选择性支气管封堵术治疗18例难治性气胸的临床体会

目的 探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法 选取我院2013年8月至2015年8月期间18例难治性气胸患者,进行球囊探查加选择性支气管封堵术治疗.在常规电子支气管镜检查基础上采用双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探查定位,然后经双腔导管确认的目标支气管注入不同剂量的自身全血加凝血酶,观察是否成功封堵及相关并发症.结果 16例成功定位引流支气管,2例无法探查到引流支气管.对16例球囊探查成功者顺利施行自体血封堵术,首次封堵成功13例,其中3例于72 h内复发,对该3例行第2次封堵后2例成功,另1例封堵失败患者转入胸外科行手术治疗.封堵术最终成功并顺利拔出胸腔引流管12例,失败4例.在失败的4例中l例患者签字带管出院(跟踪随访半月,胸腔引流瓶内未见气泡逸出,复查胸片提示肺复张,遂拔出胸腔引流管);另外3例未探查到引流支气管,其中2例转入胸外科行手术治疗.结论 球囊探查加选择性支气管封堵术是治疗难治性气胸安全、有效、可行的介入治疗方法.     

球囊探查加选择性支气管封堵术与凝血酶胸膜腔粘连术治疗难治性气胸的疗效比较

目的比较球囊探查加选择性支气管封堵术与凝血酶胸膜腔粘连术治疗难治性气胸的疗效。方法选取该院呼吸内科2006-01~2016-04经胸腔穿刺及胸腔置管引流术、负压吸引等措施7~14 d后自发性气胸仍未愈合的难治性气胸患者71例,接受球囊探查加选择性支气管封堵术26例,凝血酶胸膜腔粘连术45例(两法重合4例),比较两种方法疗效及不良反应。结果球囊探查加封堵术组成功率为69.2%(18/26),凝血酶胸膜腔粘连术组成功率为48.9%(22/45);球囊探查加封堵术组有效率为84.6%(22/26),凝血酶胸膜腔粘连术组有效率为71.1%(32/45)。球囊探查加选择性支气管封堵术组疗效优于凝血酶胸膜腔粘连术组,差异具有统计学意义(P0.05)。结论两种方法治疗难治性气胸均安全、有效,尤其适用于全身情况差、肺功能明显减退以及不愿接受手术者,但球囊探查加选择性支气管封堵术疗效优于凝血酶胸膜腔粘连术。     

改良式球囊探查及支气管封堵术治疗难治性气胸1例及文献复习

目的 寻找难治性气胸新的治疗途径.方法 应用三腔球囊取石导管探查引流支气管,应用自体静脉血及凝血酶选择性封堵引流支气管.结果 成功封堵支气管胸膜瘘.结论 应用球囊探查及选择性支气管封堵术是治疗难治性气胸安全、可行的方法.     

先天性心脏病介入治离的严重并发症分析及其防治

目的;探讨先天性心脏病(先心病)介入治疗中和治疗后严重并发症的发生率、原因及防治措施.方法对2 318例4种常见先心病施行了介入治疗,其中动脉导管未闭(PDA)封堵术850例(PDA封堵术组);房间隔缺损（ASD)封堵术818例(ASD封堵术组);肺动脉瓣球囊成形术548例(肺动脉瓣囊成形术组);室间隔缺损封堵术102例(室间隔缺损封堵术组).对介入治疗中和治疗后发生的34例严重并发和2例死亡的患者作回顾性分析.结果严重并发症总发生率为1.47％(34/2 318),其中PDA 封堵组为1.41％(12/850);ASD封堵组为1.47%(12/818);肺动脉瓣球囊成形术组为0.91%(5/548);室间隔缺损封堵术组为4.90%(5/102).总死亡率为0.09%(2/2 318),均为肺动脉瓣球囊成形术组036%(2/548);紧急手术为0.35％(8/2 318),择期手术为0.13％(3/2 318).结论先心病介入治疗是一种安全、有效、严重并发症及死亡率低的非手术方法.术后应作严格随访,尤其警惕ASD封堵术后晚期并发症的发生.     

选择性支气管封堵术在难治性气胸治疗中的应用

目的评价选择性支气管封堵术在难治性气胸治疗中的应用价值。方法 2010年1月至2015年1月共有26例难治性气胸患者于本院行选择性支气管封堵术,在支气管镜下寻找胸膜瘘口所属支气管,局部注入纤维蛋白原加凝血酶。观察疗效及并发症。结果 26例患者中,21例第1次封堵成功,2例第2次封堵成功,3例转胸外科行外科手术治疗,最终封堵成功率为88.5%(23/26)。术后复查CT,均未发生肺不张。术中共有10例患者出现一过性SaO_2下降,均自行恢复。2例出现术后低热,经对症治疗后恢复。结论选择性支气管封堵术是治疗难治性气胸的安全有效的方法,值得临床推广。     

球囊扩张术治疗支气管结核气道狭窄的临床价值

目的 探讨经支气管镜球囊扩张术治疗支气管结核气道狭窄的临床应用价值.方法 北京市结核病胸部肿瘤研究所2005年1月至2009年9月经支气管镜球囊扩张术治疗149例支气管结核气道狭窄患者,其中男18例,女131例;年龄16-59岁,平均(32±9)岁.回顾性分析患者治疗前后的临床表现、气道直径及肺复张情况.结果 支气管结核的临床表现不典型,且合并气道狭窄等重症患者较为多见.经球囊扩张后气道直径即刻均有不同程度的增加,狭窄段气道直径由扩张前的(2.7±1.4)mm增至扩张结束时的(6.8±2.0)mm,扩张后3个月和12个月随访时气道直径仍为(6.4±1.7)mm和(6.3±2.3)mm.患者的阻塞性肺炎等症状随气道通畅而缓解或消失.扩张结束后12个月随访结果表明,37例肺不张患者中34例肺复张,再狭窄发生率为3.4%(5/146).治疗前与治疗后3个时段比较,患者气道内径变化和肺复张的差异均有统计学意义(t值为13.09-20.50,均P<0.01),治疗后12个月各项随访结果与治疗结束时和治疗后3个月比较均无明显差别.本组球囊扩张术的成功率为93.3%(139/149),失败率为6.7%(10/149),严重并发症发生率仅为4.0%(6/149).结论 经支气管镜球囊扩张术治疗支气管结核气道狭窄是一种安全、有效的治疗手段.     

老年胆总管结石患者腹腔镜胆总管探查术后一期缝合与T管引流疗效比较

目的比较腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后一期缝合与T管引流治疗老年胆总管结石患者的临床疗效.方法回顾分析2011-2016年67例接受腹腔镜下胆总管探查术的老年胆总管结石患者的临床资料,其中34例行一期缝合,33例放置T管引流,分析比较两种手术方式的安全性及术后并发症情况.结果两组手术时间、术中出血量及腹腔引流管拔除时间均无统计学差异(P0.05),而一期缝合组肛门排气时间(2.0 d±0.6 d)、术后住院时间(9.6 d±2.2 d)明显短于T管引流组(P0.05).两组术后并发症发生率无统计学差异(P0.05),其中一期缝合组患者术后出现胆漏1例、结石复发1例,T管引流组术后出现水电解质紊乱2例、残余结石1例.结论对于老年胆总管结石患者,在LCBDE后,如严格掌握适应证、操作技术熟练,一期缝合是安全、有效的,且相对T管引流,患者的生活质量较高.     

药物涂层球囊在急性ST段抬高型心肌梗死中应用的有效性及安全性研究

目的探讨药物涂层球囊在急性ST段抬高型心肌梗死(STEMI)患者中应用的有效性及安全性。方法回顾性分析阜外华中心血管病医院明确诊断为STEMI并接受急诊介入治疗及有效随访患者106例,其中34例给予药物涂层球囊(DCB)治疗,72例给予药物洗脱支架(DES)治疗,随访 10个月并复查冠状动脉(冠脉)造影,比较两组靶病变再血管化率(TLR)、靶血管再血管化率(TVR)、晚期管腔直径丢失率(LLL)及再发心绞痛、再发心肌梗死、心源性死亡、卒中等不良事件发生率。结果两组均无TVR事件发生,TLR相比无显著差异(2.9% vs.2.8%,P0.05),晚期管腔直径丢失DCB组优于DES组[-(0.037±0.071)mm vs.(0.135±0.358)mm,P0.05],差异有统计学意义,复查冠脉造影DCB组晚期最小管腔直径获得优于DES组,差异无统计学意义[(0.033±0.132)mm vs.-(0.041±0.535)mm,P0.05],DCB组术后即刻残余狭窄劣于DES组[(9.76±5.064)% vs.(2.26±3.206)%,P0.05],差异有统计学意义。结论药物涂层球囊在STEMI患者中的应用有效且相对安全。     

纤支镜下球囊扩张治疗结核性支气管狭窄的研究

目的评价纤支镜下球囊扩张治疗结核性支气管狭窄的效果和安全性。方法回顾性分析25例纤支镜下行球囊扩张的结核性支气管狭窄患者,于术前和最后一次球囊扩张当天估计狭窄段的气道直径,密切随访,评价其长期和短期疗效。结果25例结核性支气管狭窄的患者分别接受球囊扩张2～7次,平均(3.2±1.5)次。经过球囊扩张后,狭窄段支气管管腔明显增大,由术前的(2.8±1.1mm)增加为术后的(6.7±2.3mm)(P<0.01),短期疗效达100%。所有患者术中均未发生严重并发症。经过2～36个月的随访,未发生狭窄段的再狭窄。11例出现肺不张的患者,球囊扩张后完全复张2例。结论纤支镜下球囊扩张治疗结核性支气管狭窄具有有效、安全和简便等优点。     

支气管肺泡灌洗治疗老年重症肺炎合并呼吸衰竭的临床疗效

目的观察支气管肺泡灌洗术辅助治疗老年重症肺炎合并呼吸衰竭的临床疗效。方法将入选的90例患者随机分为观察组(46例)与对照组(44例),观察组予常规治疗,对照组在此基础上加用支气管肺泡灌洗术3～5次,对比两组患者治疗后动脉血气分析指标及临床疗效。结果①治疗72 h后,两组患者ApacheⅡ评分、SaO2、PaO2、PaCO2等均明显改善,观察组改善情况优于对照组(P<0.05);②治疗10d后,观察组显效率(45.7%)与总体有效率(84.8%)均高于对照组(22.7%、65.9%)(P<0.05)。结论支气管肺泡灌洗治疗老年重症肺炎合并呼衰能明显改善临床疗效,降低有创通气比例与病死率。     

Transbronchoscopic selective bronchial occlusion for intractable pneumothorax

Background and objective: The aim of this study was to evaluate the efficacy, complications and safety of the application of transbronchoscopic balloon detection (TBD) and selective bronchial occlusion (SBO) to intractable pneumothorax. Methods: Forty patients with pneumothorax, who had experienced more than 7 days of chest tube drainage without closure of the pleural fistula, underwent TBD and SBO. In 10 patients, oxygenation and pulse rates were recorded. A thoracic CT scan was performed 10 days after SBO. Results: The bronchi leading to the pleural fistula were located by TBD in 34 of 40 patients (85%). The air leakages ceased after the first occlusion in 30 patients, and five of these 30 patients underwent a second occlusion due to recurrence of pneumothorax 72 h after the first occlusion. In three of these patients, air leakages ceased after the second occlusion, while the remaining two patients underwent thoracoscopy. In total, 28 of 40 patients (70%) were cured using SBO. During TBD/SBO, the lowest SaO2 was 89.0 ± 2.8%, the mean SaO2 was 93.4 ± 2. 6% and the percentage of time during the procedure that SaO2 was <90% was 10.7 ± 17.5%. Ten days after SBO, thoracic CT scans were performed on 10 patients and no obstructive atelectasis was detected in any patient. Conclusions: These results indicate that TBD and SBO are safe and effective procedures for treating patients with intractable pneumothorax.     

胸膜疾病纤维支气管镜胸腔诊治的应用价值

目的　探讨纤支镜代胸腔镜诊治胸膜疾病的临床应用价值。方法 对25例自发性气胸和22例胸腔积液患者在局麻下用纤支镜行开放式胸腔检查治疗术。结果 胸腔积液患者的诊断率为95.4%(21/22),包括胸膜转移癌11例,胸膜间皮瘤1例,胸膜结核6例,脓胸3例,气胸患者中13例寻找到肺大疱或胸膜破口,而48%(12例)镜下未见明显异常。结论 局麻下纤支镜代胸腔镜术安全、简便,可直视下观察胸腔病变并进行活检,有利明确积液病因,对脓胸和自发性气胸的诊治也有较大的意义。     

负压吸引下自体血胸腔粘连术治疗难治性气胸临床研究

目的总结持续胸膜腔负压吸引下利用自体血治疗难治性气胸的疗效。方法对18例难治性气胸患者在持续负压吸引下一次性胸腔内注射自体静脉血60~100 m l。结果18例难治性气胸中有17例成功,1例失败,成功率为94.4%,不良反应低。结论负压吸引下胸腔内注射自体血治疗难治性气胸疗效确切,适用于基层医疗机构使用。     

白蛋白泡沫定位气胸肺漏气支气管的临床应用

目的 探讨经气道人体白蛋白泡沫定位肺漏气支气管的方法,并评价其效果及安全性.方法 29例气胸患者,在纤维支气管镜直视下,人体白蛋白泡沫靶支气管内注射,定位肺漏气所属支气管.结果 29例患者肺漏气支气管均定位成功,从泡沫注射至确定肺漏气支气管定位所需平均时间为(4.0±1.2)min,20%人体白蛋白用量平均(8.0±2.6)ml/例.医用生物蛋白胶封堵成功21例,α-氰基丙烯酸酯封堵成功8例.并发症:剧烈咳嗽6例,发热和胸腔出血各4例,胸痛1例.结论 人体白蛋白泡沫靶支气管内注射是一种操作简单、价格低廉、安全和有效的肺破裂支气管定位的方法.

Abstract：

Objective To evaluate the efficacy and safety of a new method to determine the bronchus for air leakage in pneumothorax by injection of human albumin foam.Methods In 29 cases with pneumothorax,the bronchus responsible for air leakage was localized by injecting foam of human albumin into target bronchus under direct view of bronehoscopy.Results The bronchus for air leakage was successfully localized in all the 29 cases of pneumothorax.The average time for locating(from injection of the foam to the localization of the bronchus)was(4.0±1.2)min.and the average amount of 20%human albumin used was(8.0±2.6)ml for each patient.The air leakage Was treated accordingly,and occlusion by fibrin glue was successfully carried out in 21 cases and by OB glue in 8 csses.Severe couth was noted in 6,fever in 4,thoracic bleeding in 4 cases,and chest pain in 1 case.Conclusion Injection of human albumin foam into target bronchus under bmnchoseopy was a simple,safe and effective method for the localization of the bronchus for air leakage in pneumothorax.     

福建省高致病性禽流感A/H5N1病毒感染并支气管胸膜瘘患者的救治体会

目的 总结重症高致病性禽流感A/H5N1病毒感染(简称人禽流感)患者的临床特点、治疗经验以及合并支气管胸膜瘘的处理方法.方法 对2007年2月福建省建瓯市立医院成功救治的1例重症人禽流感并发右侧支气管胸膜瘘患者的临床资料和诊治过程进行回顾性分析.结果 患者女,44岁,发病前3 d有病死鸡接触史,以发热、气促为主要症状,经呼吸道分泌物检测A/H5N1病毒核酸阳性确诊.患者住院第7天发展为急性呼吸窘迫综合征,病情重、进展快,病程中出现呼吸机相关肺炎、双侧气胸、右侧支气管胸膜瘘等多种并发症.经奥司他韦抗病毒、糖皮质激素抗炎、输注康复期血浆、机械通气、抗感染等治疗,病情有所缓解,但支气管胸膜瘘持续存在并形成脓胸,导致脱机困难.经纤维支气管镜下气囊探查加选择性支气管封堵术、经纤维支气管镜右侧支气管胸膜瘘OB胶粘堵术等介入治疗,患者痊愈,发病第99天出院.结论 人禽流感并发难治性支气管胸膜瘘患者在采取抗病毒、抗感染、机械通气支持、输注康复期血浆等综合治疗的基础上结合介入治疗是可行的.     

Aortic rupture and concomitant transection of the left bronchus after blunt chest trauma

We report a patient with traumatic aortic rupture and preoperatively unrecognized complete disruption of the bronchus for the left lower lobe. Preoperative state was complicated by inadequate oxygenation due to total atelectasis of the unventilated collapsed left lower lobe with consequent significant shunting of the unoxygenated blood. The patient had no massive pneumothorax because the intact peribronchial tissue and pleura covered the injured place, preventing important air leakage. The suspicion of possible concomitant tracheobronchial injury and early diagnostic bronchoscopy are important in patients with aortic rupture after blunt chest trauma.     

Treatment of spontaneous pneumothorax by electrocoagulation via a fiberoptic bronchoscope with a hysteroscope irrigation outer sheath as a thoracoscope

Since 1981 in Yamagata Prefectural Central Hospital, the authors performed electro-coagulation therapy for air leakage from bullae (blebs) via a rigid thoracoscope in 31 patients with spontaneous pneumothorax. Among these patients, this treatment was unsuccessful in 14 patients (45.2%) because of 5 multiple or giant bullae and 9 cases in which it was impossible to visualize the bullae in the mediastinum or because of pleural adhesion. In order to widen the visual field and increase the mobility of the thoracoscope, we employed a fiberoptic bronchoscope with a hysteroscope outer sheath used for irrigation as a flexible thoracoscope. This method makes it possible to examine both mediastinal pleura and adhesive pleural space, and to electrocoagulate bullae which cannot be visualized by a rigid thoracoscope. It was possible to visualize the blebs in all 13 cases with spontaneous pneumothorax in which this examination was attempted. This therapeutic procedure causes the patients less pain and the hospitals more economical because no new thoracoscope is necessary. This method of thoracoscopic therapy of spontaneous pneumothorax using a fiberoptic bronchoscope is more successful, effective, economical and painless than by rigid thoracoscope and should be attempted before thoracotomy.     

Endoscopic treatment of bronchus stump fistulae following pneumonectomy with fibrin sealant in domestic pigs

Occlusion of the transected bronchus after pneumonectomy was achieved by transthoracic fibrin sealing in 14 domestic pigs. In 9 additional animals standardized bronchus stump fistulae could also be closed with fibrin sealant which was applied through a flexible bronchoscope. An average of 1 ml of fibrin sealant containing 500 units of thrombin and 3500 units of Aprotinin was necessary to achieve bronchial closure and to prevent early dissolution of the sealant. Endoscopic closure of a bronchus fistula by fibrin plug was successfully employed in one clinical case.     

Case of intractable hemoptysis controlled by bronchial occlusion with an Endobronchial Watanabe Spigot (EWS)]

A man in his eighties with massive hemoptysis was referred to our hospital in order to control the bleeding. Chest computed tomography (CT) indicated that the hemoptysis originated from the right upper lobe. We performed arterial embolization twice, but failed to stop it. A surgical lobectomy was considered to be very difficult to perform because of his poor general condition and the strong adhesions between the right upper lobe and parietal pleura. We therefore performed fiberoptic bronchoscopy and plugged 4 EWS (Endobronchial Watanabe Spigot) into his right B1b, B1, B2, B3, and this procedure was able to successfully and completely control the hemoptysis. Bronchial occlusion with EWS has been developed in order to treat patients with intractable pneumothorax, pyothorax with bronchial fistula and similar problems. Our findings suggest that this method is also highly effective in controlling hemoptysis in cases in which arterial embolization is unable to stop the bleeding or surgery is difficult to perform.