经纤维支气管镜冷冻治疗中、晚期中心型肺癌致气道梗阻的疗效

目的探讨经纤维支气管镜冷冻治疗中、晚期中心型肺癌的疗效。方法经纤维支气管镜用液态CO2对31例不适合常规开胸手术的中、晚期中心型肺癌患者进行冷冻治疗,并与治疗前比较,以观察其疗效。操作方法：将冷冻探针经支气管镜活检孔插入,置于肿瘤中心或边缘,冷冻约30～120s,冷冻温度-50～-70℃,在其探针顶端形成的冰球未完全溶解前“撕脱”切除肿瘤,反复多次操作直至管腔再通。结果经1～6次（平均2.5次）治疗,症状缓解率：咳嗽74%（23/31）、咯血87%（27/31）、呼吸困难87%（27/31）,胸痛58%（18/31）。显效61%（19/31）,有效39%（12/31）。肺功能改善：第一秒用力呼气容积（FEV1）从（1.21±0.22）L提高到（1.72±0.35）L（t=21.843,P=0.001）,用力肺活量（FVC）从（1.86±0.31）L提高到（2.26±0.43）L（t=33.703,P=0.001）。结论经纤维支气管镜冷冻治疗能使管腔得以重新疏通,使阻塞性肺炎得到控制,呼吸困难和咯血得到改善,生活质量明显提高,是一种简便有效的微创治疗方法。     

支气管镜介导下冷冻治疗中央型支气管肺癌

目的 探讨应用纤维支气管镜引导冷冻治疗中央型支气管肺癌的疗效。方法 经纤维支气管镜对92例中央型肺癌进行冷冻治疗并与治疗前比较，以观察其疗效。结果 完全缓解者5l例(占55．4％)，部分缓解者3l例(占37．7％)，总有效率93．1％。所有患者咳嗽、咯血、呼吸困难均有不同程度缓解。结论 内镜下冷冻治疗管腔内生长的中央型支气管肺癌，能使瘤体缩小，管腔得以重新疏通，使阻塞性肺炎得到控制，呼吸困难和咯血得到改善．生活质量明显提高，但总体上对生存率无明显改善。     

肺移植治疗肺弥漫性病变的疗效观察(附37例报告)

目的 观察肺移植治疗肺弥漫性病变的临床效果.方法 2002年9月至2009年4月,共对72例患者进行了肺移植,其中肺弥漫性病变患者37例.37例中,男性30例,女性7例,年龄(52.9±13.2)岁;原发病包括特发性肺间质纤维化30例,矽肺4例,肺淋巴管平滑肌瘤病2例,弥漫性泛细支气管炎1例.术前和术后常规监测肺功能,采用心脏超声检测肺动脉收缩压,并通过动脉血气分析计算氧合指数(氧分压/吸入氧浓度).观察和比较受者移植前后各项肺功能检测指标的变化.结果 术后1周,受者的肺动脉收缩压较术前有明显下降,从(54.30±17.41)mm Hg(1 mm Hg=0.133 kPa)降至(41.52±9.36)mm Hg(P＜0.05),氧合指数明显改善,从185.89±77.25上升至392.12±98.23(P＜0.05).术后1个月时,肺功能较术前明显改善,用力肺活量(FVC)由术前的(1.52±0.71)L上升至(2.26±0.64)L;第1秒用力呼气量(FEVl)由术前的(1.33±0.64)L上升至(1.81±0.57)L;一氧化碳弥散量由术前的(2.87±1.26)L上升至(4.22±2.05)L;各项检测值与术前比较,差异均有统计学意义(P＜0.05).结论 肺移植是治疗肺弥漫性病变的有效方法,可明显提高患者的存活率和生存质量.     

慢性阻塞性肺疾病合并非小细胞肺癌的外科治疗(附32例分析)

目的 探讨慢性阻塞性肺疾病(COPD)合并非小细胞肺癌患者术前肺功能改善、手术方法 和治疗效果.方法 回顾性分析我院2003年2月至2008年7月收治的32例COPD合并肺癌并接受手术治疗患者的临床资料.结果 15例重度肺功能减退的患者中,FEV1、MVV%、PaO2和PaCO2值分别从入院时的(0.82±0.10)L、(35.1±2.6)%、(60.3±6.3)mm Hg、(37.4±2.3)mm Hg增加为术前的(1.22±0.24)L、(45.4±4.9)%、(71.1±4.0)mm Hg、(44.7±3.4)mm Hg,P值均小于0.01.32例全部接受手术,7例行电视辅助胸腔镜(VATS)肺楔形切除术,7例行VATS小切口肺叶切除术,18例行常规开胸肺叶切除术,其中5例行袖式肺叶切除术,1例行左全肺切除术.术后低氧血症和呼吸衰竭、肺部感染、心律失常、支气管胸膜瘘、肺漏气延长的发生率分别为43.8%、21.8%、53.1%、3.1%、21.8%,住院期间死亡率为6.3%.结论 术前积极治疗可以改善肺功能,但对COPD合并肺癌患者施行肺切除时,术后并发症和死亡率较高.对无法耐受标准肺叶切除的Ⅰ期和ⅡA期患者可考虑行局部肺叶切除,改善患者预后.     

全麻下氩等离子凝固联合冷冻治疗中央型肺癌的护理

目的:探讨全麻下氩等离子凝固联合冷冻治疗中央型肺癌的护理方法.方法:选择我科2009年7月至2011年5月共32例在全麻下经电子支气管镜应用氩等离子凝固联合冷冻治疗中央型肺癌患者,给与做好充分的术前准备,术后严密观察,积极处理并发症,观察护理效果.结果:32例患者恢复良好,无并发症发生.结论:对经电子支气管镜下氩等离子凝固联合冷冻治疗患者给与精心护理,能有效的控制并发症的发生,促进患者康复.     

舌下含服粉尘螨滴剂治疗儿童过敏性哮喘的长期疗效观察

目的评价舌下含服粉尘螨滴剂对儿童过敏性哮喘的长期疗效及安全性。方法将109例儿童过敏性哮喘患者按随机数字表法分为对照组51例（单纯使用对症药物）和治疗组58例（舌下含服粉尘螨滴剂＋对症药物）。对两组治疗前后不同时间的哮喘症状、用药评分、肺功能及各项免疫学指标、不良事件进行比较分析。结果与对照组比较，随着治疗时间的延长，治疗组症状评分及用药评分显著降低（P〈0．05），治疗后24个月时分别为（1．06±0．62）、（0．57±0．31）分；肺功能指标如呼吸峰流速、第1秒用力呼气容积则逐渐得到改善，治疗后24个月时分别为（358．52±221．85）L／min和（2．37±0．62）L；血清sIgG4水平显著增高（P〈0．01），治疗后24个月时为（450．37±223．62）mg/L；治疗期间未发生严重不良事件。结论长期舌下含服粉尘螨滴剂安全有效，可用于儿童过敏性哮喘的治疗。     

卡文对癌症患者生活质量改善的疗效观察

目的 探讨卡文对改善癌症患者生活质量的作用.方法 选择26例癌症患者,均接受至少5 d的卡文治疗,分别于治疗前1 d,治疗第3天,治疗第6天评估体力状况评分(KPS),生活质量评估方面:非肺癌患者应用癌症患者生活质量评估表(QLQ-C30),肺癌患者应用肺癌症状评估表(LCSS),同时对血红蛋白进行监测.结果 治疗前1 d非肺癌患者组生活质量评分为(57.5±17.5),肺癌患者组症状评分为(325.0±50.0),完成5 d的卡文治疗后在治疗第6天再次评分,非肺癌组(50.5±20.5),肺癌组(450.0±100.0),与卡文治疗前相比,差异有统计学意义(P＜0.05).治疗前1 d血红蛋白水平为(110.0±27.0)g/L,治疗第6天血红蛋白水平为(113.0±25.0)g/L,差异无统计学意义(P＞0.05).治疗前1 d KPS评分为(70±20),治疗第6天KPS评分为(75±25),差异有统计学意义(P＜0.05).结论 卡文能改善癌症患者的生活质量和体力状况,并对血红蛋白水平没有明显的影响,安全可靠.     

肾动脉狭窄80例外科治疗

目的 探讨肾动脉狭窄外科治疗方法的选择和疗效.方法 回顾性分析1997年11月到2008年8月80例肾动脉狭窄患者的外科治疗经验.男性53例,女性27例,年龄9～80岁.病变包括动脉硬化42例,大动脉炎23例,肌纤维发育不良11例.共接受外科治疗83人次,其中腹主动脉肾动脉旁路术13例,自体肾移植术5例,肾切除术1例,肾动脉内膜切除术1例,肾动脉狭窄段切除吻合术1例,球囊扩张术14例,支架成形术48例.结果 围手术期死亡1例.63例获得随访,随访时间1～129个月,2例死亡.随访患者血压(135.7±15.8)/(80.1±8.5)mm Hg(1 mm Hg=0.133kPa),较术前(149.8±18.3)/(88±13.6)mm Hg下降(P<0.01).总的降压有效率为65.6%,动脉硬化、大动脉炎、肌纤维发育不良患者的降压有效率分别为50%、73.3%和100%(P<0.05).随访患者肌酐(112.7±53.6)/μmol/L,低于术前(131.7±91.7)μmol/L(P<0.05).结论 肾动脉狭窄通过外科治疗可以有效改善血压和肾功能,动脉硬化病变首选支架成形,肌纤维发育不良性病变首选球囊扩张,大动脉炎性病变首选手术治疗.     

术前Halo重力牵引对重度僵硬型脊柱侧凸患者肺功能和营养状况的作用

目的探究术前Halo重力牵引在改善重度僵硬型脊柱侧凸患者脊柱畸形、肺功能以及营养状况方面的应用价值。方法回顾性分析2012年11月—2015年12月在本院行术前Halo重力牵引的重度僵硬型脊柱侧凸的15例患者资料,其中男5例,女10例;年龄13~37岁,平均21.3岁。采用全脊柱影像学检查中主弯Cobb角度评价脊柱畸形程度,用力肺活量(FVC)与预测值的百分比(FVC%)评价肺功能,体质量指数(BMI)和血浆白蛋白浓度衡量患者的一般营养状况。对牵引前后上述指标进行比较分析。结果经平均135.6 d的Halo重力牵引后,患者主弯Cobb角由牵引前92.1°±26.2°改善至牵引后74.8°±3.2°,矫形效果达(20±16)%。FVC%由(60.0±15.0)%上升至(67.0±9.6)%。BMI值由牵引前(16.4±3.9)kg/m~2小幅升高至(18.0±2.8)kg/m~2,血浆白蛋白浓度由牵引前(42.3±3.4)g/L小幅升高至(45.4±2.3)g/L。牵引前后患者主弯Cobb角、FVC%、BMI值及血浆白蛋白浓度比较,差异均具有统计学意义(P0.05)。结论术前Halo重力牵引对于重度僵硬型脊柱侧凸患者有一定的改善肺功能、矫正脊柱畸形的作用,但在提高患者营养状况方面的作用有限。     

系统呼吸训练对肺癌患者术后肺功能的影响

目的探讨系统呼吸训练对肺癌患者术后肺功能的影响.方法将152例肺癌术后患者随机分为观察组(82例)和对照组(70例),对照组行常规胸部术后护理;观察组在此基础下行缩唇呼气训练及深呼吸训练6个月,并于术前、术后2周、3个月、6个月评估两组患者肺功能(FVC,FEV1,FEV1/FVC).结果两组术后不同时段肺功能均较术前下降(P<0.05,P<0.01).观察组术后3、6个月肺功能较术后2周显著改善(均P<0.05);与对照组同时段比较,差异有显著性意义(均P<0.05).而对照组仅FEV1在术后3、6个月有所改善,与术后2周比较,差异有显著性意义(均P<0.05).结论术后呼吸训练能够改善肺癌患者术后肺功能.     

Clinical experience using percutaneous cardiopulmonary support system for stent replacement

Three cases of tracheal or mein bronchus stenoses were treated using percutaneous cardiopulmonary support system (PCPS). Case 1 was a 63-year-old male admitted for dyspnea due to stenotic trachea with primary lung cancer invasion. YAG-laser operation and Dynamic stent was inserted to the trachea using PCPS. Case 2 was a 74-year-old male admitted for dyspnea due to stenotic right mein bronchus with primary lung cancer invasion. Dumon Y stent was inserted to the right mein bronchus using PCPS. Case 3 was 57-year-old male admitted for dyspnea due to stenotic trachea and occluded left mein bronchus with ischemic change after primary esophageal cancer operation. Dynamic stent was inserted to the trachea and left mein bronchus using PCPS. Tracheal and mein bronchus stenoses the trachea of all was dilated after placement of stent. These three cases had no complications during or after these treatment. These results indicated that using PCPS was a very useful, powerful and satisfactory method in the treatment of tracheal or mein bronchus stenoses during the lack of lung ventilation.     

A case of metastasis of lung cancer to renal cell carcinoma]

A 62-year-old male was admitted with abnormal shadow in chest X-P. CT and other examinations were done, and he was diagnosed left renal cell carcinoma with metastatic lung cancer. He rejected operation and was discharged. We gave him alpha-interferon injection every day. About 5 months later, he complained of fever and dyspnea, and was admitted. On the 10th day after admission, he died suddenly with massive hemoptysis. This hemoptysis was from the pulmonary artery, which was surrounded by tumors and ruptured into the trachea. Pathological diagnosis was double cancer, such a case is very rare with a primary lung cancer (oat cell carcinoma) which has metastasized into a renal cell carcinoma (common type, clear cell subtype).     

术前肺康复对肺癌合并中一重度慢性阻塞性肺疾病患者运动耐力的影响

目的评估术前肺康复（PR）对肺癌合并中一重度慢性阻塞性肺疾病（COPD）患者运动耐力的影响。方法选择2009年3月至20lO年8月华西医院胸外科收治32例肺癌伴中重度COPD患者作为研究对象,其中30例完成术前为期2周的肺康复训练并接受手术治疗,男18例,女12例;年龄62．5±7．7岁。中度C（）PD12例,重度COPD18例;康复前后均进行心、肺功能评估,并分析这些患者的术后肺部并发症发生情况及住院时间。结果（1）静态肺功能试验中第1秒用力肺活量（FEV1）、第1秒用力肺活量百分比（FEV,％）、第1秒用力肺活量与用力肺活量比（FEV1／FVC）、最大通气量（MVV）康复后较康复前（1．30±0．30I,VS．1．24±0．40L,59．19±18．00LVS．51．89±14．00L,47．74±12．00LVS．46．59±10．00L,56．63±13．00LVS．49．67±13．00L）增加不显著（P〉0．05）;一氧化碳弥散能力（DLco）康复前和康复后（19．38±18．00LVS．15．38±4．10L）变化不明显（P〉0．05）。（2）6-分钟步行距离（6-MwD）在肺康复后显著高于康复前（594．87±116．00mvs．502．67±157．00m,P〈0．05）;呼吸困难指数（Borg指数）在康复后显著低于康复前（o．12±0．10VS．0．26±0．20,P〈0．05）;疲劳指数在康复后显著低于康复前（0．12±0．10VS．0．24±0．20,P〈0．05）。（3）呼气峰流速（PEF）在康复后显著高于康复前（255．33±70．00L／minVS．209．33±66．00L／min,P〈0．05）。（4）30例接受手术治疗患者,围手术期无死亡（术后30d内）,术后出现肺部并发症（PPC）8例,术后平均住院时间为8．0±2．4d。结论术前肺康复可提高肺癌伴中一重度COPD患者的运动耐力,可能对肺癌伴中重度COPD患者降低术后肺部并发症有所帮助。     

The Insertion of Self Expanding Metal Stents With Flexible Bronchoscopy Under Sedation for Malignant Tracheobronchial Stenosis: A Single-Center Retrospective Analysis

ObjectiveTo describe a 10-year experience of inserting Ultraflex? self-expanding metal stents (SEMS) under sedation using flexible bronchoscopy for the treatment of malignant tracheobronchial stenosis in a tertiary referral center.MethodsMedical notes were retrospectively reviewed for all patients who underwent SEMS insertion between 1999 and 2009.ResultsA data analysis of 68 patients who had Ultraflex? SEMS inserted under sedation was completed. Thirty-three males and 35 females with a mean age of 67.9 years (range 35–94) presented with features including dyspnea/respiratory distress (39 patients), stridor (16 patients), and hemoptysis/dyspnea (13 patients). Etiology of stenosis included lung cancer (46 patients), esophageal cancer (14 patients), and other malignancies (8 patients). Mean dose of midazolam administered was 5 mg (range 0–10 mg). The trachea was the most common site of stent insertion followed by the right and left main bronchus, respectively. Adjuvant laser therapy was applied at some stage in 31% of all cases, and chemotherapy and/or radiotherapy was administered to at least 64% of patients with malignant disease.Hemoptysis and stent migration were the most frequent complications (5 and 4 patients, respectively). The mean survival time of stented non-small cell lung cancer (NSCLC) patients was 214 days (range 5–1233) and that of esophageal malignancy was 70 days (range 12–249). Mean pack-year history of individuals with lung cancer requiring stent insertion was 37 (range 2–100).ConclusionUltraflex stents offer a safe and effective therapy for patients who are inoperable or unresectable that otherwise would have no alternative therapy. It has an immediate beneficial effect upon patients, not only through symptom relief but also, in some, through prolongation of life. Survival data are no worse than other studies using different varieties of stents and insertion techniques indicating its longer-term efficacy. Moreover, this report highlights the feasibility of performing this procedure successfully in a respiratory unit, without the need for general anesthesia.     

Palliative intubation of the tracheobronchial tree

Sixteen patients with far-advanced neoplastic lesions in the trachea and main-stem bronchi were studied. Ten of them were admitted to the ward in extremely poor general condition with marked cyanosis and dyspnea at rest. Palliative intubation was undertaken with two types of tubes: a Neville tracheal prosthesis and a Tracheoflex tracheostomy tube. Both types of tubes had to be specially prepared, as they had originally been designed for other purposes. The tubes were placed in the stenotic sections of the trachea and, depending on anatomical relations, within the right or left main bronchus as well. Intubation of the bronchus in the case of changes involving only the trachea was necessary to properly position and fasten the tube in the bronchial tree and to prevent displacement of the prosthesis inside the trachea. In two patients the esophagus was intubated as well. An improvement in the general condition of all patients was observed. Intubation resulted in reexpansion of a completely collapsed lung in two patients. The longest time of intubation was 9 months. The method is simple, and every physician experienced in endoscopy can use it. The results obtained encourage its further and wider application.     

Upper Lobectomy for Lung Cancer with True Tracheal Bronchus: A Unique Presentation

Tracheal bronchus is an aberrant bronchus usually originating from the right lateral wall of the trachea, with an incidence ranging from 0.1% to 5% and usually within 2.0cm above the carina. The incidence of lung cancer with bronchial anomaly is very rare. Only nine cases of lung cancer developing from the tracheal bronchus have been reported in literature. Histological examination showed squamous cell carcinoma in only three of them, and we present a fourth case, in a 57-year-old man. Interestingly, our patient's anomaly included both an absence of the right upper bronchus and the fact that the right upper lobe was ventilated by the true tracheal bronchus. This is the first documented case in the world of a squamous carcinoma originating in the true tracheal bronchus. Post-surgical histological stage was T2aN0M0 (stage IB). The patient is in a good condition 48 months after the operation and has no evidence of recurrence.     

Stenting for postoperative airway stenosis due to traumatic tracheobronchial rupture

A 43-year-old man underwent repair for the broken trachea, left main bronchus and right main brouchus due to trauma. Twenty-seven months after the initial surgery, he developed dyspnea and required ventilatory support. Computed tomography showed severe stenosis of the left main bronchus, tracheomalasia and bronchomalasia of right main bronchus. A self-expandable metallic stent (SEMS) was placed in the bilateral main bronchus and T-tube in the trachea. SEMS developed granulatory and cicatricial stenosis of the airway, which caused severe dyspnea. Replacement of SEMS with Dumon stents was successfully done and dyspnea was disappeared. A silicon stent should be used for treating postreconstructive airway stenosis including tracheobronchomalasia.     

23例次肺移植术后受者的临床分析

目的 评估23例次肺移植术后受者的临床预后情况.方法 总结2003年1月至2007年8月施行的23例次(21例患者)肺移植的临床资料.分析存活率及并发症.结果 肺移植围手术期死亡率为13%;术后3个月、1年、2年和3年的累积存活率分别为82.6%、82.6%、69.7%和58.1%.受者术后2个月时的通气和换气功能较术前明显改善(P<0.05).有10例受者术后6个月内出现轻度急性排斥反应,经激素冲击治疗后均缓解.4例受者分别于术后8个月、9个月、14个月和24个月时出现慢性排斥反应;术后6、12和24个月时未发牛慢性排斥反应的受者分别为95%、78.2%和71.1%.术后肺部感染发生率为33.3%;气管吻合口软化和狭窄发生率为14.3%.结论 肺移植术后受者的中期存活率较高;肺部感染和支气管吻合口软化及狭窄是肺移植术后主要并发症.     

全胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例

目的探讨胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌的安全性、有效性。方法2016年4月~2019年8月我院行胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例,采用三孔法,先行系统性淋巴结清扫,然后行解剖性肺叶切除,最后行支气管切除吻合。结果110例完成全胸腔镜支气管袖式/成形肺叶切除(支气管袖式切除86例,支气管楔形切除成形24例);10例中转开胸(8.3%):肺门叶间淋巴结钙化4例,肿瘤侵犯肺动脉干4例(2例中转为左全肺切除),术中大出血2例。手术时间115~440 min,中位数210 min;出血量50~1000 ml,中位数200 ml。术后平均带管5.8 d(2~34 d),平均住院6.6 d(3~35 d)。术后病理:非小细胞不明类型肺癌2例,鳞癌91例,腺癌13例,混合癌3例(鳞癌为主),神经内分泌癌2例,腺样囊性癌、肉瘤样癌、类癌、肺母细胞瘤、黏液表皮样癌各1例,小细胞肺癌4例。无围手术期死亡,3级以上并发症(Clavien分级)11例(9.2%),包括肺部感染支气管镜吸痰4例(2例呼吸衰竭经历ICU过渡治疗),胸壁皮下气肿行胸腔闭式引流6例,支气管吻合口漏二次手术1例。新辅助化疗后19例中,2例发生3级以上术后并发症(均为皮下气肿置管引流)。113例随访1~41个月,中位随访时间20个月,非肿瘤死亡1例,全身广泛转移死亡11例,Kaplan-Meier生存分析1、2、3年累积生存率分别是98.9%、90.7%、85.4%。结论全胸腔镜支气管袖式/成形肺叶切除治疗包含部分局部晚期的中央型肺癌安全有效,新辅助化疗不额外增加手术风险,值得临床推广。