纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌气道阻塞

目的观察纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌致气道阻塞的近期疗效。方法对18例支气管肺癌所致气道阻塞患者进行纤维支气管镜下高频电刀烧灼切割术,再行气管内192Ir放疗,观察治疗前和治疗后临床指标的改善情况。结果治疗后18例支气管肺癌患者的临床气促分级、Kamofsky评分与肺功能指标均有显著好转,无明显副反应。结论纤维支气管镜下高频电刀术联合腔内放疗是治疗肿瘤性气道阻塞的有效方法,操作简便易行,值得推广。     

支气管腔内放疗治疗肺癌的疗效

目的：探讨支气管腔内后装近距离腔内放疗的方法、剂量和疗效。方法：用导丝导入法行支气管腔内放疗，可达亚段支气管。参考点20mm，单次剂量6-7GY，5-7日/间隔，2-4次/人。治疗中央型肺癌（均侵犯支气管）76例212人次。结果：病灶消失22例，缩小39例，稳定12例，进展3例，总有效率85.5％。起效时间均短于3周。结论：支气管腔内后装放疗是治疗腔内肿瘤及缓解伴随症状的有效方法。疗效及起效优于外照射和化疗。对复治患者仍然有效。     

支气管腔内近距离放射治疗

近距离治疗是将放射源置在肿瘤内部或附近进行治疗 ,是放射治疗的一种形式。 2 0世纪 80年代 ,由于纤维支气管镜(下称纤支镜 )、支气管腔内激光治疗、放射源 Ir1 92的出现 ,特别是遥控后装装置的发明 ,使支气管腔内近距离放疗得到了广泛的应用。现支气管腔内近距离放疗已广泛用于支气管肺癌的治疗。目前 ,最常用的放射源是 Ir1 92 ,是由多个铱粒相连组成的线形放射源 ,或仅含有单个高活性铱粒的点状放射源 ,可以用遥控后装装置来驱动 ,所以近距离放疗常常也被称为后装放疗。根据放射源的放射性强弱 ,治疗的剂量率被分为低剂量率 ( L DR)、…     

纤维支气管镜下冷冻治疗气道阻塞性疾病的护理

晚期支气管肺癌、结核性肉芽肿、气管内支架放置后肿瘤物的再生成以及气管腔内放疗后肿瘤的坏死物所导致的气道阻塞 ,常规治疗均不能直接解决气道阻塞症状 ,手术治疗创伤大且不能反复进行。我科近年采用纤维支气管镜 (纤支镜 )下冷冻治疗 12例气道阻塞性疾病近期疗效较好。现将术前、术中及术后护理配合报告如下。材料与方法1.一般资料本组男性 8例 ,女性 4例 ;年龄 18～ 72岁。 12例中支气管肺癌 2例 ,其中腺癌 1例 ,鳞癌 1例 ;支气管内膜结核性肉芽肿2例 ,气管内支架放置后肿瘤物的再生成 4例 ,气管腔内放疗后肿瘤的坏死物 4例。临床上气…     

支气管肺癌腔内放疗的近期疗效观察

目的探讨支气管肺癌腔内近距离放疗的近期疗效。方法2005年10月至2007年10月，共选择72例支气管肺癌患者，纤支镜引导下放置施源器，模拟机透视下将施源器词至合适位置，实施腔内近距离治疗，DT600-1800cGy／1-3次。结果23例病灶消失；39例病灶缩小；10例病灶无明显改变或病灶进展。结论：腔内近距离放疗是一种良好的姑息性治疗方法。     

支气管镜下介入治疗支气管结核气道阻塞82例临床疗效分析

目的 探讨经支气管镜下介入治疗支气管结核气道阻塞的临床疗效。方法 对82例支气管结核气道阻塞的患者在全身常规抗结核治疗的同时,联用支气管镜下介入治疗,根据气道阻塞狭窄程度选择冲洗、钳夹清除、高频电凝治疗及球囊扩张术治疗,后再局部管腔内注入抗结核药物INH。结果 82例患者管腔完全通畅54例、管腔轻度狭窄26例,气道阻塞未改变2例。结论 经支气管镜下介入治疗支气管结核气道阻塞的疗效确切,能有效解除气道阻塞。     

合理设计中心气道阻塞性病变的介入治疗方案

人虽然有两个肺脏，但只有1根气管，2根主支气管，在功能上右肺占55％，左肺占45％。气管出现阻塞，直接影响双肺的呼吸功能，而主支气管出现阻塞，同侧肺功能受到影响，甚至丧失。因此无论是气管还是主支气管，阻塞后都将引起严重的呼吸功能障碍，甚至窒息死亡。近年来出现的气道内介入治疗，通过非外科手术方法，可快速解除或缓解中心气道阻塞。但各种腔内介入技术都有其局限性，笔者结合患者和病变的类型，介绍腔内介入治疗方案的设计和麻醉方法的合理使用。     

气管、支气管、肺

531626 气管、支气管内良性肿瘤14例报告/孙成孚等//中华外科杂志.-1985,23(9).-537～8 气管、支气管内良性肿瘤较少见。作者报告14例,均经病理证实。该症的临床表现为三方面:1.由于肿瘤阻塞气管管腔而引起远端肺部反复发作的感染;2.由于肿瘤阻塞气道而引起的通气功能障碍;3.以咯血为主较少见。气管正侧位断层摄片对气管部位的肿瘤诊断有很大帮助,一般都能见到气管腔内肿瘤阴影。对位于中间支气管以下部     

支气管镜球囊扩张治疗良性气道狭窄12例临床观察

气道狭窄为支气管结核常见的并发症,临床上患者可出现活动受限、气促、呼吸困难,导致劳动力的丧失,亦可引起狭窄远端反复肺部感染.支气管腔内介入治疗气道狭窄是近年开展的一项新技术,使得许多以往需要手术治疗或者无法治疗的一些气道腔内病变,可以借助支气管镜下介入治疗而获得满意疗效.经支气管镜介导球囊扩张术治疗良性气道腔内疾病引起的气道狭窄可改善患者通气功能障碍.[第一段]     

置入支架行腔内放疗加体外照射治疗晚期肺癌

目的观察置入ＮＴ支架后行腔内１９２ＩＹ放疗加体外照射治疗大气道阻塞晚期肺癌患者的疗效。方法将４０例晚期肺癌患者，随机分为观察组（２０例）与对照组（２０例）。观察组采用ＮＴ支架及置入器，通过纤维支气管镜直视下无Ｘ线监视及钢丝引导，置入气道狭窄处，退出置入器，将施源器经纤维支气管镜活检管道插至肿瘤所致狭窄部位，然后遥控后装机，使１９２Ｉｒ进入该处行腔内放疗。腔内放疗结合体外照射，二者交叉进行。对照组只单纯行体外照射，１个月后，两组患者均行全身静脉化疗，化疗方案相同。结果观察组２０例，完全缓解７例（３５％），部分缓解１１例（５５％），无变化及恶化共２例（１０％），有效率９０％，明显高于对照组的６０％，Ｐ＜０．０５。结论置入ＮＴ支架后，能即刻解除患者的呼吸困难，行腔内加体外照射明显缓解因肺癌支气管内复发或其他部位肿瘤转移到气管、支气管树所引起的阻塞症状，其客观疗效及症状缓解均优于单纯体外照射。     

肺支气管原发性平滑肌瘤1例并文献复习

目的探讨肺支气管原发性平滑肌瘤的病例特点及治疗方法。方法分析I例肺支气管原发性平滑肌瘤患者的临床资料并复习相关文献。结果患者表现咳嗽、咯血、阻塞性叶段不张及肺炎,经胸片及纤维支气管镜活检等检查后确诊左上支气管平滑肌瘤（病理及免疫组化）,经纤维支气管镜介入冷冻治疗后病情好转并治愈。结论肺支气管原发性平滑肌瘤为良性肿瘤,依赖病理活检及免疫组化检查可确诊及确定组织来源。主要治疗方法为手术切除,也可经纤维支气管镜介入行镜下腔内肿瘤摘除术。同时,镜下冷冻治疗是气管、支气管内型的优选而少创伤的方法。     

Braided bronchus: A previously undescribed airway anomaly

Infants with congenital heart disease frequently experience recurrent atelectasis, in many cases associated with anomalous branching of the bronchial tree. The bridging bronchus has been well described and has been associated with both left-sided obstructive lesions and a sling-like left pulmonary artery. We describe a similar, though distinct airway anomaly, the “braided bronchus,” associated with a bridging bronchus in a child with coarctation of the aorta and recurrent atelectasis. Methods used to delineate the “braided bronchus” are described. Pediatr Pulmonol. 1998; 25:348–351. © 1998 Wiley-Liss, Inc.     

Primary Benign Bronchial Schwannoma Presenting as Asthma

Recurrent wheezing in children is frequently due to asthma and responds to bronchodilator therapy. We report a case of a 13-year old boy with a 2-year history of presumed asthma not responding to bronchodilator therapy. Bronchoscopy revealed a right main bronchus tumor, which was diagnosed as bronchial schwannoma after resection by sleeve lobectomy. We review the literature on this tumor.     

成人气管性支气管2例报告并文献复习

目的 提高对成人气管性支气管疾病的认识和诊断水平.方法 对2例成人气管性支气管的临床资料进行回顾性分析,分析其临床特征及电子支气管镜检查在诊断和治疗方面的作用.结果 该2例患者因肺部占位性病变行电子支气管镜检查,发现伴有气管性支气管,予电子支气管镜下活检占位组织后,气管性支气管未予处理.结论 气管性支气管是少见的气道先天发育异常,目前国内成人报告病例极少,随着介入肺脏病学及医学影像学的发展,其检出率日益增多,若无临床症状可不予特殊处理.     

支气管结核248例临床分析

目的　探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993～2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查,治疗结果。结果 248例患者中15～34年龄组青年女性明显高于其它组占69.2% (72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例,肺切除术后病理确诊14例。全组病例均予规范抗结核化疗,其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗,是改善临床症状,减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

Bronchial anomalies in VACTERL association

VACTERL association is an acronym made of associated defects including vertebral anomalies, anal atresia, cardiac, tracheal-esophageal fistula, and renal/radial limb anomalies. Tracheal bronchus is a condition characterized by ectopic location of the right upper lobe bronchus at the mid to distal trachea. This condition is associated with congenital anomalies and has been reported in one previous case of VACTERL. We report another infant with VACTERL presenting with respiratory complications due to presence of tracheal bronchus. She also had a narrowed segment of her right main stem bronchus.     

气管-支气管肺肌上皮瘤临床分析

目的探讨气管-支气管肺肌上皮瘤临床表现、诊断及治疗。方法回顾性分析本院1例、近15年国内外报道的10例确诊的气管-支气管肺肌上皮瘤病例资料、随访记录。结果发现气管-支气管肺肌上皮瘤多表现咳嗽、气促、咯血；确诊及治疗依靠手术。结论气管-支气管肺肌上皮瘤是一种罕见的肺部肿瘤，手术切除足治愈本病的主要手段。     

The bridging bronchus: A comprehensive review of a rare,potentially life‐threatening congenital airway anomaly associated with cardiovascular defects

The bridging bronchus is a rare congenital airway anomaly in which the right upper lobe of the lung is supplied by the right main bronchus while the right lower lobe, and often the right middle lobe is supplied by an aberrant bronchus arising from the left main bronchus. The aberrant bronchus crosses (bridges) the lower part of the mediastinum, hence the term bridging bronchus (BB). This potentially life‐threatening condition, usually accompanied by diffuse or focal airway stenosis, commonly presents with signs and symptoms related to large airway obstruction, such as respiratory distress, apnea, wheezing, stridor, and recurrent respiratory tract infections. Diagnosis of the BB is often challenging because the associated signs and symptoms mimic those of common conditions such as bacterial and viral bronchiolitis, bronchial asthma, cystic fibrosis, and foreign body aspiration. The BB is also often accompanied by congenital cardiovascular anomalies, including left pulmonary artery sling, atrial, and ventricular septal defects, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta. Patients presenting with the above signs and symptoms who are not responsive to standard treatment modalities, and have accompanying cardiovascular congenital anomalies should, therefore, be investigated for the BB. Herein, we review the anatomy, embryology, clinical presentation, differential diagnosis, imaging techniques and surgical management of the BB.     

成人纤维支气管镜在幼儿支气管异物治疗中的应用

目的探讨成人纤维支气管镜在幼儿(11/12～3)支气管异物治疗中的可行性及价值。方法在全麻插管下行气管切开,从切开处将纤维支气管镜缓慢插入气管,观察异物所在部位,并根据异物的性质采用不同的手法取出。结果本组共8例,治疗全部取得成功,无并发症出现。结论在全麻插管控制呼吸下应用成人纤维支气管镜钳取幼儿支气管异物的治疗方法是可行的,尤其适用于异物过深或有多个异物的患儿。     

Anterior bridging bronchus

Previously reported patients with a bridging bronchus (BB) presented with respiratory distress. In addition, each patient had one or more associated anomalies. All but two patients progressed to cardiopulmonary failure and death. We describe a case of an anterior BB without associated anomalies, who did well without operative intervention. This patient presented with a cough at 6 months of age. Chest X-ray was normal, but due to suspicion of foreign body aspiration, bronchoscopy was performed, which revealed a third bronchus at the carina. Bronchography demonstrated the anatomy of the BB. The patient has continued to do well without further intervention.