支气管扩张大咯血的DSA表现及介入治疗

目的:探讨支气管扩张大咯血的支气管动脉造影表现及栓塞效果。方法:选择支气管扩张大咯血患者43例,进行支气管动脉造影观察血管异常情况,进行支气管动脉栓塞观察术后即时止血率及长期随访止血率。结果:全部病例支气管动脉造影均可见血管异常,为支气管动脉增粗、分支增生、增多、扭曲,部分伴有出血灶,并可见支气管动脉畸形;经支气管动脉栓塞后即时止血效果及长期止血效果较好。结论:支气管扩张大咯血行支气管动脉造影和支气管动脉栓塞为一种安全有效的诊断、治疗方法。     

支气管扩张伴咯血的DSA表现及栓塞治疗

目的:探讨支气管扩张伴咯血患者供血动脉的数字减影血管造影(DSA)表现及栓塞治疗的价值、血管造影对支气管扩张患者出现咯血的病因分析.方法:对42例支气管扩张患者行选择性动脉造影,分析其DSA表现,确定供血动脉,选择合适的栓塞剂行栓塞治疗并判断疗效.结果:支气管扩张伴咯血患者的DSA表现主要为供血动脉增粗、支气管动脉肺循环分流.行栓塞治疗的总有效率为97.6%,无严重的并发症发生.结论:支气管扩张患者咯血和动脉的异常有关.经动脉栓塞术前仔细分析DSA表现对栓塞治疗有指导意义.     

肺段支气管剔除术治疗支气管扩张10例

对１０例支气管扩张病人施行左肺下叶切除同时舌段支气管剔除术，临床效果满意。本手术与肺段切除比较，避免了损伤段间静脉、出血多、止血费时等缺点；有操作简单、胸内残腔小、术后易于恢复等优点。就肺段支气管剔除术的理论依据、手术操作，进行了初步讨论。     

支气管扩张症合并肺出血的影像学表现

目的：探讨支气管扩张症合并肺出血的影像学表现及病理基础。方法：对25例支扩合并咯血患者行常规胸部X线，CT及高速螺旋CT（HRCT）检查。结果：平片表现局限性或弥漫性片絮状淡薄阴影12例。短期再次摄片，病变吸收变化9例；1例进展增多。HRCT证实为支气管扩张症，其中柱状12例。静脉曲张型9例。囊状8例，诊断为支扩合并肺出血13例。结论：影像学，尤其是动态影销售量学观察对发现支扩合并肺出血很敏感，可以为临床诊断，治疗和随访提供极有价值的影像学资料。     

Surgical treatment of bronchiectasis in children

Background purpose

Surgical treatment of childhood bronchiectasis has not been discussed extensively because of decline in prevalence and experience with this disease. It remains controversial as to which children would benefit from surgery and surgical points that may affect the outcome. Therefore, a retrospective series was prepared to evaluate the results of surgical treatment of bronchiectasis in children.

Methods

The records of 54 children who underwent surgery for bronchiectasis between 1991 and 2002 were analyzed retrospectively for age; sex; clinical features; radiologic examinations; details of surgery including type of resection, operative morbidity, and mortality; and outcome.

Results

Fifty-four patients underwent 58 pulmonary resections during the study period. The mean ages at diagnosis of bronchiectasis and at the time of surgery were 7.80 ± 3.70 years (range, 1 to 15 years) and 9.25 ± 3.92 years (range, 1.5 to 17 years), respectively, with a male to female ratio of 5:4. The causes of bronchiectasis were lung infection (n = 39), hereditary and inborn diseases (n = 14), and foreign body aspiration (n = 1). Chest X-rays, bronchography (n = 12) or chest computed tomography (n = 43), and ventilation-perfusion scintigraphy (n = 13) were used, and pulmonary function tests (n = 21) and bronchoscopy (n = 54) were performed. The types of resections were lobectomy (63%), pneumonectomy (18.5%), lobectomy with segmentectomy (11.1%), segmentectomy (3.7%), and bilobectomy (3.7%). Four patients required a second operation. Forty-one patients (76%) had complete resection, and 13 patients (24%) had incomplete resection. Intraoperative and postoperative complications were encountered in 4 (7.4%) and 4 patients (7.4%), respectively. The course after surgery was well in 23 (42.5%), improved in 23 (42.5%), and unchanged or worse in 5 patients (9.4%). The mortality rate was 5.6%.

Conclusions

The decision for bronchiectasis surgery should be made in cooperation with the chest diseases unit. Anatomic localization of the disease should be mapped clearly by radiologic and scintigraphic investigations. The morbidity and mortality rates of bronchiectasis surgery are within acceptable ranges. Most of the children benefit from surgery, especially when total excision is accomplished. Pneumonectomy is well tolerated in children without increase in morbidity and mortality. Therefore, pneumonectomy may be preferred instead of leaving residual disease when bronchiectasis is unilateral.     

高分辨率CT在轻微支气管扩张诊断中的应用

目的评价高分辨率CT（以下简称HRCT）在轻微支气管扩张诊断中的价值。方法对48例临床怀疑为支气管扩张、28例有慢性支气管炎及哮喘病史的患者以及20例健康检查者分别进行常规螺旋CT扫描和深吸气及深呼气相HRCT扫描。将螺旋CT与HRCT扫描结果进行对照分析，找出HRCT在轻微支气管扩张诊断中的优势及深吸气与深呼气相HRCT的特点。结果48倒可疑支气管扩张患者中，螺旋CT发现支气管扩张38例，HRCT发现支气管扩张43例：在28例有慢性支气管炎或哮喘病史的患者中，呼气相HRCT发现支气管壁增厚18例；显示病变肺叶的空气潴留征11例。结论深吸气相HRCT对显示肺小气道病变尤其是小支气管扩张比常规CT有更大的优越性；深呼气相HRCT在发现支气管壁增厚方面明显优于常规CT并能清晰的显示病变肺叶的空气潴留征。对临床怀疑支气管扩张的患者。应首选HRCT检查。     

支气管扩张大咯血DSA特点及栓塞治疗

目的探讨支气管扩张(支扩)大咯血病变动脉DSA表现特点及栓塞治疗疗效。方法35例支扩大咯血患者,参考胸片、CT等影像资料行选择性支气管动脉及其他目标血管DSA检查,根据造影表现行病变动脉栓塞治疗,栓塞材料为PVA和(或)明胶海绵颗粒(条),术后随访疗效。结果①DSA表现:病变血管单独为支气管动脉占74.3%,合并非支气管体循环动脉22.9%,单独为非支气管动脉2.9%,异常动脉数量为1～5(平均1.8)支/例。显示出血直接征象25.7%,间接征象100%。②栓塞情况及疗效:栓塞34例共61支病变血管;应用微导管16例。1例3d内栓塞2次无效,3个月内复发4例,3个月后复发2例,栓塞治疗总有效率为85.3%,复发率为20.6%,无脊髓损伤等严重并发症。结论支扩大咯血DSA检查阳性率高,参考造影特点行选择性病变动脉栓塞治疗安全性好,疗效确切。     

Kartagener氏综合征（附2例报告及文献复习）

本文报告了2例Kartagener氏综合征。其X线特点是全内脏反位，支气管扩张，副鼻窦炎。并结合有关文献讨论了其发病率，发病年龄，病因以及X线诊断思路。认为本病是全身纤毛无活动性综合征的一部分，是先天性全身纤毛缺乏轴丝臂引起的，而后天感染为其发病的诱因。并提出了诊断本病的思路为心脏反位→支气管扩张→副鼻塞炎→其它脏器反位。这样可早发现本病。     

无创性机械通气在慢性呼吸衰竭中的治疗价值--一个为期3年(2002～2005)的回顾性研究

目的探讨高碳酸性呼吸衰竭患者(慢性阻塞性肺病,肥胖低通气综合征和支气管扩张)使用无创性机械通气的治疗价值.方法116例慢性阻塞性肺病,19例肥胖低通气综合征和46例支气管扩张患者,因慢性高碳酸性呼吸衰竭而住院.第1次住院时未使用无创性机械通气,而在第2次住院时予以无创性机械通气.观察患者的肺功能,动脉血气和住院天数的变化.结果慢性阻塞性肺病、肥胖低通气综合征和支气管扩张患者在使用无创性机械通气的过程中①大多患者能表现很好的依从性,占91%.②动脉血气有所改善.PaCO2在慢性阻塞性肺病患者由62±10 mmHg降至53±6mmHg,(P＜0.01);在肥胖低通气综合征患者由52±10 mmHg降至42±7 mmHg,(P＜0.001);在支气管扩张患者由56±6 mmHg降至44±10 mmHg,(P＜0.005).同时PaO2也有上升,分别由(61±13)mmHg、(60±12)mmHg、(58±11)mmHg升到(71±15)mmHg、(71±11)mmHg和(75±18)mmHg,(P均＜0.001).③与未用无创性机械通气的住院时间相比,住院天数有减少(P＜0.05).结论无创机械通气在慢性阻塞性肺病、肥胖低通气综合征和支气管扩张的治疗中依从性好、动脉血气有改善和住院天数缩短.     

支气管扩张顽固性咯血的临床及病理特征

目的　了解支气管扩张 (支扩 )症顽固性咯血的可能原因 ,为临床治疗提供依据。方法　收集19例因顽固性咯血经术前胸部CT及术后病理检查确诊为支扩的病例 ,进行总结分析。结果　患者均无营养不良及杵状指 ,肺部罗音少 ;影像学改变明显、胸部CT显示支扩更为明确 ;切除肺部标本可见胸膜、软骨及肺血管发育不良 ,标本剖面有脓液 ;病理学镜下示粘膜以淋巴细胞浸润为主的慢性炎症改变为著。合并曲菌感染 8例 (42 % )。结论　支扩顽固性咯血 ,感染可能是重要原因。除细菌感染外 ,还应关注真菌感染