肺气肿肺减容术对同侧和对侧肺叶的影响

摘要目的研究肺减容术治疗肺气肿对同侧和对侧肺叶的容积及密度产生的影响。方法本研究包括经支气管镜肺减容术的289例不均匀性肺气肿病人以及132例未经治疗的对照组病人,根据CT图像评估肺叶的容积和透亮度的改变。采用回归分析(Spearman’sρ)观察病变肺叶容积与其他肺叶容积和密度变化的相关性。     

呼吸系统疾病的非血管介入治疗

复习近年文献中有关呼吸系统疾病非血管介入治疗的技术和方法 .气道内金属支架植入可以迅速解除患者的气道阻塞、改善呼吸,由于植入后再狭窄的发生率较高,因此,对于良性疾病是否采用金属支架植入疗法仍持慎重态度.与传统的肺减容术相比,经支气管镜肺减容术是一种有效、安全、微创的治疗方法 ,其临床应用有待于进一步研究.经支气管镜介入治疗支气管瘘,为该类患者提供了除外科手术以外的有效治疗手段.B超或CT引导下经皮肺穿刺技术已经逐步应用于肺部一些良、恶性疾病的治疗,取得了一定的疗效.     

肺减容术治疗肺气肿的新进展

对肺气肿(COPD)采用手术治疗是由Brantigan等〔1〕1957年首先报道。切除部分肺组织,可使胸腔压力下降,肺功能获得明显改善,用以治疗严重肺气肿,这种手术称为肺减容术。近几年来,肺减容术已取得令人鼓舞的效果,现结合文献,对肺减容术的术式、效果、机制及存在问题进行综述。1　肺减容术的术式及效果1.1　手术切除　Brantigan等1957〔1〕年首先报道,肺减容术治疗肺气肿,其临床症状改善率75%,但由于病死率高达16%,故未能普及推广。Cooper等〔2〕1995年对Brantigan术式进行了改进,采用胸骨正中切开术,使用牛心包加固在纤维包扎线上面,防止手…     

定量CT在肺减容术中的应用

肺减容术是近年兴起的姑息性治疗终末期肺气肿的外科方式。定量CT可以准确、高效地评估肺气肿。介绍定量CT的新进展及其在肺减容术中的应用、临床意义和优点,并展望定量CT的应用前景。     

定量CT在肺减容术中的应用

肺减容术是近年兴起的姑息性治疗终末期肺气肿的外科方式.定量CT可以准确、高效地评估肺气肿.介绍定量CT的新进展及其在肺减容术中的应用、临床意义和优点,并展望定量CT的应用前景.     

微创肺减容术的研究进展

肺减容是指去除过度充气的肺组织,以使剩余肺实质及呼吸肌的功能恢复。自Cooper于1995年首先将外科肺减容术（lung volume reduction surgery,LVRS）应用于治疗重度肺气肿以来,大量的临床研究已经证实其有效性。其作用机理主要是：切除严重病变的肺组织,使肺的弹性回缩力增加;膈肌上升,以膈肌为主的呼吸肌恢复正常的收缩状态,     

支气管镜肺减容术的研究现状

经支气管镜肺减容术(BLVR)是基于肺减容术(LVRS)治疗肺气肿的理论,目前仍处于实验和临床试用阶段,许多问题还有待阐明。BLVR的治疗机制主要包括肺萎陷、局灶性纤维化、通气血流再分布、呼吸力学优化等。对手术靶区的选择,目前基本上限于上叶或者病变破坏严重的肺段。手术方法应用较多的是经支气管镜向靶区引流支气管放置单向阀。临床效果,近期疗效尚满意。     

支气管、肺动脉双袖式肺癌肺叶切除

支气管成形肺癌肺叶切除术治疗效果的优越,使其价值已被肯定,近年来得到普遍而迅速地发展。但受病变局部条件的限制,使这一手术占总的肺切除术的比例仍未超过10％。尤其当肺动脉被肿瘤侵犯时,往往不能行支气管袖式切除或常规肺叶切除。我院最近对两例上叶肺癌侵犯主支气管及肺动脉主干包括上、下干的病例,行支气管、肺动脉双袖式肺叶切除,术后经过良好。报告如下:     

肺隔离症的CT诊断与鉴别诊断

肺隔离症又称支气管肺隔离症，为胚胎时期一部分肺组织和正常非组织分离而单独发育。与正常支气管树不相通，而且其血供来自体循环的异常分支。引流静脉可经肺静脉、下腔静脉或奇静脉回流。可分为肺叶内型和肺叶外型。     

功能性肺叶切除术的初步研究

目的通过动物实验研究功能性肺叶切除的可行性。方法健康犬12只,随机分成3组,每组4只。A组行靶肺支气管肺泡灌注碘化油平阳霉素及靶支气管聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)堵塞;B组行靶支气管PMMA栓塞;C组行肺叶切除。分析各组术前、术后即刻、术后1～4周的动脉血气,4周后作胸部X线、组织病理学检查及靶肺组织细菌学培养。结果3组动物术后动脉氧分压低于术前(P<0.01),术后动脉CO2分压显著高于术前(P<0.01),术后1周后动脉血气恢复正常,与术前差异无显著性意义(P>0.05);术后第4周肺部摄片及大体标本见实验组靶肺肺不张形成,组织病理学显示靶肺呈纤维化改变,靶肺组织细菌学培养阴性。B组有2例肺不张形成,靶肺未见明显纤维化。结论通过靶肺支气管肺泡灌注及靶支气管堵塞可使靶肺形成肺不张、纤维化,达到功能性肺叶切除术目的。该术式创伤小,安全、有效,有望部分替代外科性肺叶切除。     

自制气道封堵器在经支气管镜肺减容术中的应用

目的 探讨自制内塞式支气管封堵器在经支气管镜肺减容术(BLVR)中的应用效果.方法 选择2例稳定期重度慢性阻塞性肺疾病(COPD)患者,在支气管镜引导下于靶位支气管置入1或2枚自制的镍钛合金封堵器,比较患者术前、术后7个月的肺功能、动脉血气、圣·乔治呼吸疾病问卷(SGRQ)、胸部CT及并发症等指标的差异,评价BLVR的疗效.结果 置入的封堵器无一脱落或移位;局部黏膜仅见轻度肉芽组织增生;被封堵的靶位肺组织出现不张或膨胀不全.术前和术后7个月,病例1、2的静态肺容积(VC)分别从3.08L上升至3.57L,2.19L上升至2.58L;用力肺活量(FVC)分别从2.87L上升至3.57L,2.60L上升至2.58L;SGRQ调查显示患者的呼吸困难症状显著改善,分值分别从62降低至26,48降低至23;但动脉氧分压提高均不明显.2例患者均未发生阻塞性肺炎、气胸等严重并发症.结论 本课题组自行研制的封堵器在两例重度COPD患者中初步应用已显示出其置入简便、稳定性好、封堵效果确实、并发症少的优点,能够达到肺减容及改善肺功能的目的.     

Intensity modulation with respiratory gating for radiotherapy of the pleural space.

We wanted to describe a technique for the implementation of intensity-modulated radiotherapy (IMRT) with a real-time position monitor (RPM) respiratory gating system for the treatment of pleural space with intact lung. The technique is illustrated by a case of pediatric osteosarcoma, metastatic to the pleura of the right lung. The patient was simulated in the supine position where a breathing tracer and computed tomography (CT) scans synchronized at end expiration were acquired using the RPM system. The gated CT images were used to define target volumes and critical structures. Right pleural gated IMRT delivered at end expiration was prescribed to a dose of 44 Gy, with 55 Gy delivered to areas of higher risk via simultaneous integrated boost (SIB) technique. IMRT was necessary to avoid exceeding the tolerance of intact lung. Although very good coverage of the target volume was achieved with a shell-shaped dose distribution, dose over the targets was relatively inhomogeneous. Portions of target volumes necessarily intruded into the right lung, the liver, and right kidney, limiting the degree of normal tissue sparing that could be achieved. The radiation doses to critical structures were acceptable and well tolerated. With intact lung, delivering a relatively high dose to the pleura with acceptable doses to surrounding normal tissues using respiratory gated pleural IMRT is feasible. Treatment delivery during a limited part of the respiratory cycle allows for reduced CT target volume motion errors, with reduction in the portion of the planning margin that accounts for respiratory motion, and subsequent increase in the therapeutic ratio.     

自制支气管封堵器介入性肺叶切除实验研究

目的:探讨运用自制支气管封堵器行介入性肺叶切除的可行性.方法::健康犬12只随机分成3组,每组4只,A、B 组行靶肺支气管肺泡灌注平阳霉素-碘化油乳剂,A组用支气管封堵器堵塞靶支气管,B组用骨水泥堵塞靶支气管,C组为空白对照组.分别于术后28d及56d取肺组织,测定肺纤维化的程度.结果:A、B组动物均示肺不张形成,组织病理学显示靶肺呈纤维化改变;A、B组非靶肺与C组双肺均未见明显纤维化.结论:通过支气管肺泡灌注平阳霉素-碘化油乳剂后堵塞靶支气管可达到介入性肺叶切除目的,其中使用国产支气管封堵器比骨水泥行介入性肺叶切除术更方便,是一种安全简便的方法.     

胸腔镜肺减容术治疗重度肺气肿24例

目的探讨胸腔镜肺减容手术对重度肺气肿的治疗价值。方法对24例重度肺气肿患者行胸腔镜肺减容术。根据CT确定的靶区位置的不同,上下调整1个肋间切口位置。从后操作孔置入卵圆钳提起气肿性肺组织,前操作孔用45 mm Endo-G IA,沿预先设计的切割线围绕肺叶作∪或∩形的切割边缘。总肺减容组织在20%~30%。结果术后1个月肺部感染致呼吸衰竭2例,其中1例死亡,余呼吸困难明显减轻或消失。呼吸困难指数分级,Ⅰ级3例,Ⅱ级9例,Ⅴ级1例。获得6个月随访的15例病人肺功能均较术前显著改善。结论胸腔镜肺减容手术与开胸手术减容比较,效果类似,但胸腔镜肺减容术创伤小、恢复快,更安全。     

Emerging roles for transthoracic ultrasonography in pulmonary diseases

As a result of many advantages such as the absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this second part of a comprehensive review that deals with the role of TUS in pleuropulmonary pathology, the normal findings, sonographic artifacts and morphology of the most important and frequent pulmonary diseases are described. In particular, the usefulness of TUS in diagnosing or raising suspicion of pneumonia, pulmonary embolism, atelectasis, diffuse parenchymal diseases, adult and newborn respiratory distress syndrome, lung cancer and lung metastases are discussed, as well as its role in guidance for diagnostic and therapeutic interventional procedures. Moreover, the preliminary data about the role of contrast enhanced ultrasonography in the study of pulmonary pleural-based lesions are also reported. Finally, the limits of TUS when compared with chest computed tomography are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.     

急性大咯血的介入治疗

目的探讨介入治疗大咯血的临床价值。 方法回顾性分析27例咯血保守治疗无效行介入治疗患者的资料。包括支气管扩张（5例）、肺癌（10例）和肺结核（12例）。采用明胶海绵和聚乙烯醇颗粒进行支气管动脉栓塞治疗。 结果治疗后27例患者出血明显减少;2例患者1周后又出现大咯血,治疗失败。治疗有效率92.59%(25/27)。 结论支气管动脉栓塞术是急性大咯血安全、方便、有效的治疗方法。     

肺癌血管造影表现及临床意义

目的：研究肺癌的肿瘤血管形态，指导肺癌的诊断和介入治疗。材料和方法：对１００例肺癌病人在治疗前行支气管动脉ＤＳＡ，其中２０例同时作了肺动脉ＤＳＡ。结果：①肺癌的血供来自支气管动脉；②供血的支气管动脉增粗；③出现肿瘤血管和肿瘤染色；④少数病例可见支气管动脉与肺动脉或肺静脉直接交通；⑤纵膈或肺门淋巴结显影。表现与原发癌相似。结论：肺癌的介入治疗应选择支气管动脉为靶血管，不但要进行灌注化疗，而且要栓塞支气管动脉以阻断肿瘤的血供和异常交通，不但要栓塞原发瘤的供血动脉也要栓塞转移淋巴结的供血动脉。     

Assessment of lung volumes in pulmonary emphysema using multidetector helical CT: comparison with pulmonary function tests.

The purpose of this study is to evaluate the usefulness of multidetector helical CT (MDCT) with three-dimensional (3D) postprocessing for assessing the lung volume at inspiration and expiration of the pulmonary emphysema and for comparing it with pulmonary function tests. Percentage lung volume at the threshold of -930, -900, -810, -790, and -770 at expiration showed good correlation with FEV1, FEV1/FVC, and DLCO/Va. Excellent correlation was observed between percentage lung volume at the threshold of -900 and FEV1/FVC. CT densitometry at expiration showed better correlation than that at inspiration with pulmonary function tests. MDCT with 3D technique is useful for assessing the severity of pulmonary emphysema.     

介入性肺叶切除术的实验研究

目的通过动物实验研究介入性肺叶切除的可行性。方法健康犬12只,随机分成3组,每组4只,A组行靶肺支气管肺泡灌注碘化油、肺泡上皮细胞毁损混合剂及靶支气管聚甲基丙烯酸甲酯(PMMA)堵塞;B组行靶支气管PMMA栓塞,C组行肺叶切除。分析各组术前、术后即时、术后1~4周的动脉血气,4周后作胸部X线、组织病理学检查及靶肺组织细菌学培养。结果3组动物术后即时动脉血氧分压(PaO2)低于术前(P<0.01),动脉血CO2分压(PaCO2)显著高于术前(P<0.01);术后1周动脉血气恢复正常,与术前无显著差异(P>0.05);术后第4周肺部摄片及大体标本见实验组靶肺肺不张形成,组织病理学显示靶肺呈纤维化改变,靶肺组织细菌学培养阴性。B组有2例肺不张形成,靶肺未见明显纤维化。结论通过靶肺支气管肺泡灌注及靶支气管堵塞可使靶肺形成肺不张、纤维化,达到介入性肺叶切除术目的。