气管镜诊断气管-支气管肺低度恶性肌上皮瘤2例并文献复习

目的:探讨气管镜诊断气管-支气管肺肌上皮瘤的要点及肌上皮瘤的治疗方案。方法:回顾性分析本院2例及国内外报道的气管-支气管肺肌上皮瘤病例资料和随访记录。结果:气管-支气管肺肌上皮瘤多表现为咳嗽、气促、咯血;确诊及治疗需依靠手术。结论:气管-支气管肺低度恶性肌上皮瘤是一种非常罕见的肿瘤,气管镜标本量少,需要仔细观察标本组织形态并结合免疫组化明确诊断。     

Developmental anatomy of the airway

The airway develops from the primitive foregut at 4 weeks’ gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults, with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight-bladed laryngoscope are usually used for intubation. Neonates are also obligate nasal breathers and simultaneously suckle and breath. Minute volume is rate dependent and the highly compliant chest easily displays sternal and intercostal recession during respiratory distress, and early onset of fatigue. From the neonatal period onwards the anatomy gradually begins to resemble that of adults. The cricoid descends caudally, the epiglottis becomes firmer and shorter, and the relatively large occiput recedes. The conventional wisdom of the cricoid ring being the narrowest part of the paediatric airway is not supported by contemporary investigation. The consequence of these findings on endotracheal tube selection and the rationale for increasing use of cuffed endotracheal tubes in children is discussed.     

Aerosol‐based airway epithelial cell delivery improves airway regeneration and repair

Aerosol‐based cell therapy has emerged as a novel and promising therapeutic strategy for treating lung diseases. The goal of this study was to determine the safety and efficacy of aerosol‐based airway epithelial cell (AEC) delivery in the setting of acute lung injury induced by tracheal brushing in rabbit. Twenty‐four hours following injury, exogenous rabbit AECs were labelled with bromodeoxyuridine and aerosolized using the MicroSprayer® Aerosolizer into the injured airway. Histopathological assessments of the injury in the trachea and lungs were quantitatively scored (1 and 5 days after cell delivery). The aerosol‐based AEC delivery appeared to be a safe procedure, as cellular rejection and complications in the liver and spleen were not detected. Airway injury initiated by tracheal brushing resulted in disruption of the tracheal epithelium as well as morphological damage in the lungs that is consistent with acute lung injury. Lung injury scores were reduced following 5 days after AEC delivery (AEC‐treated, 0.25  ±  0.06 vs. untreated, 0.53  ±  0.05, P  <  0.01), and rapid clearance of haemorrhage, proteinaceous debris and hyaline membranes occurred. In the trachea, AEC delivery led to an upsurge in epithelium regeneration and repair. Re‐epithelialization was significantly increased 5 days after treatment (AEC‐treated, 91.07  ±  2.37% vs. untreated, 62.99  ±  7.39%, P  <  0.01). Our results indicate that AEC delivery helps in the regeneration and repair of the respiratory airway, including the lungs, following acute insults. These findings suggest that aerosol‐based AEC delivery can be a valuable tool for future therapy to treat acute lung injury. Copyright © 2017 John Wiley & Sons, Ltd.     

Optimized isolation and expansion of human airway epithelial basal cells from endobronchial biopsy samples

Autologous airway epithelial cells have been used in clinical tissue‐engineered airway transplantation procedures with a view to assisting mucosal regeneration and restoring mucociliary escalator function. However, limited time is available for epithelial cell expansion due to the urgent nature of these interventions and slow epithelial regeneration has been observed in patients. Human airway epithelial cells can be expanded from small biopsies or brushings taken during bronchoscopy procedures, but the optimal mode of tissue acquisition from patients has not been investigated. Here, we compared endobronchial brushing and endobronchial biopsy samples in terms of their cell number and their ability to initiate basal epithelial stem cell cultures. We found that direct co‐culture of samples with 3T3‐J2 feeder cells in culture medium containing a Rho‐associated protein kinase inhibitor, Y‐27632, led to the selective expansion of greater numbers of basal epithelial stem cells during the critical early stages of culture than traditional techniques. Additionally, we established the benefit of initiating cell cultures from cell suspensions, either using brushing samples or through enzymatic digestion of biopsies, over explant culture. Primary epithelial cell cultures were initiated from endobronchial biopsy samples that had been cryopreserved before the initiation of cell cultures, suggesting that cryopreservation could eliminate the requirement for close proximity between the clinical facility in which biopsy samples are taken and the specialist laboratory in which epithelial cells are cultured. Overall, our results suggest ways to expedite epithelial cell preparation in future airway cell therapy or bioengineered airway transplantation procedures.     

The Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction.Patients and Methods: 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems.Results: Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes.Conclusion: ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.     

血管化肋软骨结合纤毛化内皮内壁的人工气管重建

目的：探讨血管化肋软骨结合纤毛化内皮内壁合成人工气管重建气管长段及特殊缺损的可行性,建立与天然气管的生理结构、功能更接近的人工气管模型。方法以8例新西兰白兔为动物实验模型,I期颈部双层带血供筋膜包埋培养自体肋软骨和鼻中隔黏膜,II期人工气管原位移植,术后定期评估生理、呼吸及病理学等指标。结果8例实验兔II期术后平均存活时间21.9 d,死亡原因为呼吸困难。人工气管组织解剖可见瘢痕增生,无塌陷,有弹性和硬度。组织病理可见肋软骨和气管环软骨在组织学上有较高相似度;肋软骨在带血供筋膜包裹培养下均未被吸收,仍可见肋软骨组织;鼻中隔黏膜在体内加压及带血供筋膜营养下继续分化,HE染色切片下可见人工气管内壁覆有上皮样组织。结论肋软骨可作为制备人工气管塑形材料;包裹肋软骨的带血供筋膜可提供充足的血供,弥补了游离培养肋软骨致其吸收的缺陷;鼻中隔黏膜在体内加压及带血供筋膜的营养下,有望模拟气管纤毛上皮,从而发挥其与气管内壁相似的生物学特性。     

Functional changes are associated with tracheal structural abnormalities in patients with acromegaly

Introduction

Although impaired pulmonary function and respiratory sleep disorders are described as responsible for increased mortality in acromegalic patients, little is known about the tracheal abnormalities in this group of patients. Thus, the objectives of this study were to describe the tracheal structural abnormalities and correlate these changes with the respiratory function and clinical data of acromegalic patients.

Material and methods

This is a cross-sectional study that was carried out at two university hospitals. Twenty acromegalic patients underwent spirometry, forced oscillation technique, and computed tomography (CT) assessments. Dyspnea and daytime sleepiness were assessed using the Modified Medical Research Council (MMRC) scale and the Epworth Sleepiness Scale (ESS), respectively. Forty matched subjects served as controls.

Results

The acromegalic patients exhibited larger median ratios between forced expiratory flow and forced inspiratory flow at 50% of the forced vital capacity (FEF_50%/FIF_50%) (2.05 vs. 1.06, p = 0.0001) compared with healthy volunteers. In the CT analysis, acromegalic patients exhibited larger median differences between their cervical and thoracic tracheal diameters (Δ tracheal diameters) (3 vs. 1 mm; p = 0.003). An association was found between FEF_50%/FIF_50% and the following variables: mean resistance (Rm), cervical tracheal diameter, and Δ tracheal diameters. Rm also exhibited a negative correlation with cervical tracheal diameter. Neither the MMRC scale nor the ESS exhibited any significant correlation with large airway obstruction (LAO) indices or with the measured tracheal diameters.

Conclusions

Acromegalic patients have tracheal structural abnormalities which are associated with functional indicators of LAO but not with clinical data.     

纤维支气管镜介入在各型气管、支气管结核治疗中的作用探讨

目的探讨纤维支气管镜介入在各型气管、支气管结核治疗中的作用。方法对76例确诊的气管、支气管结核病人，在全身抗结核治疗的同时，根据镜下所见病变类型不同分别实施局部病变多点注射药物（异烟肼、链霉素、激素等）、局部病灶毁损术（微波、激光、高频电刀等）和高压球囊扩张术等治疗方法进行综合治疗。结果显效47例（61．8％），有效25例（32．9％），总有效率为94．7％。无效4例。结论应用纤维支气管介入对各型气管、支气管结核病人进行局部治疗，可迅速缓解症状，加快病灶吸收，避免形成气道狭窄及其相关的外科手术，并发症少见，病人易接收，值得临床推广应用。     

术前气管推移训练联合雾化吸入对颈椎前路手术患者咽部症状的影响

目的：观察术前气管推移训练联合氧气雾化吸入对减轻颈椎前路手术患者术后咽部不适的疗效。方法2009年7月至2012年3月选择颈椎前路手术患者70例,试验组34例,对照组36例。两组均按常规治疗、护理,试验组行气管推移训练,在术前3 d给予氧气雾化吸入,对照组仅行气管推移训练。比较两组患者术后咽部相关症状及评分。结果试验组术后咽部不适症状明显轻于对照组（ Z=-5.732,P〈0.001）。结论颈椎前路手术术前预防性使用氧气雾化吸入联合气管推移训练能有效减轻患者术后的咽部不适。