支气管扩张症65例手术治疗分析

目的总结支气管扩张症手术治疗的临床经验。方法回顾性分析65例支气管扩张症患者手术治疗的有关临床资料。结果全组无手术死亡。术后出现胸膜腔明显渗血致休克、二次开胸止血1例,胸腔积液2例,肺不张、合并肺部感染2例,脓胸1例,切口感染1例,并发症发生率为10.8%,经相应处理后痊愈。术后随访58例患者(89.2%),临床痊愈者52例(89.7%),症状减轻者6例(10.3%)。结论外科手术治疗是支气管扩张症一种安全、有效的治疗方法。     

吴银根运用膏方治疗支气管扩张经验

总结吴银根教授运用膏方治疗支气管扩张的经验：以平为期,平衡标本正邪与动静升降;注重辨痰、辨咯血及辨兼病。并举医案3则以说明。     

胃转安方治疗癌前病变气虚夹瘀型胃院痛59例

【摘要】 目的 慢性阻塞性肺疾病是一种高发病率、高死亡率的疾病。支气管扩张症和慢性阻塞性肺疾病可以同时存在于同一患者,即支气管扩张症 慢性阻塞性肺疾病重叠综合征（Bronchiectasis Chronic Obstructive Pulmonary Disease overlap syndrome, BCOS）。该综合征是目前国内外被忽略的一个研究领域,其流行病学特征、发病机制、危险因素及治疗等尚不清楚,亟待进一步研究和讨论。本文就支气管扩张症 慢性阻塞性肺疾病重叠综合征目前的研究进展作一述评。     

Lung resections in children for congenital and acquired lesions

We reviewed a single-center experience of pediatric lung resections for various congenital and acquired benign lung conditions. Thirty-five children underwent lung resections between 1998 and 2006, their age ranging from 8 days to 12 years (mean 3 years), with a male:female ratio of 4:1. Twelve patients were neonates. Antenatal diagnosis was available in only one patient. The presenting symptoms were respiratory distress and respiratory tract infections. Imaging with chest X-ray with/without a CT scan picked up the lesion in all cases. Preoperative ventilation was required for five patients. One patient had pneumothorax at presentation; however, ten patients had inadvertent intercostal tube insertion before surgical referral. The surgical procedures performed included lobectomy (28), segmentectomy (3), and pneumonectomy in 4 cases. Twenty-one patients underwent emergency surgery. Six patients required postoperative ventilation. The histopathological diagnosis was congenital lobar emphysema (CLE) (9), congenital cystic adenomatoid malformation (CCAM) (9), bronchiectasis (9), sequestration (3), atelectasis (1), lung abscess (1), unilobar tuberculosis (1), hydatid cyst (1), and foreign body with collapse (1). There was considerable discrepancy between the preoperative diagnosis based on imaging and the postoperative histopathological diagnosis. Postoperative complications included atelectasis (2), pneumothorax (2) and fluid collection (4 cases). Three patients died, one from compromised cardiac function, one from overwhelming sepsis and one from respiratory failure due to severe bilateral CCAM; the rest of the patients made a satisfactory recovery. At short-term follow-up all patients were doing well. Pulmonary resections are necessary for various congenital and acquired lung lesions in children and can be done safely in a pediatric hospital setup. Proper preoperative diagnosis can avoid inadvertent intercostal tube insertion in patients with congenital cystic lung lesions. The histopathological diagnosis often differs from the radiological diagnosis. Emergency lobectomies for acute respiratory distress, even in neonates, result in a satisfactory outcome.     

Lung disease in ataxia-telangiectasia

Ataxia-telangiectasia (AT) is a multi-systemic disease caused by mutational inactivation of the ATM gene. We report a retrospective study of lung disease in 15 patients. PATIENTS AND METHODS: A diagnosis of AT was made if the patient met the following criteria: neurological features and at least one the following: oculo-cutaneous telangiectasia, elevated serum alpha-feto-protein level. RESULTS: Recurrent sino-pulmonary infections were usually present in 11 of the cases and occurred during the first 2 years of life. Other lung injuries noted were bronchiectasis, obstruction and restriction of the airways, fibrosis, pneumothorax and haemoptysis. Eleven children had immunodeficiencies. DISCUSSION: Recurrent sino-pulmonary manifestations precede neurological complications, but the severity of neuro-degeneration and pulmonary disease were not correlated. Pulmonary status was a prognosis factor. Immunodeficiency was the main, but not the only, aetiology for lung disease in AT. CONCLUSION: There is little dispute over the role of ATM in lung and respiratory epithelium. To reduce the morbidity associated with AT, there needs to be greater awareness of respiratory complications. Early management and monitoring lung function is necessary to minimize lung damage.     

支气管扩张症患者中肺曲霉病的研究进展

支气管扩张症（支扩）是多种病因导致的一支或多支的近端支气管不可逆性扩张（支气管直径>2 mm的气道慢性炎症性疾病。其多数是由感染引起,而感染又能诱发支扩,两者互为因果。支扩患者感染的病原体大多为细菌,且已得到充分研究证实,而曲霉在支扩患者中定植比较少见,发病机制尚不明确,但是近年来肺曲霉病发生率呈上升趋势,尤其是在支扩伴感染的患者中更为常见。另外支扩患者中维生素D水平已被证实与其严重程度呈负相关,但相关研究文献较少。该文对支扩与肺曲霉病的相关方面及诊治进行探讨,旨在为相关研究提供理论支撑。     

硝酸甘油与垂体后叶素治疗支气管扩张伴咯血的临床疗效观察

目的探讨硝酸甘油与垂体后叶素治疗支气管扩张伴大咯血的疗效与安全性。方法选取2010年1月至2012年1月东南大学附属江阴人民医院呼吸科收治的支气管扩张伴大咯血患者80例,随机分为A组40例和B组40例,两组均给予氧疗、抗感染、祛痰等基础治疗,同时A组予以垂体后叶素治疗,B组予以硝酸甘油与垂体后叶素治疗。治疗24h时,记录两组止血的效果,同时记录与服用药物有关的不良反应,并对两组进行比较。结果B组止血总有效率为97．50％,A组总有效率为85．00％,B组的疗效显著优于A组（P〈0．05）,B组出现胸闷、高血压、心悸等不良反应显著少于对照组（P〈0．05）,而出汗、面色苍白、腹泻、腹痛的不良反应与对照组比较差异无统计学意义（P〉0．05）。结论硝酸甘油与垂体后叶素治疗支气管扩张伴大咯血的疗效确切,安全性高。     

Nasal or oral oil application on infants: A possible risk factor for adult bronchiectasis

Lipid pneumonia has been observed in infants exposed by inhalation of oil or butter applied into the nose or throat as part of an old custom. We performed a case-control study to test the hypothesis, that this ancient tradition may be a predisposing factor to bronchiectasis. A case group of 59 patients with bronchiectasis and three control groups — 46 patients with COPD, 32 asthmatics, and 71 healthy Saudis — were questioned about possible risk factors of bronchiectasis including nasal or oral application of oil/butter at infancy. The risk of witnessed exposure to this old folk remedy was significantly higher among the cases than the controls (OR=3.9 (1.7–8.8), (95% confidence interval)p<0.001). Application of oil or butter into the nasal or oral cavity of infants may be a risk factor for bronchiectasis.     

支气管扩张症的外科治疗（附74例报告）

本文总结了我院手术治疗支气管扩张症７４例的经验，并对手术指征、手术及麻醉并发症进行分析讨论。     

DR在支气管扩张症诊断中的应用研究

目的 探讨DR胸部影像中对支气管扩张症病灶进行计算机图像后处理的应用价值。方法 选取100例经临床或CT确诊的支气管扩张症的DR胸部影像。（1）采用影像对照方法，评价DR平片，影像增强片对支气管扩张病灶的显示能力。（2）对DR影像增强前后的囊状透光区进行灰度测量，比较其囊壁囊腔平均差值，观察其灰度轮廓的特征。结果 （1）DR平片，影像增强片对支气管病灶的显示，有显著差异。（2）DR胸片影像增强前后囊状病灶灰度轮廓线呈凹形城墙样曲线，而正常支气管管腔轮廓线无此改变，（3）DR胸片影像增强前后囊壁囊腔灰度平均差修正人显著差异。结论 DR胸片经数字化影像增强技术处理，对显示支气管扩张症的病灶明显优于处理前的DR平片，灰度轮廓线与影像增强技术有助于提高支气管扩张症的诊断准确率。