other benign swallowing disorders. 63 patients (67%) had no complications, 28 patients (30%) had wound infections, and in two patients hemorrhage was observed (small hematoma requiring no further intervention). One patient had laparotomy because of suspected perforation--however, laparotomy was negative. In 7 patients (7%) wound infections (n = 28) were mild and needed only local or no therapy. In 18 patients (19%) we found a relevant infection that required systemic antibiotic therapy. 2 patients had serious local infections that caused further interventions. One patient died from sepsis caused by wound infection. Patients receiving antibiotic therapy at the time of PEG-placement suffered from wound infections in 25%. Patients with malignant diseases more often had wound infections. 8 patients died after 7 days and 19 patients after 30 days (8% and 19%, respectively) from their underlying disease. CONCLUSIONS: PEG is regarded as a small intervention with low morbidity and mortality. However, our analysis of daily practice shows a remarkable rate of complications. The high mortality in our study reflects the seriousness of the comorbidities. Antibiotic therapy failed to prevent wound infection in 25% of our patients.     

Management of non-neoplastic stenoses of the GI-tract--a further indication for Nd-YAG laser application

Four non-tumoral stenoses - 2 peptic in the esophagus, and 2 postoperative in the rectosigmoid colon - have been successfully treated with Nd YAG laser without any complications. This new therapeutic technique represents a new approach to curative management and is basically capable of replacing surgical treatment.     

人工晶体光学性能与Nd-YAG激光损伤的影响***

背景：临床上解决后发性白内障的主要方法是Nd-YAG激光后囊膜切开治疗，但治疗中损伤人工晶体的事件时有发生。
　　目的：以实验室测试为基础，研究Nd-YAG激光损伤对人工晶体光学性能的影响。
　　方法：以10枚疏水性丙烯酸酯人工晶体为试验样品，Nd-YAG激光单脉冲能量5.0 mJ，在每个试验样品后表面直径3 mm中心区域内进行50个单脉冲激光射击，激光射击后的试验样品在扫描电镜下观察其损伤形状，光学分析仪测试其平均光焦度和光焦度分布变化。
　　结果与结论：扫描电镜在放大40倍和1000倍的条件下进行观察，人工晶体后表面出现近圆形凹陷，直径在50μm左右，凹陷周边有一圈突起。人工晶体光学分析仪测试结果显示，激光损伤后人工晶体平均光焦度变化不大，但光焦度分布发生了明显变化，直径3 mm中心区域内光焦度分布出现以近圆形损伤凹陷为中心，向周围放射状的环状分布。Nd-YAG 激光损伤对人工晶体平均光焦度影响很小，但对人工晶体光焦度分布有较大影响。