nm23蛋白在纤支镜活检中的表达意义

应用免疫组化ＳＰ法,通过纤支镜取材或刷片研究肺癌及肺良性病的ｎｍ２３蛋白表达情况,以探索ｎｍ２３在肺癌中与肺门或纵隔淋巴结转移的关系。结果：肺癌组ｎｍ２３蛋白阳性率低于肺良性病组（Ｐ〈０．０５）,肺癌组肺门或纵隔淋巴结转移的ｎｍ２３蛋白阳性率低于无淋巴结转移组（Ｐ〈０．０５）。表明：ｎｍ２３蛋白的表达可为术前肺癌有无肺门或纵隔淋巴结转移的参考指标。     

肺癌患者术前纤支镜取材检测nm23蛋白的临床价值

为了探讨ｎｍ２３蛋白在肺癌早期诊断中的价值及其与肺门或纵隔淋巴结转移的关系，采用ＳＰ法对３６例肺癌和３６例肺良性疾病患者，在术前以纤支镜取材并作ｎｍ２３蛋白免疫组织化学研究。结果显示：肺癌组纤支镜刷检涂片和活检组织标本中ｎｍ２３蛋白阳性率低于肺良性疾病组（Ｐ＜０．０５），肺癌组中有肺门或纵隔淋巴结转移的病例（Ｎ１～Ｎ３），ｎｍ２３蛋白阳性率低于无淋巴结转移的病例（Ｐ＜０．０５）。结果表明术前纤支镜取材检测ｎｍ２３蛋白，对肺癌诊断及术前判断有无肺门或纵隔淋巴结转移有一定的参考价值。     

469例经支气管镜检查确诊40岁以下肺癌患者的临床分析

背景与目的近年来,青年肺癌在临床上已不少见,发病率呈逐年上升趋势,临床上易误诊,预后较差。现将我科诊治的469例40岁以下肺癌患者支气管镜及临床特点回顾性分析如下,探讨40岁以下肺癌患者的肿瘤病理分型与性别、生长部位等的关系。方法对经支气管镜检查取材确诊的469例40岁以下肺癌进行回顾性分析。结果469例40岁以下患者肺癌患者中,男性332例,女性137例,男女性别比为2.42:1,病理分型,鳞状细胞癌155例(33.0%),其次是腺癌122例(26.0%),小细胞癌96例(20.5%),男性鳞癌的比例40.7%,明显高于女性14.6%,腺癌比例19.0%明显低于女性43.1%,男性和女性的肿瘤病理类型分布构成有显著差异(P<0.05)。病变部位以双上叶居多,右侧多于左侧。镜下改变新生物及黏膜浸润等直接征象占81.4%。结论40岁以下肺癌患者中,男性以鳞癌为主,女性以腺癌居多。青年人肺癌易漏诊和误诊,支气管镜检查是其诊断的重要手段,应该提高对青年肺癌的警惕和认识,及早进行支气管镜检查。     

鱼腥草注射液肺泡灌洗治疗神经外科重症监护室肺部感染

目的 观察鱼腥草注射液肺泡灌洗治疗神经外科重症监护室呼吸机相关性肺炎52例临床疗效。方法 52例患者采用全身应用抗菌素结合床边纤维支气管镜鱼腥草肺泡灌洗术治疗，观察患者术前术后的症状、体征、动脉血氧分压（PaO2）、氧合指数，所有患者于灌洗前后48～72h检查胸片。结果所有患者症状明显改善，灌洗治疗前后胸部X线片示病灶明显吸收。换气功能显著改善（P=0．000）。结论 鱼腥草注射液经纤维支气管镜肺泡灌洗局部注药部位准确，浓度高，有效地清除脓痰和气道分泌物，抗感染疗效显著，减少了全身用药。     

Fibrobronchoscopic treatment of foreign body aspiration in children: an experience of 5 years in Hangzhou City, China

Objective

The aims of the study were to evaluate duration of symptoms, clinical manifestation, radiological findings, fibrobronchoscopic findings, and the complications of airway foreign body (FB).

Methods

A retrospective review of 304 children who had airway FB removed via fibrobronchoscopy from January 1997 to June 2003 was conducted in the Children's Hospital of Zhejiang University School of Medicine, China. Two hundred eight boys and 96 girls were included. Their ages ranged from 2 months to 11 years, and the median was 18 months.

Results

Three patients died; 81.24% of the patients had a history of FB aspiration, and the most frequent clinical manifestation was paroxysmal coughing (89.25%). Positive radiological findings were found in 90.13% of patients, and the most common type of FB was peanut (35.53%). Serious complication of lung was found in 65 patients, and the associated factors were age, sex, and times of fibrobronchoscopy and location of FB in the right or left lung.

Conclusions

FB aspiration remains a major cause of morbidity and mortality in childhood. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality.     

经纤维支气管镜局部化疗治疗晚期肺癌

目的 观察经纤维支气管镜（纤支镜）局部化疗加全身静脉化疗治疗气道阻塞晚期肺癌患的疗效。方法 ①将４０例晚期肺癌患,随机分为观察组（２０例）与对照组（２０例）。观察组采用Ｏｌｙｍｐｕｓ ＢＦ及配套的ＮＭ－３Ｋ型注射针注入卡铂３００ｍｇ至瘤体中央及周围并卡铂、依托泊甙（ＣＥ方案）常规化疗。对照组单纯用ＣＥ方案化疗。结果 观察组２０例中,完全缓解７例（３５％）,部分缓解１１例（５５％）,无变化２例（     

Analysis of the therapeutic evolution in the management of airway infantile hemangioma

AIM: To analyze the evolution in the management of airway infantile hemangioma (AIH) and to report the results from 3 pediatric tertiary care institutions.METHODS: A retrospective study of patients with diagnosis of AIH and treated in 3 pediatric tertiary care institutions from 1996 to 2014 was performed.RESULTS: Twenty-three patients with diagnosis of AIH were identified. Mean age at diagnosis was 6 mo (range, 1-27). Single therapy was indicated in 16 patients and 7 patients received combined therapy. Two therapeutic groups were identified: Group A included 14 patients who were treated with steroids, interferon, laser therapy and/or surgery; group B included 9 patients treated with oral propranolol. In group A, oral corticosteroids were used in 9 patients with a good response in 3 cases (no requiring other therapeutic option), the other patients required additional treatment options. Cushing syndrome was observed in 3 patients. One patient died of a fulminant sepsis. Open surgical excision and endoscopic therapy were performed in 11 patients (in 5 of them as a single treatment) with a response rate of 54.5%. Stridor persisted in 2 cases, and one patient died during the clinical course of bronchial aspiration. In group B, oral propranolol was used in 9 patients (in 8 of them as a single treatment) with a response rate of 100%, with an mean treatment duration of 7 mo (range, 5-10); complications were not observed.CONCLUSION: Our experience and the medical literature support the use of propranolol as a first line of treatment in AIH.     

经纤维支气管镜气道内置入双腔球囊导管治疗支气管扩张咯血

目的 观察经纤维支气管镜（纤支镜）气道内置入双腔球囊导管治疗支气管扩张咯血的疗效。方法 支气管扩张咯血经常规内科治疗无效者15例,经纤支镜于出血部位置入新型气道内双腔球囊导管,压迫出血的支气管,观察球囊内注入的液体量、止血时间、停留导管时间、停留导管的副作用等。结果 15例患者均顺利置入导管,出血立即停止,停留导管时间为2-4d不等,无明显副作用。结论 该技术操作简便、疗效迅速可靠,患者容易耐受。     

纤支镜代替胸腔镜诊治不明原因胸腔积液的研究

目的探讨纤支镜代替胸腔镜诊治不明原因胸腔积液的价值。方法采用纤支镜代替胸腔镜对26例不明原因胸腔积液患者在局部麻醉下进行胸腔检查。结果①26例患者中25例获得了病因学诊断（阳性率96.15%）,全部都有病理学的诊断;②镜检中直视所见胸膜结核和转移性胸膜癌表现不同;③对转移性胸膜癌患者于术后行胸膜腔内注药效果好;④该方法并发症轻而少且经济节约。结论纤支镜代替胸腔镜诊治不明原因胸腔积液病因诊断的阳性率高,方法简单,创伤小,并发症少,经济节约,是一种值得临床使用的方法。     

Endobronchial migration of prosthetic patch after congenital diaphragmatic hernia repair

Surgical repair of congenital diaphragmatic hernia (CDH) can be performed by means of either direct suturing of the diaphragm or positioning of a prosthetic patch. However, half of all prosthetic patches show evidence of reherniation. We describe the case of an 8-year-old girl who presented with prosthesis dislocation and fistulization in the right lower bronchus as a complication of a CDH repair that she underwent when she was 1 year old. Abdominal ultrasound and magnetic resonance imaging suggested a hernia relapse, whereas chest computed tomographic scan failed to identify the diaphragmatic defect. Only fibrobronchoscopy allowed fistulization of the prosthesis into the bronchi to be correctly diagnosed.