Transbronchial needle aspiration of mediastinal lymph node

In Malaysia, transbronchial needle aspiration (TBNA) is a relatively new procedure performed only in a handful of respiratory centres. We reviewed TBNA of mediastinal lymph node performed in Hospital Tengku Ampuan Afzan (HTAA) to determine the yield and its complications. Data was retrieved from endoscopy databases and patients' records, CT thorax images and all cytological and histological slides were reviewed. Twenty-five patients had TBNA performed. TBNA was positive in 15 patients (60%). Overall, 80% had confirmed malignancy after bronchoscopy. Only four patients had documented bleeding after TBNA and in two of them, bleeding stopped spontaneously and another two patients required diluted adrenaline to stop the bleed. No mortality was reported from this procedure. Hence, TBNA is a safe procedure.     

经支气管镜针吸活检在纵隔疾病诊断中的价值

目的探讨经支气管镜针吸活检（TBNA）在纵隔疾病诊断中的价值。方法对168例CT扫描发现有纵隔病变患者, 在支气管镜检查过程中完成TBNA操作,直接涂片送检。结果TBNA 诊断阳性率为92.9％,其中恶性肿瘤81.0％。主要并发症为穿刺点少许出血, 未出现纵隔气肿、感染等不良反应。结论TBNA 创伤性小、安全性高,是诊断纵隔病变的有效方法。     

经纤维支气管镜支气管黏膜下针吸活检在肺癌早期诊断中的意义

目的　探讨经纤维支气管镜 (纤支镜 )支气管黏膜下针吸活检 (TBNA)在肺癌早期诊断中的价值。方法　对 12 6例肺部块影而纤支镜下未见新生物的患者进行可疑病变局部TBNA检查 ,同时进行局部黏膜表面钳取活检并刷检。结果　 12 6例患者TBNA对肺癌的诊断符合率为78 6 % (6 6 / 84 ) ,刷检阳性率为 36 9% (31/ 84 ) ,钳取活检阳性率为 14 3% (12 / 84 )。 89例 (70 6 % )患者穿刺部位有少量出血 ,余患者均无其它严重并发症发生。结论　对支气管黏膜下进行TBNA是肺癌早期诊断的有效方法 ,且操作简便、安全、阳性率高 ,值得临床推广应用     

TBNA在支气管腔外病变中的临床应用价值

目的 探讨经支气管针吸活检(TBNA)对支气管腔外病变的诊断价值.方法 对87例胸部CT检查提示支气管腔外病变且常规气管镜检查示管腔呈外压性狭窄、多次活检或刷检均阴性的患者行TBNA检查.结果 TB-NA诊断准确率为94.3%(82/87),其中恶性肿瘤86.2%(75/87).除8例穿刺部位少量出血外,无显著不良反应.结论 TBNA操作简单,创伤小,诊断率高,是诊断支气管腔外病变安全、有效、可靠的方法.     

超声支气管镜引导下经支气管针吸活检术在肺疾病中的早期诊断研究

目的：研究超声支气管镜引导下经支气管针吸活检术（EBUS‐TBNA ）在肺疾病的早期诊断中的高效性、安全性和并发症。方法选取2013年5月至2014年5月胸部CT提示胸内包块或纵隔淋巴结肿大的28例患者行EBUS‐TBNA ,穿刺标本行病理学检查。结果28例患者中23例行EBUS‐TBNA检查,EBUS‐TBNA诊断出肺癌患者10例,转移性肿瘤4例,淋巴瘤3例,结核病3例,结节病2例,炎性患者1例。EBUS‐TBNA诊断恶性肿瘤率高达74．0％,比预期诊断率明显升高（53．2％,P＜0．01）。EBUS‐TBNA诊断准确率：肺癌91．0％;淋巴瘤100．0％;转移性肿瘤75．0％;结核75．0％,结节病50．0％,炎性病变100．0％。所有行EBUS‐TBNA检查患者,仅有2例出现轻度缺氧,1例出现出血症状。结论 EBUS‐TBNA针对早期诊断呼吸疾病特别是纵隔肿块,是一种高效、微创、安全的检查手段。     

经支气管镜针吸活检术在纵膈占位病变中的临床应用价值

目的 探讨当前支气管镜针吸活检术（transbronchial needle aspiration,TBNA） 在纵膈占位病变诊断价值。方法 回顾性分析总结 2013 年 7 月至 2014 年 10 月河北大学附属医院 68 例患者经 CT 扫描发现纵膈占位,接受支气管镜针吸活检术检查后的临床资料。结果 所研究的患者,在常规支气管镜下有 22 例获得诊断,其中恶性病变 16 例,良性病变 6 例,确诊率 32.35％(22/68);经 TBNA 检查后 57 例获得诊断,其中恶性病变 42 例,良性病变 15 例,确诊率 83.82％(57/68)。TBNA在纵膈占位病变良恶性诊断和鉴别诊断方面的敏感性、特异性和准确性分别为95.45％(42/44),62.5%(15/24) 和83.82%(57/68)。所有患者检查耐受良好,有 2 例出现了少量出血,给予对症止血治疗。结论 在新技术快速发展的今天,对于纵膈占位病变,TBNA 目前仍然是一种安全、有效的诊断及鉴别诊断方法。     

经支气管针吸活检在ⅢA-N2期非小细胞肺癌新辅助化疗纵隔再分期中的应用

目的: 讨经支气管针吸活检(transbronchial needle aspiration, TBNA)在ⅢA-N2期非小细胞肺癌(non-small cell lung cancer, NSCLC)新辅助化疗后纵隔再分期中的临床应用价值和安全性。方法: 15例经TBNA证实的ⅢA-N2期NSCLC患者给予新辅助化疗后行TBNA再分期,所有患者行肺癌根治切除术及淋巴结清扫术分析TBNA在NSCLC新辅助化疗后纵隔再分期中的诊断敏感性、特异性、准确性、阳性预测值和阴性预测值。结果: TBNA活检的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是80.6％、100％、87.2％、100％和72.7％。病理分型总符合率为80％。术前采用TBNA的c-N分期准确率达86.7％(13／15)。所有患者均未出现严重并发症。 结论: 经TBNA对NSCLC进行纵隔再分期准确率高,安全性高,具有一定的临床实用价值。     

经纤支镜纵隔淋巴结针吸活检对肺癌TNM分期诊断中的应用

目的　探讨经纤维支气管镜 (纤支镜 )纵隔淋巴结针吸活检在肺癌TNM分期诊断中的作用和效果。方法　运用Wang氏纵隔淋巴结穿刺定位方法 ,结合CT片对纵隔淋巴结进行定位 ,在常规纤支镜检查中分别对 5 0例 77组淋巴结进行针吸活检。结果　经纤支镜针吸活检 (TBNA)的诊断率为 61.5 %,与CT引导下检查的结果相似。所有患者均无明显并发症。结论　运用Wang氏定位方法对纵隔淋巴结行TBNA检查方便 ,安全 ,诊断率高 ,可作为肺癌TNM病理分期的首选方法     

Intraoperative complications of outpatient interval tubal sterilization at a teaching hospital in Turkey

OBJECTIVE: To evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. METHODS: The data of 461 patients who underwent interval tubal ligation (ITL) at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique, and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or who had a complication and/or an unplanned laparotomy were analyzed. RESULTS: The mean age of patients was 35.1 (range: 21-51), gravidity was 4.6 (range: 2-9), parity was 3.2 (range: 2-7), and number of living children was 3.1 (range: 2-6). Out of 461 patients, only 2 (0.4%) had complications related with general anesthesia. Two cases (0.4%) had bleeding from the port-site, 3 cases (0.6%) had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding (0.2%) and one case had bleeding (0.2%) from the vaginal wall. There was only one (0.2%) intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1%, and all the complications were encountered in patients who had laparoscopic surgery. CONCLUSION: Outpatient tubal ligation is a convenient and safe procedure, and implementing endoscopic surgical techniques is necessary for correction of the complications.     

Upper gastrointestinal endoscopy in children

The purpose of this paper is to study the use of upper gastrointestinal (Gl) fiberoptic endoscopy in children. Two hundred consecutive patients referred to one of the authors were reviewed. The indications for performing upper gastrointestinal endoscopy in these 200 patients were: (1) recurrent abdominal pain (46.5%), (2) persistent vomiting (14.5%), (3) haematemesis (14.5%), (4) acute abdominal pain (13%) and (5) other indications such as foreign body removal, failure to thrive and unexplained chest pain (11.5%). The endoscopy was performed with the Olympus P3 or Olympus XP-10 gastroscopes. The sedation used was a combination of intravenous pethidine (2mg/kg) and diazepam (0.5 mg/kg). Among the patients with recurrent abdominal pain, upper Gl endoscopy showed duodenal ulcer in 7 patients (7.5%), duodenitis in 4 (4.3%), oesophagitis in 4 (4.3%) and gastric ulcer in 2 (2.2%). The rest of the patients were normal (81.7%). With regard to persistent vomiting, 37.9% of the patients showed gastroesophageal reflux and 6.9% had a hiatus hernia. Of 29 patients examined endoscopically for upper Gl bleeding, no focus of bleeding was identified in 27.6%. The remaining 72.4% were bleeding from acute gastric erosion (27.6%), oesophagitis (17.2%), oesophageal varices (13.8%), duodenal ulcer (10.3%) and Mallory-Weiss tear (3.5%). The Majority of the patients with acute abdominal pain were normal endoscopically (61.5%). The two common abnormal findings were acute gastritis (27.0%) and acute duodenitis (11.5%). No major complications were encountered during the procedure in these 200 patients. It was concluded that upper Gl endoscopy is useful for defining upper Gl mucosal pathology. The procedure can be performed safely in children under sedation.     

经支气管镜针吸活检术在肺部及纵隔疾病诊断中的价值

目的探讨经支气管镜针吸活检术（TBNA）对纵隔及肺门肿大淋巴结的诊断价值,评估其安全性。方法选择胸部CT检查发现纵隔、肺门淋巴结肿大、估计气管镜检查不能发现气道内新生物的患者,采用TBNA技术进行检查,观察其诊断的阳性率及并发症。结果 84例患者中57例诊断为肺癌,13例诊断为结节病,3例诊断为肺结核,1例诊断为恶性淋巴瘤,10例最终无明确诊断。84例患者共穿刺136组淋巴结,其中TBNA阳性结果69例（82.14%）。TBNA联合黏膜活检及肺泡灌洗等方法的阳性率（88.1%）高于单行TBNA（82.1%）,但差异无统计学意义（P=0.252）。TBNA阳性率与淋巴结大小相关（P〈0.05）。有1例患者穿刺中出现大出血,其余均为少量出血,无其他并发症。结论 TBNA对纵隔、肺门淋巴结肿大的诊断具有重要的应用价值,对肺癌的诊断和分期有很大的帮助,对肺部良性病变的诊断亦有一定价值,其安全性高,操作简单,费用低,值得临床推广应用。     

气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值

目的 研究气管内超声实时引导经支气管针吸术(EBUS-TBNA)对肺癌纵隔和肺门淋巴结的诊断价值及安全性.方法 2008年7-12月,对25例[男18例,女7例,年龄(68±9)岁]诊断为肺癌或疑为肺癌且CT检查显示纵隔或肺门淋巴结肿大患者的28组淋巴结行EBUS-TBNA(EBUS-TBNA组).以2008年1-月由同一操作者因相同适应证而进行常规经支气管针吸术(C-TBNA)的26例患者[男18例,女8例,年龄(66±8)岁)]的28组淋巴结为对照(C-TBNA组).以穿刺针抽吸物检查找到特异性细胞物质或淋巴细胞为阳性结果.比较2组的诊断阳性率及并发症发生情况.结果 EBUS-TBNA组诊断阳性率为92.9%(26/28),明显高于C-TBNA组(60.7%,17/28,χ2=8.114,P=0.004).2组均未发现气胸、气道撕裂、出血(>5 ml)等并发症.结论 气管内超声实时引导可显著提高经支气管针吸术对肺癌患者纵隔和肺门淋巴结的诊断阳性率,且安全性高,应进一步开展应用研究.     

气管镜针吸活检联合刷检在诊断纵隔、肺部肿瘤中的作用

目的 探讨经气管镜行纵隔淋巴结及肺部肿瘤针吸活检联合刷检的诊断作用.方法 对经CT检查的67例纵隔淋巴结肿大和(或)叶、段支气管腔外占位的患者通过经气管镜行针吸活检和刷检并与传统的常规钳取活检对照.结果 针吸阳性诊断率为74.63%,针吸联合刷检阳性诊断率82.09%;常规钳取阳性诊断率17.91%.单纯针吸和针吸联合刷检诊断率均高于常规活检(P＜0.01).结论 经气管镜针吸活检术是一种简便、安全、阳性率高的检查技术.     

Outpatient diagnostic hysteroscopy: analysis of 429 cases

OBJECTIVE: To evaluate the diagnostic accuracy of outpatient hysteroscopy. METHODS: Outpatient CO2 hysteroscopy using video-camera for monitoring was performed on 429 patients from November 1995 to December 1996. The indications included post-menopausal bleeding (32.2%), menorrhagia (25.4%), irregular bleeding (24.7%), intermenstrual spotting (10.2%) and others (7.5%). RESULTS: Hysteroscopy was successfully performed on 420 (97.9%) patients. Although no anaesthetics were used, only two (0.47%) patients complained of severe pain during the procedure. Twenty-one (4.9%) patients had poor view due to submucosal fibroid or bloody view. There were no operative complications. Normal uterine cavity was found in 36.8% and atrophic endometrium in 34.7% of patients. The pathologies included submucosal fibroid (10.7%), endometrial polyp (5.8%) and fibroid polyp (2.8%). Five (1.2%) out of 429 patients were confirmed histologically to have endometrial carcinoma. No malignant lesions were missed. A total of 372 (86.7%) patients had histological confirmation of hysteroscopic findings. In 57 (13.2%) patients, the histological results did not correlate with the hysteroscopic findings. CONCLUSIONS: Outpatient hysteroscopy and suction curettage is a safe, cost-effective and acceptable procedure.     

经支气管针吸活检对肺癌术前TNM分期与术后分期的对比分析

目的探讨经支气管针吸活检(TBNA)在肺癌分期中的临床应用价值。方法对2002年1月至2004年8月间术前胸部CT疑有淋巴结转移的46例肺癌病人行TBNA检查94组纵隔淋巴结并与术后病理检查结果进行对比。结果术前TBNA后cTNM分期与术后pTNM分期对比正确率达86.9%(40/46),全组病人TBNA后均未发生严重并发症。结论经TBNA进行肺癌分期方法简便、安全,经济实用,分期正确率高,具有较高的临床实用价值。     

选择性和非选择性分流术控制食管曲张静脉出血的结果

我们自1980年1月至1985年12月使用分流术治疗门静脉高压症伴食管曲张静脉出血41例,其中一组行非选择性肠-腔桥式分流术12例;另一组行选择性远端脾肾静脉分流术29例。两组患者的临床和实验室检查资料以及肝功能分级情况无明显差异。治疗结果非选择性分流组术后1例死亡,经随诊平均59.5月复发出血率27.3%,肝性脑病率9.1%,1～5年生存率90.9%;选择性分流组亦1例术后死亡,随诊平均33.4月,复发出血率3.6%,无脑病发生,1～5年均存活。从治疗效果看选择性分流优于非选择性分流。本文还对治疗方法选择的认识,施行远端脾肾静脉分流术的体会和理想手术方法等问题进行了初步探讨。     

经纤维支气管镜纵隔淋巴结针吸活检对肺癌的诊断价值及其分期和安全性评价

目的探讨经纤维支气管镜针吸活检(transbronchial needle aspiration,TBNA)技术的安全性及应用价值.方法在CT定位下,对手术前伴有纵隔淋巴结肿大的32例肺癌患者进行TBNA检查,并与开胸手术结果比较.结果32例纵隔淋巴结穿刺活检患者,阳性17例(53%),11例假阴性,TNM分期符合率62.5%.只有1例手术后有少量咯血,无气胸及其他严重并发症发生.结论TBNA对肺癌的诊断和TNM分期有较高的应用价值,无严重并发症.     

选择性球囊阻断术在救治腹腔动脉-肝动脉破裂大出血的应用

内脏动脉破裂大出血可导致急性循环衰竭。用血管内球囊阻断术可迅速控制出血、为后续治疗创造条件。 作者报道2例胰-十二指肠切除术后出血患者,在做血管造影术中发生大出血、失血性休克,造影证实为腹腔动脉-肝动脉破裂,不适宜做常规栓塞治疗。通过8F导管鞘、将直径12mm的专用阻断球囊选择性插入至腹腔动脉,使出血立刻停止,经输血、补液后纠正休克。随后1例患者在持续球囊阻断下进行了手术修补、1例患者做覆膜支架置入术。2例均救治成功。 结论：选择性血管内球囊阻断术是救治凶险性内脏动脉破裂大出血的快捷有效技术,可为后续治疗赢得时间。     

Local experience in paediatric flexible bronchoscopy

All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.     

宫颈环形电切术治疗宫颈病变的临床观察

目的：探讨宫颈环形电切术(LEEP)冶疗宫颈病变的效果。方法：应用宫颈环形电切术，对143例宫颈病变患者进行治疗，并对其疗效进行回顾性分析。结果：宫颈环形电切术治疗宫颈病变的成功率96．5％(138／143)．手术时间平均为8.4min，术中出血量平均为9ml。结论：宫颈环形电切术治疗操作简单、安全、成功率高。