23例气管、支气管、隆突成形术的体会

目的 报告23例气管、支气管、隆突成形术。方法 右肺上叶袖式切除13例。左肺上叶袖式切除4例(同时行肺动脉楔形切除1例)，右全肺袖式切除 隆突成形3例，隆突切除、呼吸道重建1例，左总支气管部分切除、端端吻合1例，气管肿瘤切除、端端吻合术1例。结果 全组术后近期死亡1例，手术死亡率4．3％，死亡原因为呼吸衰竭。结论 气管、支气管、隆突成形术安全，易于掌握，能最大限度切除病变组织且最大限度保留有功能的肺组织，符合肿瘤治疗原则。     

气管、支气管或(和)心血管成形术用于中心型肺癌的治疗

为探讨中心型肺癌选择性地进行扩大切除手术的可行性，总结了134例中心型肺癌施行肺叶或一侧肺切除同时行气管、支气管或(和)心血管形成手术。本组支气管袖式肺叶切除成形术67例，支气管楔形切除成形术11例；气管袖式切除一侧肺切除成形术4例；心血管成形术54例(32例同时行支气管成形术)，包括上腔静脉成形术7例，左心房部分切除成形术14例，肺动脉袖式切除成形术12例，肺动脉侧壁切除成形术21例。手术结果：死亡1例，并发症16例(11．9％)。对2000年12月以前手术124例中的117例进行了随访，随访率94.4％。气管、支气管成形术1、3、5年生存率分别为84．7％、56．7％、45．7％；心血管成形术1、3、5年生存率分别为69．2％、46.8％和22.2％。结论：对侵及胸腔重要器官的中心型肺癌选择性地进行肺叶或肺切除的同时进行气管、支气管或(和)心血管成形术是可行的，能延长患的生存期。     

支气管肺动脉成形术治疗支气管肺癌的体会

支气管肺动脉成形术治疗支气管肺癌的体会毛新高小增张胜卫侯波１９９０年５月至１９９６年６月，我科运用支气管成形或同时行肺动脉成形术对５例Ⅱ～Ⅲ期左上肺支气管肺癌的病人施行了手术治疗，扩大了手术适应症，疗效满意报告如下。临床资料本...     

单腔插管麻醉下支气管成形肺叶切除治疗肺癌38例体会

目的 总结本院在单腔插管麻醉下支气管成形肺叶切除术治疗38例中心型肺癌的临床经验.方法 回顾性分析本院在2001年4月至2005年6月期间在单腔插管麻醉下支气管成形肺叶切除术治疗的中心型肺癌38例,其中I b期16例(T2N0M0),Ⅱb期13例(T2N1M0,T3N0M0),ⅢA期9例(T2N2M0,T3N1M0).支气管袖状成形肺叶切除术30例,支气管楔形切除成形肺叶切除术6例,支气管肺血管双成形术2例.结果 手术死亡率0,术后并发肺不张3例,经纤支镜吸痰处理后治愈.支气管胸膜瘘1例,经胸腔闭式引流治愈.术后随访1～96个月,1生存率为82.21%,5年生存率46.7%.结论 单腔插管麻醉下支气管成形肺叶切除能提高中心型肺癌的手术切除率,最大限度保护肺功能,保证患者术后生活质量.且术中不需要改变麻醉,为患者降低了医疗费用.     

闭合性气管支气管损伤7例诊治分析

目的 探讨闭合性气管、支气管损伤的诊断及治疗方法。方法分析7例闭合性气管、支气管损伤的临床特点、早期诊断及治疗方法。结果3例颈部气管损伤急诊行修补后痊愈,1例胸部气管膜部损伤行纵隔引流保守治疗痊愈,3例气管、支气管损伤行气管、支气管缝合、修补、成形痊愈。结论早期明确诊断,及时合理的治疗,是提高闭合性气管支气管损伤治愈率、减少并发症、降低死亡率的关键。     

支气管肺动脉成形术治疗中央型肺癌的临床分析

目的探讨支气管肺动脉成形术治疗肺癌的效果。方法自2003年至2005年对36例肺癌患者施行支气管肺动脉同时成形术。术后病理诊断结果：鳞癌24例,腺癌6例,腺鳞癌5例,小细胞未分化癌1例。pTNM分期：ⅡB期5例（T2N1M0 4例,T3N0M0 1例）,ⅢA期27例（T3N1M0 11例,T2N2M0 9例,T3N2M0 7例）,ⅢB期4例（T4N0M0 1例,T4N1M0 1例,T4N2M0 2例）。结果该组手术近期死亡0例。术后1、3、5年生存率分别为74％（26／35）、48％（11／23）、33％（3／9）。结论采用支气管肺动脉同时成形术治疗中央型肺癌减少了全肺切除和单纯剖胸探查的率扩大了手术适应证,为肺癌患者提供了更有效、安全、合理的治疗机会。     

气管支气管成形术的护理对策

从1985年6月～2002年1月我院共收治气管癌9例 ,中心型肺癌37例 ,并分别行气管、支气管成形术 ,现将临床护理报道如下 :1临床资料1.1一般资料 :全组46例 ,男39例 ,女7例 ,年龄32～73岁 ,平均58.8岁 ,60岁以上患者21例 ,肺功能呈中度阻塞性改变者25例。症状为胸闷、咳嗽、血性痰、胸痛、间断性发热、呼吸困难 ,占100%。X线表现除了3例胸片无明显阴影 ,仅体层片示叶支气管开口气管狭窄外 ,作均见肿块影3cm×3cm～12cm×12cm ,伴有肺不张4例。30例行痰脱落细胞检查 ,20例发现癌细胞 ,阳性率为66.7%。本组40例行支气管镜检查 ,有4例示气管隆凸部…     

影响非小细胞肺癌支气管成形术预后因素分析

目的探讨支气管成形术治疗非小细胞肺癌的临床疗效及预后影响因素。方法23例行支气管成形术治疗的非小细胞肺癌患者的临床资料进行回顾性分析。生存率计算用Kaplan-Meier法,Log-rank法进行检验;多因素危险度分析用Cox—regression模型。结果全组23例患者5年总的生存率为41．8％。术后病理分期：Ⅰ期3例,Ⅱ期10例,Ⅲ期10例。Ⅰ期、Ⅱ期、Ⅲ期的5年生存率分别为66．8％、55．8％、14．5％,Ⅲ期患者生存率与Ⅰ期、Ⅱ期比较,差异有统计学意义（x^2=7．078,P〈0．01）。多因素分析发现,只有TNM分期是影响本组患者累计生存率的预后因素。结论支气管成形肺叶切除术后的非小细胞肺癌患者远期生存率和传统的肺叶切除效果相当,TNM分期是独立的预后因素。     

带蒂肌瓣修补治疗支气管胸膜瘘34例

目的 总结1991-2000年用带蒂肌瓣修补治疗支气管胸膜瘘34例经验。方法 全组病例行胸廓成形术带蒂肌瓣修补支气管胸膜瘘治疗。结果 32例临床治愈占93．5％，显著好转2例，占65％，随访1年以上，无支气管残端瘘复发。结论 带蒂肌瓣治疗支气管胸膜瘘是一种操作简便，行之有效、治愈率高的治疗方式。     

创伤性气管支气管断裂的诊断及治疗

目的　分析创伤性气管、支气管断裂的诊断及治疗 ,总结早期急诊及晚期诊断 (1周后 )依据 ,探讨误诊原因 ,分析治疗效果。方法　本组1 1例 ,伤后距手术时间 72小时 8例 ,6周至 3个月 3例。气管、支气管断端吻合 8例 ,修补成形 3例。结果　治愈 1 0例 ,死亡 1例。结论　早期诊断、早期治疗及应用生物蛋白胶可提高治愈率 ,减少术后并发症 ,有利于肺功能恢复     

Classification of beta-adrenoceptors in human isolated bronchus.

(+/-)-Isoprenaline (Iso), (-)-adrenaline (Ad), (-)-noradrenaline (NA), (+/-)-phenylephrine (Phe) and the beta 2-selective adrenoceptor agonist (+/-)-fenoterol (Fen) caused a concentration-dependent relaxation of human isolated bronchial preparations. Iso, Ad and NA caused complete relaxation of both spontaneous and carbachol-induced bronchial tone. Fen, which was only tested in preparations where tone was induced with carbachol, also caused complete relaxation. However, Phe was a partial agonist in all preparations tested. When relaxation responses to these amines were calculated as a % of their maximal effects, comparison of EC50 values showed that the order of potency was Iso greater than Ad = Fen greater than NA greater than Phe (92:27:25:1:0.2) in preparations with carbachol-induced tone and Iso greater than Ad greater than NA greater than Phe (112:38:1:0.3) in preparations with spontaneous tone. pA2 values determined for the beta-adrenoceptor antagonists propranolol (non-selective), atenolol (beta-selective) and ICI-118, 551 (beta 2-selective), using Iso as an agonist were, 9.3, 5.3 and 9.1 respectively. These results indicate that beta 2-adrenoceptors mediate relaxation of human isolated bronchus to sympathomimetic amines in preparations obtained 4-14 h post-mortem from non-diseased lung. alpha-Adrenoceptors were apparently sparse or absent in this tissue.     

Classification of beta-adrenoceptors in isolated bronchus of the pig.

1 (+/-)-Isoprenaline (Iso), (-)-adrenaline (Ad), (-)-noradrenaline (NA), the beta 2-selective adrenoceptor agonist (+/-)-fenoterol (Fen) and the beta 1-selective adrenoceptor agonist (+/-)-RO363 caused concentration-dependent relaxation of preparations of pig bronchus pre-contracted with carbachol 40-ng/ml (0.22 microM). Iso, Ad, NA and Fen caused complete relaxation of carbachol-induced tone, but RO363 caused relaxation equivalent to only 59% of the maximal response to Iso. 2 When relaxation responses to these amines were plotted as a % of their maximal effects, comparison of EC50 values showed that the order of potency was RO363 greater than Iso greater than NA greater than Fen greater than Ad (14.4:4.6:1:0.4:0.3). 3 pA2 values determined for the beta-adrenoceptor antagonists propranolol (non-selective) and atenolol (beta 1-selective), or the partial agonist salbutamol (beta 2-selective) using Iso as agonist were 8.3, 7.3 and 4.4 respectively. The pA2 value for atenolol using RO363 as the agonist was 7.6. 4 These results indicate that porcine bronchus contains a homogeneous population of beta 1-adrenoceptors.     

Effect of steroids on beta-adrenoceptor-mediated relaxation of pig bronchus.

1--Progesterone, testosterone (40 microM), cortisol and cortisol hemisuccinate (80 microM) caused 6-8 fold potentiations of (+/-)-isoprenaline (Iso)-induced relaxations of pig bronchus while several other steroids caused smaller potentiations or had no effect. 2--17 beta-Oestradiol (40 microM) increased the potency of Iso, (-)-adrenaline (Adr) and (-)-noradrenaline (NA) by 10.6, 2.3 and 2.6 fold respectively but had no significant effect on the potency of fenoterol (Fen). 3--Inhibition of catechol-O-methyl transferase (COMT) with U-0521 (30 microM) caused a 6 fold increase in the potency of Iso but failed to alter the potency of Adr, NA or Fen. The extraneuronal uptake inhibitor normetanephrine (50 microM) caused significant 2 fold increases in the potency of Iso and Adr but did not potentiate the responses to NA or Fen. 4--In preparations where the potency of Iso had already been increased by U-0521 (30 microM) or by normetanephrine, 17 beta-oestradiol produced no significant further increase in potency. These results indicate that steroid-induced increases in the potency of catecholamines in pig bronchus can be explained in terms of inhibition of COMT or extraneuronal uptake or both.     

Endothelin-induced contraction and mediator release in human bronchus.

1. To elucidate the role of acetylcholine and various autacoids in endothelin-1 (ET-1)-induced contraction in human bronchus, the effects of various receptor antagonists were examined. In addition, the ability of ET-1 to stimulate the release of histamine, peptidoleukotrienes and prostanoids was determined. 2. ET-1 was a potent and effective contractile agonist in human bronchus, possessing similar potency and efficacy to leukotriene D4 (LTD4); EC50 (-log M): ET-1 = 7.76 +/- 0.09, n = 7; LTD4 = 8.46 +/- 0.53, n = 7; P > 0.2; maximum response (% 10 microM pre-carbachol): ET-1 = 103.8 +/- 17.4, n = 7; LTD4 = 95.5 +/- 9.3, n = 7; P > 0.6. 3. The cyclo-oxygenase inhibitor, sodium meclofenamate (1 microM) or the potent and selective thromboxane receptor antagonist, SQ 29,548 (1 microM) were without significant effect on ET-1 concentration-response curves. 4. In the presence of sodium meclofenamate (1 microM), the muscarinic receptor antagonist, atropine (1 microM), the platelet activating factor (PAF) receptor antagonist, WEB 2086 (1 microM) or the combination of the H1-histamine receptor antagonist, mepyramine (10 microM) and the leukotriene receptor antagonist, SK&F 104353 (10 microM), were without marked effect on ET-1 concentration-response curves. In addition, the combination of all four receptor antagonists did not antagonize ET-1-induced contraction. 5. ET-1 (0.3 microM) did not stimulate the release of histamine or immunoreactive leukotrienes from human bronchus.(ABSTRACT TRUNCATED AT 250 WORDS)     

Contractile activity of big endothelin-1 on the human isolated bronchus.

1. We have studied the contractile activity of the 39 amino acid precursor of endothelin-1 (ET-1), big endothelin-1 (big ET-1), on human isolated bronchi. The contribution of the metalloproteases, neutral endopeptidase (NEP) and angiotensin converting enzyme (ACE), in the presence or absence of the epithelium lining, by use of specific inhibitors, was also evaluated on the effects of big ET-1. 2. Big ET-1 elicited a potent contraction of human isolated bronchus. The -log EC50 value for big ET-1 was 7.53 +/- 0.08 (n = 11) and Emax 78.5 +/- 3.8% (% of ACh 3mM). 3. Incubation of human isolated bronchi with the NEP inhibitor phosphoramidon (10(-5) M) induced a rightward shift of the concentration-response curve induced by big ET-1 (10(-9) M to 3 x 10(-7) M). Similar results were observed when human bronchi were incubated with thiorphan (10(-5) M), but the shift to the right was significantly less (P less than 0.01) than that observed in the case of phosphoramidon (-0.35 +/- 0.05 vs -0.67 +/- 0.07 log unit). 4. The two inhibitors of angiotensin I converting enzyme (ACE), captopril or enalapril diacid, did not affect the concentration-response curve for contraction induced by big ET-1. 5. When the epithelium was removed, a leftward shift of the concentration-response curve of big ET-1 (10(-9) M to 3 x 10(-7) M) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

儿童气管、支气管非金属异物的影像学诊断

目的 探讨气管、支气管非金属异物的影像学表现，提高对该病的早期诊断率。方法 回顾性分析了60例气管、支气管非金属异物的临床与影像学征象。结果 本组60例中，右侧支气管异物32例，左侧支气管异物22例，主气管异物6例。常见的影像学表现为阻塞性肺气肿51例，纵隔摆动48例。结论 病史及影像学表现是诊断气管、支气管非金属异物的主要手段。     

Effects of BRL 38227 on neurally-mediated responses in the guinea-pig isolated bronchus.

1. In guinea-pig isolated bronchus treated with indomethacin (2.8 microM), electrical field stimulation (EFS; 10 Hz, 0.5 ms, 60-70 V, for 10 s) evoked a tetrodotoxin (3 microM)-sensitive, biphasic contraction comprising a rapid, atropine (1 microM)-sensitive cholinergic response succeeded by a slowly developing, capsaicin (10 microM)-sensitive, non-adrenergic, non-cholinergic excitatory (NANCe) response. 2. BRL 38227 (0.3-3 microM), salmeterol (0.003-3 microM) and ketotifen (1.0-300 microM) each produced concentration-dependent inhibition of both NANCe and cholinergic responses to EFS in guinea-pig isolated bronchus. 3. Substance P (SP; 1 microM) and neurokinin A (NKA; 0.07 microM) produced contractions equivalent in magnitude to the NANCe response to EFS, which were inhibited by salmeterol (1 microM), but not by BRL 38227 (3 microM) or ketotifen (100 microM). 4. Acetylcholine (ACh; 6 microM) was equi-effective with the electrical activation of cholinergic neurones. BRL 38227 (3 microM) slightly inhibited responses to ACh (6 microM). Salmeterol (1 microM) and ketotifen (100 microM) markedly inhibited responses to ACh (6 microM). 5. In bronchial rings pre-contracted with ACh (100 microM), BRL 38227 (0.1-30 microM), salmeterol (0.001-3 microM) and ketotifen (0.1-100 microM) each produced concentration-dependent relaxation. Unlike ketotifen, BRL 38227 and salmeterol only partially (18.8 +/- 2.1% and 51.8 +/- 3.9% respectively) reversed the ACh-induced contraction. 6. The (+)-analogue of BRL 38227, BRL 38226 (0.3-100 microM), was without effect on responses to EFS and had no effect on the inhibition caused by BRL 38227.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bronchodilatation by tachykinins and capsaicin in the mouse main bronchus.

1. The effect of sensory neuropeptides and capsaicin on basal and stimulated tone of mouse bronchial smooth muscle has been evaluated. 2. In basal conditions neither sensory neuropeptides (substance P, neurokinin A or calcitonin gene-related peptide (CGRP) nor capsaicin exerted any contractile effects. However, when a tonic contraction was induced with carbachol (1 microM) a prompt relaxation was induced by substance P (1- 100 nM) and by neurokinin A (1- 100 nM), with substance P being more potent. A second application of substance P was without effect. CGRP (10 nM) produced only a very small and erratic relaxation. Relaxation was also induced by capsaicin (1 microM), and this response could be evoked only once in each preparation. In 4 out of 6 preparations a cross-desensitization between substance P and capsaicin was observed. 3. The selective NK1 tachykinin agonist, [Pro9]-SP sulphone (1 microM), exerted potent bronchodilator actions on carbachol-contracted mouse bronchial preparations. In contrast, neither [beta Ala8]-NKA (4-10) nor [MePhe7]-NKB (both at a concentration of 1 microM), selective synthetic agonists for NK2 and NK3 receptors, exerted significant relaxant effects. Furthermore, the selective NK1 tachykinin antagonist, (+/-)-CP 96,345 (1 microM), abolished substance P (1 nM)- but not isoprenaline (0.1 microM)-induced relaxations. 4. Application of electrical field stimulation (EFS) (20 Hz, supramaximal voltage, 0.5 ms for 10 s) to carbachol-contracted preparations evoked a transient contraction followed by a relaxation. The tetrodotoxin-sensitive slow component of this relaxation was reduced following capsaicin desensitization. 5. In the presence of indomethacin (5 microM) the relaxation induced by substance P, capsaicin or EFS was suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)     

特殊类型气管支气管异物的诊治

目的探讨特殊类型气管支气管异物的诊断及治疗方法。方法回顾性分析26例特殊类型气管支气管异物患者的临床资料。结果异物均成功取出,其中18例经支气管镜通过声门取出,4例经直达喉镜取出,3例经支气管镜经气管切开日取出,1例经纤支镜取出。1例并发肺水肿,经治疗后痊愈。结论特殊类型的气管异物由于异物的特殊性,选择合适的麻醉方法、手术方式及手术器械是手术成功的关键。