纤维乳管内视镜在乳腺疾病中的应用与护理

目的对乳头溢血、溢液患者实施纤维乳管内视镜检查，发现并用定位针锁定病变组织，选择不同的治疗方案。方法把358例参与纤维乳管内视镜检查的患者分为A、B两组。A组为41例用定位针锁定腔内微小病变患者，B组为317例乳管周围炎患者。A组患者在表面麻醉下用专用内视镜插入乳头进入乳管腔内进行检查，找到异常部位后用定位针锁定微小病变组织，在留置定位针期间予以护理干预。B组患者在炎症部位注入抗生素。结果A组有40例在术中找到定位针锁定的病变目标，定位针有效率为97．6％（40／41）。B组应用抗生素1～2次而治愈。结论用纤维乳管内视镜检查，可以在直视下找到病变部位，为诊断、手术和治疗提供了依据。     

Tracheal Irrigation Without Bronchoscopy as an Alternative Emergent Treatment of Blood Aspiration

BackgroundTracheobronchial foreign body aspiration can cause mild symptoms but may also become dangerous enough to cause death. Bronchoscopy is the first choice for the diagnosis and the removal of aspirated foreign bodies. So, when bronchoscopy is not available, the situation might get challenging.Case ReportA 62-year-old man was waiting for emergent surgery for traumatic epidural hematoma in the Emergency Department (ED). Endotracheal intubation was performed for surgery and airway maintenance. However, oxygen saturation dropped and respiratory arrest was expected. As emergent bronchoscopy could not be performed, the emergency physician decided to irrigate the trachea by using 0.9% normal saline in the ED. After three rounds of irrigation, vital signs including oxygen saturation improved and the patient could undergo neurosurgical surgery. The patient was subsequently discharged with improved health.Why Should an Emergency Physician Be Aware of This?Bronchoscopy is the first choice for the treatment and diagnosis in cases of bronchial aspiration of blood, such as that caused by epistaxis. However, in emergency situations, such as deteriorating vital signs due to aspiration of life-threatening amounts of blood from epistaxis, using blind tracheal irrigation as an alternative tool when bronchoscopy is not available can help in achieving clinically acceptable results.     

肺不张纤维支气管镜检查590例分析

目的:探讨纤维支气管镜(纤支镜)检查在肺不张病因诊断中的价值。方法:对临床及胸部X线、CT检查诊断为肺不张的590例患者行纤支镜检查,并对其病因、镜下特点、部位及年龄等进行分析。结果:肺癌428例,炎症133例,结核21例,支气管异物5例,曲菌2例,淋巴瘤1例。结论:纤支镜检查是明确肺不张病因的主要手段,对原因不明的肺不张均应及时行纤支镜检查。     

H-type tracheo-oesophageal fistula: appearance on three-dimensional computed tomography and virtual bronchoscopy

H-type tracheo-oesophageal fistula (TOF) is a rare type of fistula without oesophageal atresia. The symptoms are usually present at birth, but the diagnosis is often delayed. Traditionally, contrast oesophagography and/or fiberoptic bronchoscopy are used to confirm the diagnosis. We describe the imaging features of a case of H-type TOF seen on three-dimensional computed tomography and virtual bronchoscopy and the usefulness of these techniques in pre-operative evaluation. Accepted: 11 August 2000     

纤维乳管内视镜在乳头溢液性乳腺疾病诊断中的应用

目的：探讨纤维乳管内视镜在乳头溢液性乳腺疾病诊断中的应用价值。方法：分析2004年2月～2005年2月在我院进行纤维乳管内视镜检查的45例乳头溢液患者资料,观察溢液导管及其分支的管腔和管壁结构,确定病灶位置,记录病变形态,并对30例有占位性病变的患者进行手术切除,记录病理结果。结果：镜检诊断乳腺癌5例,乳头状瘤9例,乳头状瘤病4例,乳管扩张症12例,乳管炎症10例,未发现异常5例,经病理证实符合率97.2%。结论：纤维乳管内视镜能够更准确、直观明确乳头溢液性乳腺疾病的病因、病变范围及部位,提高了早期乳腺癌的检出率。     

纤维支气管镜用于双腔支气管导管定位

【目的】比较肺部听诊法和纤维支气管镜（简称纤支镜）检查法判断双腔支气管插管位置的准确性.【方法】60例需双腔支气管插管单肺通气下行胸科手术的患者,在插管及放置手术体位后,分别以听诊法和纤支镜检查法判断双腔管的位置.【结果】插管后听诊法导管位置满意36例（60%）,改变体位后12例听诊肺隔离不满意,进一步行纤支镜检查发现8例（13.3%）导管发生近端移位,发生率67%（8/12）.【结论】在双腔管插管时和放置体位后,宜常规行纤支镜检查定位.     

改良颈椎固定器在电子支气管镜检查护理中的应用效果探讨

目的分析改良颈椎固定器在电子支气管镜检查护理中的应用效果。方法选择我院2014年1-6月行电子支气管镜检查的80例患者为研究对象,分为两组,每组各40例;对照组患者行常规电子支气管镜检查及护理,观察组患者检查中应用改良颈椎固定器并综合护理干预,比较两组干预前后SAS评分及并发症发生率。结果观察组干预后SAS评分（35.24±6.34）分,与对照组的（46.30±8.01）分比较,差异有统计学意义（P〈0.05）。另外,观察组咯血、黏膜出血发生率分别为2.5%、0,明显低于对照组的15.0%、12.5%,差异有统计学意义（P〈0.05）。结论电子支气管镜检查中应用改良颈椎固定器及综合护理干预,能明显缓解患者的焦虑症状,降低并发症,值得临床推广。     

Pseudomembranous Tracheobronchitis With Severe Tracheal Stenosis and Masked Bronchial Obstruction

BackgroundPseudomembranous tracheobronchitis (PMTB) is a rare condition characterized by the formation of endobronchial pseudomembranes. PMTB overlaps with necrotizing tracheobronchitis or plastic bronchitis. The reported infectious etiology mainly includes invasive aspergillosis. PMTB can cause serious airway obstruction; however, urgent tracheotomy is rarely required.Case ReportA 46-year-old woman was transferred to the emergency department (ED) with a 1-week history of progressive dyspnea and cough that was preceded by fever and sore throat. She was previously healthy except for a 20-year history of mild palmoplantar pustulosis. Stridor was evident. Nasolaryngoscopy performed in the ED revealed severe tracheal stenosis caused primarily by mucosal edema and secondarily by pseudomembranes. Initially, tracheitis was considered the sole cause of dyspnea. Although she underwent urgent tracheotomy to prevent asphyxia, her respiration deteriorated progressively. Bronchoscopy revealed massive pseudomembranes obstructing the bilateral bronchi, which led to the clinical diagnosis of PMTB. Subsequent toilet bronchoscopy markedly improved her ventilation. The causative pathogen was not identified despite extensive work-up, including molecular biological testing. Histopathologic examination of the pseudomembranes revealed fibrin with abundant neutrophils, which was consistent with PMTB. Associated conditions, including immunodeficiency, were not found. Her condition improved with antibiotics and repeated toilet bronchoscopy.Why Should an Emergency Physicians Be Aware of This?PMTB is an important differential diagnosis of airway emergencies. PMTB can present with critical edematous tracheal stenosis and masked bronchial pseudomembranous obstruction. Emergency physicians should include PMTB in the differential diagnosis in adult patients with acute central airway obstruction because it requires prompt multimodal treatment.     

368例支气管镜刷检液基细胞学与细胞DNA定量分析的研究

目的:对比支气管镜刷检细胞DNA定量分析与液基细胞学诊断结果，探讨细胞DNA定量分析在支气管镜刷检中的应用价值。方法: 选取同时进行细胞DNA定量分析与液基细胞学诊断的368例患者细胞标本和细胞片，将其检测结果与病理活检进行对比。结果: 细胞DNA定量分析在支气管镜刷检诊断中的灵敏度、特异度分别为90.8%(177/195)和79.8%(138/173)，液基细胞学在支气管镜刷检诊断中的灵敏度、特异度分别为68.1%(124/182)和63.4%(118/186)。细胞DNA定量检测的灵敏度、特异度均高于液基细胞学，二者比较差异显著（P<0.01）。细胞DNA定量分析与病理活检阳性诊断符合率为83.5%。结论:细胞DNA定量分析在支气管镜刷检中有很好的应用价值，同时联合液基细胞学检查能提高恶性肿瘤的检出率，降低漏诊的风险。