气管上皮-肌上皮瘤1例

正肌上皮瘤主要见于涎腺,包括腮腺、颌下腺及腭部、唇、颊、龈、磨牙后区、口腔底部的小涎腺以及泪腺、乳腺~[1]。而发生于气管-支气管及肺部的肌上皮瘤则甚为罕见,近期作者在唐都医院进修期间诊治一例气管上皮-肌上皮瘤病例,现报道分析如下:病例资料患者女性,51岁,主因"咳嗽、咳痰、气短2月余,加重1月"于2014年10月入院。入院时查体:口唇无发绀,气管居中,胸廓对称,双侧呼吸动度一     

肺支气管原发性平滑肌瘤1例并文献复习

目的探讨肺支气管原发性平滑肌瘤的病例特点及治疗方法。方法分析I例肺支气管原发性平滑肌瘤患者的临床资料并复习相关文献。结果患者表现咳嗽、咯血、阻塞性叶段不张及肺炎,经胸片及纤维支气管镜活检等检查后确诊左上支气管平滑肌瘤（病理及免疫组化）,经纤维支气管镜介入冷冻治疗后病情好转并治愈。结论肺支气管原发性平滑肌瘤为良性肿瘤,依赖病理活检及免疫组化检查可确诊及确定组织来源。主要治疗方法为手术切除,也可经纤维支气管镜介入行镜下腔内肿瘤摘除术。同时,镜下冷冻治疗是气管、支气管内型的优选而少创伤的方法。     

结核性气管支气管狭窄的外科治疗

目的报告结核性气管、支气管狭窄的外科治疗经验。方法分析的３５例中气管狭窄２例，支气管狭窄３３例。全肺切除１４例，肺叶切除１３例，肺叶切除支气管成形３例，右全肺切除加气管下段部分切除２例，主支气管节段切除１例，右全肺切除加气管成形术１例，气管切开、气管下段肉芽肿摘除术１例。结果术后效果良好，无支气管胸膜瘘、支气管再狭窄和手术死亡。结论对气管、支气管结核性狭窄，将狭窄之气管、支气管连同受累肺叶一并切除并加气管或支气管成形术为首选方式。     

体-肺循环畸形导致的大咯血4例报告

目的通过对4例咯血病人的分析了解支气管动脉-肺动静脉畸形导致大咯血的特点、诊断及治疗。方法收集我科自2003年～2006年收治的4例支气管动脉-肺动静脉畸形病例，对其临床表现、确诊依据、治疗方法进行认真分析回顾。结果4例支气管动脉-肺动静脉畸形病例，在病史、体征、胸部X片及CT方面均无特异性表现。结论体-肺循环畸形导致的咯血在咯血病人中占有一定比例，需要引起临床医生高度重视。诊断主要依靠支气管动脉造影，支气管动脉栓塞是有效的治疗方法，根治需要手术切除。     

支气管上皮-肌上皮癌1例

上皮-肌上皮癌(epithelial-myoepithelial carcinoma,EMC)又称恶性肌上皮瘤、腺肌上皮瘤、透明细胞腺瘤等,是一种低度恶性肿瘤,发病率很低,多发于老年男性,常发生在唾液腺,也可以发生在乳腺,泪腺,汗腺,鼻腔,鼻窦等部位。而支气管的上皮-肌上皮癌发生率更低,原发于支气管的上皮-肌上皮癌多起源于大支气管黏膜下层腺体,常伴有气道阻塞症状。本病罕见,国内外少有报道,现将我诊断的一例气管上皮-上皮癌结合文献报告分析如下。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993－2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查，治疗结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69．2％（72／104）。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84．6％。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

高频电刀联合球囊扩张及冷冻术治疗支气管结核管腔闭塞型的疗效观察

管腔闭塞型气管支气管结核是最严重的结核性气管支气管狭窄的类型, 常导致患者肺不张甚至肺毁损。部分患者需手术行病变气道及肺切除术, 严重影响其生存质量甚至生命危险。本文通过回顾性分析30例湖南省胸科医院收治的管腔闭塞型气管支气管结核患者病例资料, 分析并总结其经支气管镜下高频电刀联合球囊扩张及冷冻术治疗取得较好疗效的经验, 以提高支气管镜医生对管腔闭塞型气管支气管结核的治疗能力。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析1993年1月至2000年10月248例气管支气管结核住院病例资料临床表现、影像学、纤支镜检查结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69.2%(72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中合并雾化治疗72例。经纤支镜支气管腔内给药的26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时合并雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不同逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

支气管结核248例临床分析

目的　探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993～2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查,治疗结果。结果 248例患者中15～34年龄组青年女性明显高于其它组占69.2% (72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例,肺切除术后病理确诊14例。全组病例均予规范抗结核化疗,其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗,是改善临床症状,减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

肺段支气管异物治疗分析

目的探讨肺段支气管异物的发病原因、临床表现和治疗方法。方法发生于肺段的支气管异物一般较小且病史较长,临床症状隐匿或表现为肺部反复感染、肺不张和肺气肿等,对3例肺段支气管异物患者实施电视监控带鼻内镜检查,辅助应用气管内镜、纤维支气管镜,观察异物的形态、位置、大小及与气管壁的关系,并取异物。结果 3例肺段支气管异物全部一次成功取出,其中2例行气管切开术,术后无气胸、纵隔气肿等并发症。结论对于异物较小、临床症状复杂的肺段支气管异物,要做详细的术前检查,术中要选择应用适宜的异物钳、气管内镜、纤维支气管镜等,必要时辅助气管切开以缩短手术路径,并注意防止气胸等并发症的发生。     

成人气管性支气管2例报告并文献复习

目的 提高对成人气管性支气管疾病的认识和诊断水平.方法 对2例成人气管性支气管的临床资料进行回顾性分析,分析其临床特征及电子支气管镜检查在诊断和治疗方面的作用.结果 该2例患者因肺部占位性病变行电子支气管镜检查,发现伴有气管性支气管,予电子支气管镜下活检占位组织后,气管性支气管未予处理.结论 气管性支气管是少见的气道先天发育异常,目前国内成人报告病例极少,随着介入肺脏病学及医学影像学的发展,其检出率日益增多,若无临床症状可不予特殊处理.     

Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis]

A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation.     

支气管Dieulafoy病1例并文献复习

目的 介绍1例支气管Dieulafoy病并复习国内外文献,以提高对这一少见病的认识.方法 对1例确诊为支气管Dieulafoy病患者的临床表现及检查结果进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 支气管Dieulafoy病是一种病因尚未明确的以支气管黏膜下畸形动脉破裂出血为病理特征的罕见疾病,临床常见表现为反...     

Lobectomía superior por cáncer de pulmón con bronquio traqueal verdadero: una presentación inusual

Tracheal bronchus is an aberrant bronchus usually originating from the right lateral wall of the trachea, with an incidence ranging from 0.1% to 5% and usually within 2.0 cm above the carina. The incidence of lung cancer with bronchial anomaly is very rare. There are only nine cases of lung cancer developing from the tracheal bronchus reported in the literature. Histological examination showed squamous cell carcinoma in only three of them, and we present a fourth case who was a 57-year-old man. Interestingly our patient's anomaly included both an absence of the normal right upper bronchus as well as right upper lobe ventilated from the true tracheal bronchus. This is the first documented case in the world of a squamous carcinoma arising from the true tracheal bronchus. Post-surgical histological stage was T2aN0M0 (stage IB). The patient is well 48 months after the operation and has no evidence of recurrence.     

Two tracheal BALT lymphoma patients successfully treated with chemotherapy including rituximab

Bronchus-associated lymphoid tissue (BALT) lymphoma of the trachea, an important differential diagnosis for tracheal tumors, is a rare disease with characteristic bronchoscopic findings. In this study, we reviewed 2 cases of patients who were symptomatic at the time of diagnosis, with tumors in the trachea and left main bronchus, putting them at high risk for asphyxia. Chemotherapies including rituximab were administered, and complete remission was confirmed in both cases. Because tracheal tumors often have a pernicious course, it might be beneficial to initiate a chemotherapeutic treatment regimen instead of adopting the “wait-and-see” approach in patients with symptomatic tracheal BALT lymphoma.     

支气管Dieulafoy病活检大出血窒息复苏成功1例并文献复习

目的 探讨支气管Dieulafoy病临床表现、诊断及治疗方法.方法 结合我院收治的1例支气管Dieulafoy病的临床资料及国内外文献报道的病例进行综合分析.结果 患者男性,70岁,反复间断咯血30年,大咯血8 h住院,胸部平片及CT未发现异常,行支气管检查发现气管黏膜呈"蚯蚓"样突起,活检过程中突然出现大出血窒息,经抢救复苏成功,后经病理及肺血管造影证实气管黏膜血管异常,考虑支气管Dieulafoy病,行栓塞治疗后好转.结论 支气管Dieulafoy病文献报道较少,发病原因不详,可能与支气管肺动脉先天发育异常和(或)后天的慢性炎症刺激、损伤有关,文献报道少可能与认识不足有关.遇有不明原因大咯血需行气管镜检查时,气管镜检查发现气管黏膜呈"蚯蚓"样突起,应想到该病的可能,不要盲目活检,应想到有大咯血窒息可能,如确需活检,应备好抢救措施.     

支气管Dieulafoy病一例报告并文献复习

目的提高对支气管Dieulafoy病的认识。方法对1例临床确诊为支气管Dieulafoy病患者的临床资料进行分析，并结合文献复习。结果支气管Dieulafoy病是一种罕见病，以支气管黏膜下畸形的动脉破裂出血为病理特征，其病因及发病机制尚不清楚，可能与支气管肺动脉先天发育异常、气道慢性炎症或损伤有关。临床表现主要为突发大咯血或支气管腔内病灶活检后发生致命性大出血。支气管肺动脉造影是术前诊断的主要手段，手术或尸检标本的组织学检查可以确诊。支气管动脉栓塞可以作为一种治疗方法，但有复发和失败的可能，肺叶切除术可以达到根治目的。结论遇到原因不明的大咯血应注意排除支气管Dieulafoy病的可能；支气管镜检查若发现管腔内突起样病灶，不要盲目活检。     

Determinants of diagnostic bronchial washing in peripheral lung cancers.

OBJECTIVE: To establish clinical determinants affecting the diagnostic yield of bronchial washing. SETTING: We performed bronchial washing in 241 consecutive patients with bronchoscopically invisible lung tumours. Of these, 150 patients known to have lung cancer were enrolled for the final analysis. DESIGN: A multi-centre study. RESULTS: Bronchial washing provided a diagnosis of lung cancer in 30 of the 150 patients (20%). Tumour size > or = 3 cm (P = 0.005), the location of the tumour within 8 cm of the carina (P = 0.003), and exposed type bronchus sign of tumour (P < 0.001) were factors affecting diagnostic bronchial washing for bronchoscopically invisible lung cancers. However, multivariate logistic regression revealed that exposed type bronchus sign was the sole determinant (OR 19.22, 95% CI 4.23-87.46, P < 0.001). CONCLUSION: Bronchial washing is a useful procedure for the diagnosis of bronchoscopically invisible lung cancers. As the tumour-bronchus relationship is the most important determinant of a diagnostic yield, the routine use of bronchial washing should be considered for tumours with exposed type bronchus sign.     

喉罩辅助通气气管镜介入治疗高位气管息肉一例

气管息肉是由于气管黏膜受到机械刺激、炎症感染等引发。目前随着各级医院人工气道技术普遍开展,其发生率越来越高。气管息肉缺乏特异性临床表现,易引起误诊。本文报道兰州大学第二医院呼吸内科收治的1例高位气管息肉患者,并分析其发病及诊治过程,以提高临床医师对该病的认识和处理水平。     

Tracheal bronchus associated with lung cancer: a case report.

Tracheal bronchus is a rarely found congenital bronchial anomaly. It usually originates from the right lateral wall of the trachea at the level < 2 cm above the tracheal bifurcation. The patients usually are asymptomatic, but some may experience recurrent pneumonia, chronic bronchitis, or bronchiectasis. It is very rare for a malignant tumor to grow from this aberrant bronchus. There are only four cases of lung cancer developing from the tracheal bronchus reported in the world literature, and we present a fifth case.