多层螺旋CT在支气管扩张症诊断中的价值

目的分析研究多层螺旋CT在支气管扩张症诊断中的作用和价值。方法回顾性分析2010年5月至2011年5月期间在我院就诊的46例支气管扩张患者的MSCT资料。结果 46例MPR均显示扩张的支气管,其中柱状型19例,囊状型8例,静脉曲张型5例,混合型14例。行仿真内镜的24例中,16例显示支气管黏膜炎症、管腔内黏液栓、血块、环状软骨不完整及管腔扩张。采用肺透明技术重建的46例中,15例显示扩张的支气管。结论 MSCT是一种无创性显示支气管形态的最佳影像学方法,其扫描诊断支气管扩张特异性高,可以显示支气管扩张范围、程度和部位,可作为支气管扩张症的首选检查方法。     

垂体后叶素联合硝酸甘油、立芷雪治疗支气管扩张大咯血的疗效

目的观察探讨垂体后叶素(PTT)联合硝酸甘油、立芷雪治疗支气管扩张大咯血的临床疗效。方法选择2007年4月～2011年4月22例支气管扩张大咯血的患者,随机分为观察组和对照组,各11例,均采用保持呼吸道畅通、抗感染等基础治疗,对照组在基础治疗上使用PTT治疗,观察组在基础治疗上给予PTT联合硝酸甘油、立芷雪治疗,观察比较两组治疗效果。结果观察组总有效率90.9%(10/11),对照组总有效率72.8%(8/11),两组疗效比较差异显著(P<0.05),具有统计学意义。结论 PTT联合硝酸甘油、立芷雪治疗支气管扩张大咯血的临床疗效显著,能够有效止血,减少不良反应发生,安全可靠。     

酚妥拉明联合垂体后叶素治疗支气管扩张咯血的疗效观察

目的观察垂体后叶素联合酚妥拉明治疗支气管扩张咯血的疗效。方法将支气管扩张咯血患者60例随机单盲法分为治疗组和对照组各30例,两组在抗感染治疗基础上,均予止咳对症及恰当的体位引流等,对照组予垂体后叶素持续静脉使用,输液速度维持在0.1 U/(kg.h)水平。治疗组在上述应用垂体后叶素以0.1 U/(kg.h)同时加用酚妥拉明以0.08 mg/min持续静脉滴注。对比两组疗效和不良反应。结果治疗组总有效率90%(27/30)高于对照组的83%(25/30),差异有统计学意义(χ2=8.27,P<0.05)。治疗组咯血停止时间平均(3.6±1.3)d,和对照组的(4.7±1.5)d相比亦明显减少,差异有统计学意义(t=3.25,P<0.05)。对照组发现有不同程度的副反应,发生率为46.7%(14/30)。治疗组未出现明显的药物不良反应。结论垂体后叶素和酚妥拉明联用治疗支气管扩张咯血快速高效,不良反应少,值得临床推广。     

“四联疗法”对支气管扩张并大咯血的治疗观察

目的观察垂体后叶素+硝苯地平+止血敏+强的松(简称"四联疗法")对支气管扩张大咯血的临床治疗效果。方法94例患者随机将其分为甲组,乙组(四联疗法治疗组):甲组44例,乙组50例,甲组首次使用5U溶于20ml生理盐水后静脉缓推,以后500ml液体中加入20U维持滴注,每天总量20～40U。同时并用止血敏1g加入葡萄糖250ml稀疏释后静滴,每日2～3次。口服硝苯地平10mg每日3～4次。乙组首次使用5U垂体后叶素溶于20ml生理盐水后静脉缓推,以后500ml液体中加入20U维持滴注,每天总量20～40U。同时并用止血敏1g加入葡萄糖250ml稀疏释后静滴,每日2～3次。口服硝苯地平10mg每日3～4次,强的松,每日30mg。结果甲组有效止血44例,占95%,平均止血时间7天;乙组有效止血48例,占96%,平均止血时间5天(P<0.05)。结论四联疗法能缩短支气管扩张大咯血治疗时间。     

First decade's experience with thoracoscopic lobectomy in infants and children

Purpose

This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children.

Methods

From January 1995 to March 2007, 97 patients underwent video-assisted thoracoscopic lobe resection. Ages ranged from 2 days to 18 years and weights from 2.8 to 78 kg. Preoperative diagnosis included sequestration/congenital adenomatoid malformation (65), severe bronchiectasis (21), congenital lobar emphysema (9), and malignancy (2).

Results

Of 97 procedures, 93 were completed thoracoscopically. Operative times ranged from 35 minutes to 210 minutes (average, 115 minutes). There were 19 upper, 11 middle, and 67 lower lobe resections. There were 3 intraoperative complications (3.1%) requiring conversion to an open thoracotomy. Chest tubes were left in 88 of 97 procedures for 1 to 3 days (average, 2.1 days). Hospital stay ranged from 1 to 12 days (average, 2.4 days).

Conclusions

Thoracoscopic lung resection is a safe and efficacious technique. It avoids the inherent morbidity of a major thoracotomy incision and is associated with the same decrease in postoperative pain, recovery, and hospital stay as seen in minimally invasive procedures.     

临床及影像评估在非感染性多发肺囊腔样病变诊断中的价值

目的评价非感染性多发肺囊腔样病变的临床及影像学特点及其诊断价值。方法回顾性分析2009—2011年我院确定诊断的39例非感染性多发肺囊腔样病变患者的临床表现及胸部CT等方面的数据,分析不同病因引起的多发肺囊腔样病变的临床及影像特点。结果较为常见的呼吸系统受累的症状均为明显的劳力性呼吸困难,发生率40%～100%。肺外表现各异,杵状指是较为常见的肺外表现,可见于特发性肺纤维化(IPF)、支气管扩张及肺组织细胞增生症(PLCH)。不同疾病的胸部CT依据囊腔分布特点、上肺及中下肺分布差异、囊腔大小、囊壁、气液平及非气囊腔区域变化而呈现出各自不同的特点。结论非感染性多发肺囊腔样病变呼吸道症状特异性相对较差,但肺外表现具有特征性,结合有特点的影像学表现进行临床及影像综合评估对早期疾病的诊断可起到重要的辅助作用。     

女性支气管扩张并发胃食管反流病380例问卷调查分析

目的:探讨女性支气管扩张与胃食管返流病的关系。方法:通过对吉林大学第一医院呼吸科2009～2011年收治的380例女性支气管扩张患者采用GerdQ问卷评分,症状不典型者采用食道下段PH监测的方法,评分总分>12分和pH值<4持续10 s以上可诊断为胃食管返流病。结果:共筛选出48例患者同时合并有胃食管返流病(GERD),占12.6%。48例患者中GERD症状不明显者为8例(16.7%),有GRED症状者40例(83.3%)。其中表现为上腹部、胸骨后疼痛10例,烧心19例,返酸20例,吞咽困难1例。结论:女性支气管扩张患者易并发GERD。女性支气管扩张进行常规抗感染、清洁气道治疗效果欠佳者要考虑其合并胃食管返流病的可能,进行抗酸反流治疗,以提高疗效。     

Development of Microscopic Polyangiitis in Patients with Chronic Airway Disease

Microscopic polyangiitis (MPA) is a rare systemic vasculitis syndrome, which is often accompanied by positive myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA). While pulmonary involvement of MPA consists mainly of diffuse alveolar hemorrhage and interstitial pneumonia, bronchiectasis has been reported as a pulmonary lesion in association with MPA. To investigate the clinical features of patients with MPA, focusing on the presence or the absence of preceding chronic airway diseases (CAD), we conducted a retrospective observational study of 26 patients in the last 13 years at Saga University Hospital. The clinical records and radiologic chest examinations were reviewed retrospectively. Pulmonary manifestations were alveolar hemorrhage in 3 patients (12%) and interstitial pneumonia in 5 (19%). Bronchiectasis, defined by the findings of chest radiograph and computed tomography, was found in 9 patients (35%). Four patients (15%) with bronchiectasis and one patient (4%) with chronic bronchitis had experienced chronic bronchial suppuration prior to the onset of MPA. Ten patients were classified as having chronic airway disease (CAD) before the onset of MPA. MPO-ANCA tended to be lower in the CAD group than in the non-CAD group. None of the patients in the CAD group had pulmonary hemorrhage or interstitial pneumonia. Only one patient (10%) in the CAD group died within 90 days of the onset of MPA, while 7 (43.8%) of the non-CAD group died. Our study suggests that MPA may result in part from CAD and that the clinical course of MPA with CAD may be different from MPA without CAD.     

Bronchiectasis in secondary care: a comprehensive profile of a neglected disease

Background: Bronchiectasis is poorly characterised in secondary care. Methods: Over 6 months, 410 bronchiectasis patients attended our clinics. One hundred randomly selected patients were characterised in detail. Results: Patients had a mean and standard error of mean (S.E.M.) age of 57 (2) years and a median and interquartile range (IQR) of three (two to four) reviews in the last 12 months. Aetiologies identified included tuberculosis (n=15), childhood pneumonia (n=7), fibrosis (n=6), connective tissue disease (n=6), whooping cough (n=5), childhood measles (n=4) and others (n=5). There was widespread use of inhaled therapy. Treatments included oral antibiotics (n=77), corticosteroid courses (n=27) and intravenous antimicrobials (n=27, 12 domicillary) in the last year. Thirty patients had hospital admissions (13 because of the inability to administer domicillary antibiotics). Haemophilus influenzae and Pseudomonas spp. were the commonest bacterial isolates. Patients culturing Pseudomonas spp. were older and had had more reviews and intravenous antibiotic courses. Conclusions: Bronchiectasis imposes a considerable burden on hospital services. Patients culturing Pseudomonas spp. impose a greater burden. Aetiology is often unknown. Therapies with unproven benefit are often used.