65例肺部X线诊断不明的支气管镜检查结果分析

目的探讨纤维支气管镜对肺部X线诊断不明的病变的诊断价值。方法对65例经X线或CT检查发现肺部有异常病变临床不能明确诊断的患者行支气管镜检查分析病理检查。结果经纤支镜检查确定诊断恶性肿瘤31例占47.69%,炎症25例占38.46%、结核1例占0.15%。结论对肺部X线检查有异常影像改变,而临床不能明确诊断者行纤支镜检查可明显提高诊断的正确率。减少误诊率。     

支气管结核78例临床分析

目的探讨支气管结核早期诊断手段。方法分析78例支气管结核患者临床表现、胸部X线、纤维支气管镜(纤支镜)检查结果。结果通过临床情况、X线检查及纤支镜检查、对多种疑难病情达到确诊。结论当疑有支气管结核,应行纤支镜检查,及时诊断。     

26例肺癌误诊肺结核纤支镜检查结果分析

探讨纤维支气管镜(纤支镜)检查对胸部X线、胸部CT表现不典型的早期中央型肺癌诊断价值.经纤支镜综合取材结果,第一次纤支镜确诊率80.8%,第二次纤支镜确诊率92.3%.结论:肺癌的早期诊断是延长生存时间的关键,对40岁以上的咯血患者必须常规纤支镜检查,同时呼吁各基层医院同仁们不要盲目的实施抗结核治疗.     

胸片正常的支气管内膜结核15例临床分析

目的 探索胸片正常的支气管内膜结核的临床特征及早期确诊手段。方法 分析15例经纤维支气管镜(纤支镜)确诊的支气管内膜结核患者的临床表现、胸部X线(平片)及CT片、纤支镜检查结果。结果 15例中主要症状包括：咳嗽15例，气促5例，胸痛4例，发热3例，咯血2例，消瘦2例。15例的X线胸片正常。纤支镜检查示46．7％的病例有炎性浸润型病变，33．3％有增殖型病变，13．3％有溃疡型病变，6．7％有狭窄闭塞型病变。15例痰涂片行抗酸染色者中3例阳性，痰培养阳性1例；纤支镜刷片检查8例阳性，活组织检查7例证实为结核。结论 支气管内膜结核无特异性临床表现及胸部X线表现正常不能排除支气管内膜结核，确诊主要依靠纤支镜检查。对不明原因发热和呼吸道症状经积极治疗无效者，应怀疑支气管内膜结核而及时行纤支镜检查。通过镜下常规刷检找抗酸杆菌配合组织活检确诊率高。     

纤支镜与经皮针吸肺活检对恶性肺病诊断的评价

本文统计分析了我院 1987年 7月至 2 0 0 0年 7月间 2 0 48例纤维支气管镜检查病人的临床资料 ,对其中高度怀疑肺部肿瘤的 6 1例患者经纤支镜检查后 ,其中 12例因镜检时肉眼未见明显异常或感到取材不满意 ,49例因纤支镜检查结果阴性而进一步作经皮细针吸肺活检术。1　资料和方法1.1　病例　 6 1例中男 42例 ,女 19例 ,年龄 2 5～ 76岁 ,平均5 1.6岁。入选病人需符合如下标准 :(1)有详细病史、体检、常规实验室检查资料 ;(2 )纤支镜检查前均有痰细胞学和痰细菌学检查 ;(3)术前常规胸片或 CT显示为肺部段叶以远的外周性病变 ,(4)病灶 X线胸…     

244例肺不张纤支镜检查结果分析

纤支镜检查自二十世纪七十年代开始应用于临床以来,技术日臻成熟,应用范围越来越广。而肺不张是肺部疾病常见的一种X线征象,可由各种疾病引起。我院自1996年5月至2004年5月共244例患者因肺不张而进行纤支镜检查。现将其纤支镜检查镜下改变结合细胞学、细菌学检查进行综合分析,以探讨运用纤支镜检查对肺不张的诊断价值。[第一段]     

支气管结核86例临床分析

目的探讨支气管结核(EBTB)的临床特征。方法分析经纤维支气管镜(纤支镜)确诊的86例EBTB患者的临床表现、胸部X线、纤支镜检查结果等。结果纤支镜检查示大致正常仅占9%,37%有炎症浸润型病变,16%有增殖型病变,26%有狭窄闭塞型病变,12%有溃疡型病变。78例痰涂片行抗酸染色中10例阳性,86例行纤支镜刷片检查69例阳性,62例行活组织检查者中24例证实为结核。结论EBTB缺乏特异性临床表现,确诊主要依靠纤支镜检查。     

400例纤维支气管镜检查临床分析

目的探讨纤维支气管镜（纤支镜）检查在肺部疾病病因诊断中的价值及应用。方法2004年-2008年我院临床及X线不能明确肺部疾病病因的患者400例行纤支镜检查,并对经纤支镜下结果、镜下特点、病因、并发症等进行分析。结果纤支镜总诊断率93％,病理诊断肺癌282例,其中鳞癌最多,其次为未分化癌及腺癌,28例假阴性（通过其他检查确定为肺癌）,炎症56例,结核24例。结论对临床及X线不能明确肺部疾病病因的患者均应及时行纤支镜检查。     

重复纤支镜检查对肺癌的诊断价值探讨

目的探讨重复纤支镜检查在肺癌诊断中的价值。方法回顾性分析70例怀疑肺癌接受重复纤支镜检查患者的临床病例资料。结果64例患者重复纤支镜检查1次,4例患者重复纤支镜检查2次,2例患者重复纤支镜检查3次。16例患者重新获得病理学确诊,重复检查的阳性率为22.86%(16/70)。复检病理学阳性以赘生物型为主,粘膜型次之。结论首次纤维镜结果与临床,X线,特别是镜下直视不符时,应积极进行复检,重复检查以1~2次为宜,综合运用各种镜下诊断技术有助于提高阳性率。     

纤支镜检查对X线胸片正常咯血患者的诊断价值

纤维支气管镜 (纤支镜 )检查是诊断咯血病因的重要方法之一。 1995～ 2 0 0 0年 ,我们对 12 6例 X线胸片正常的咯血患者进行纤支镜检查 ,现将检查结果报告并分析如下。临床资料 :本组 12 6例中 ,男 92例 ,女 34例 ;平均年龄42 .4岁 ;咯血史最短 2天 ,最长 18年 ;12 0例为小量咯血 ,6例为中量或大量咯血。X线胸片示正常或轻度肺纹理增粗 ,或轻度肺气肿。采用 Olympus BF- P30纤支镜对肺段及亚段以上各级支气管逐次进行检查。所有患者均无手术本身所致的支气管粘膜损伤出血。大咯血患者均于咯血停止 48小时后进行纤支镜检查 ,余者检查时间…     

纤支镜对呼吸系统疾病临床应用价值的分析

目的研究纤维支气管镜在诊断呼吸系统疾病中的临床应用价值。方法对我院近3年多来经纤维支气管镜诊断的呼吸道疾病680例结合文献进行临床综合分析。结果未见异常130例(19．12％)．炎症表现306例(45％)，肺癌表现231例(33．97％)，弥漫性肺部病变6例(0．88％)，异物7例(1．03％)。结论纤维支气管镜在呼吸系统疾病的诊断、治疗、监护和抢救方面均有重要的临床应用价值。     

Clinical significance of minimal change lesions of the esophagus in a healthy Korean population: A nationwide multi-center prospective study

Background and Aim:  At least half of the patients with typical reflux symptoms have non-erosive reflux disease (NERD). Minimal change lesions are commonly seen in the screening endoscopic examinations for individuals without clinically significant symptoms. We evaluated the correlation between minimal changes and symptoms in individuals visiting the hospital for routine health check-up by a nationwide survey in 2006.
Methods:  Upper gastrointestinal endoscopic examinations as a health check-up were performed for 25 536 patients. Among them, symptom questionnaires were given in 23 350 patients without mucosal break or Barrett's esophagus. Endoscopic findings of the lower esophagus were divided into normal or minimal changes. Minimal changes in the present study included white turbid discoloration and Z-line blurring.
Results:  Among a total of 25 536 subjects, reflux esophagitis was found in 2019 subjects (7.91%) and 3043 patients (11.9%) were classified as having minimal changes. History of gastroesophageal reflux disease (GERD) was more commonly found in individuals with minimal changes. Among the reflux-related symptoms, heartburn, acid regurgitation, globus sensation, and epigastric soreness were related to the minimal changes of the esophagus. Especially, individuals with globus sensation or epigastric soreness were more likely to have minimal changes compared to individuals without respective symptoms. Male gender, current smoker, history of H. pylori eradication, frequent stooping at work, hiatal hernia, and atrophic/metaplastic gastritis were found to be risk factors for minimal changes.
Conclusion:  The minimal changes were closely related with upper gastrointestinal symptoms and had similar risk factors for GERD, suggesting that minimal changes could be considered as early endoscopic findings of GERD.     

Comparison of hematologic or biochemical parameters among elderly hospital patients, institution-dwelling residents, and health check-up examinees

Background:   The purpose of the present paper was to examine the differences in the levels of hematological or biochemical parameters among elderly hospital patients, nursing home residents, and mass health check-up recipients.
Methods:   One hundred and 44 geriatric inpatients (aged ≥ 65 years), 237 outpatients, 146 nursing home residents, 120 aged examinees from mass health check-ups, and 512 younger health check-up examinees (controls) were included in the present study. They were divided into five male and five female subgroups, respectively. The levels of hemoglobin (Hb), white blood cells (WBC), serum albumin (Alb), Ca, albumin-corrected Ca, Na, creatinine (Cr), and total cholesterol (TC) were determined and compared.
Results:   There were significantly lower levels of Hb, Alb, Ca, Na, and TC in inpatients than in other groups in both sexes. In contrast, higher levels of WBC and Cr were found in inpatients. Among women there was no difference in the level of any parameter between nursing home residents, health check-up examinees, and controls.
Conclusion:   The data indicate that the levels of these parameters are affected to a greater extent in inpatients, and that female nursing home residents and health check-up examinees show values similar to those of controls.     

超声与钼靶检查对乳腺疾病良恶性诊断的对比分析

目的系统、定量地评价超声及钼靶成像技术对乳腺疾病的诊断准确性及诊断特点,为乳腺疾病选择影像学检查提供有价值的指导。方法分析228例患者237个乳腺结节彩色多普勒超声及钼靶声像学特征,以病理组织结果为金标准,评价多普勒超声、钼靶以及两者联合对乳腺疾病良恶性诊断价值。结果本组病理检查结果良性188例（194个结节）,恶性40例（43个结节）;彩色多普勒超声诊断恶性病变灵敏度为46.5%,特异度为80.4%,正确率为74.2%;X线钼靶诊断乳腺恶性肿瘤的灵敏度为55.8%,特异度为75.2%,正确率为71.7%;两者结合诊断乳腺恶性肿瘤灵敏度为90.6%,特异度为89.6%,正确率为89.8%。结论多普勒超声及钼靶检查对乳腺肿块定性诊断均有较高价值,两者结合可提高鉴别乳腺肿瘤良恶性正确率,在临床诊断及制定治疗方案上有重要的指导价值。     

Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus

BACKGROUND & AIMS: In view of the mortality and morbidity rates of esophagectomy and the relatively large group of inoperable patients, local therapeutic techniques are required for high-grade dysplasia and early Barrett's cancer. METHODS: A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carcinoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esophagus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and histological grades G1 and G2 and/or high-grade dysplasia (group A). The remaining 29 patients were included in group B (high risk). RESULTS: A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1. 3 +/- 0.6 in group A and 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred, a case of spurting bleeding, which was managed endoscopically. Complete local remission was achieved significantly earlier (P = 0.008) in group A than in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or metachronous carcinomas were found in 14%. CONCLUSIONS: Endoscopic mucosal resection of early carcinoma in Barrett's esophagus is associated with promisingly low morbidity and mortality rates. The procedure may offer a new minimally invasive therapeutic alternative to esophagectomy, especially in low-risk situations. Comparisons with surgical results will need to be done when the long-term results of this procedure become available.     

农村居民健康体检指南(T/CHAA 005-2019)

本标准规定了开展农村居民健康体检的原则、机构要求、检查项目、服务模式、数据的管理和利用要求,适用于在国家有关法律、法规规定下开展15岁及以上农村居民健康体检的规范化管理。     

耐多药空洞肺结核药物凝胶局部介人治疗临床观察

目的探讨经纤支镜结核空洞局部灌注含药凝胶治疗耐多药空洞肺结核(multiple-drug resistance tuberculosis,MDR-TB)的临床疗效。方法将经痰抗酸杆菌涂片和培养、药敏实验,影像学诊断确诊的204例耐多药空洞肺结核患者纳入观察范围,其中108例经含药凝胶结核空洞局部介入治疗患者归入凝胶组,其余96例未用含药凝胶结核空洞局部介入治疗的患者归入一般治疗的对照组。凝胶组应用纤支镜局部结核空洞灌注含药凝胶(每20ml凝胶内含帕司烟肼600mg、链霉素1000mg、吡嗪酰胺500 mg、左旋氧氟沙星400 mg)治疗和全身抗结核药物治疗,对照组用全身抗结核药物治疗。检测2组患者治疗后6、12和18个月的痰菌阴转率、结核病灶治疗有效率、结核空洞治疗有效率、并发症及不良反应。结果凝胶组治疗后6、12和18个月痰菌阴转率为51.9%、79.6%和88.9%,显著高于对照组;凝胶组结核病灶治疗有效率为52.8%、81.5%和90.7%,结核空洞治疗有效率为50.9%、79.6%和89.8%,显著高于对照组。2组并发症及不良反应发生率差异无统计学意义。结论经纤支镜含药凝胶结核空洞局部介入治疗可以提高耐多药空洞肺结核,不良反应小、安全有效。     

Miles' resection for cancer of the rectum.

Miles' resection is the optimal surgical operation for cancer involving the lowermost third of the rectum, although some surgeons question the wisdom of subjecting the patient to permanent colostomy and use fulguration as the alternative. In the author's series of 100 patients, the five-year survival rate was 41.6%. The operative mortality rate was 4%. The median distance of the cancer above the dentate line was 3 cm and the average distance was 4.6 cm. Fifty patients had Dukes' C lesions. Of the 100 patients, 95 had adenocarcinoma, 3 had squamous-cell carcinoma, 1 had a cloacogenic lesion, and 1 had melanocarcinoma. Complications were surprisingly few. Eleven patients had perineal recurrence. The relatively poor survival rate is attributed to anatomic limitations for radical surgical measures and to the spread of cancer cells by the time of operation. Regular check-up examinations are most effective in the prevention of rectal cancer.     

纤维支气管镜在老年急性重症肺部感染并肺不张的应用价值

目的对老年急性重症肺部感染并肺不张患者行纤维支气管镜的应用价值进行探讨。方法选取我院50例老年重症肺部感染并肺不张患者作为研究对象,所有对象均先行内科常规治疗,治疗效果不佳,而后行纤维支气管镜吸痰和支气管肺泡冲洗术,观察其临床治疗效果。结果与治疗前相比,治疗后老年急性重症肺部感染并肺不张患者PaO2、SaO2及PH水平明显升高,PaCO2水平明显降低,有效率为84.00%。结论对于老年急性重症肺部感染并肺不张患者,纤维支气管镜有较好的临床治疗效果。     

A clinical study on 65 cases with tracheobronchial tuberculosis

We recently diagnosed 65 cases with tracheobronchial tuberculosis using fiberbronchoscope. All the patients presented TB symptoms and were smear positive, some of them had been misdiagnosed for chronic bronchitis or lung cancer. Among them, 16 cases were simple tracheobronchial tuberculosis (24.6%) without TB lesions in the lungs. The results show that fiberbronchoscopic examination is a good method to diagnose tracheobronchial tuberculosis and distinguish lung cancer by direct observation of tracheobronchial lostons or brush biopsy for TB.