电磁导航支气管镜研究进展

近年来,支气管镜技术在呼吸系统疾病诊断及治疗中的作用愈来愈突出,但过去一直局限于大气道,由于肺支气管树分支较多且越来越细,对于肺外周的病灶活检仍存在一定的困难,盲检必然会带来一定程度的损伤及漏检。随着CT引导经胸壁肺活检、电视辅助胸腔镜、以及超声内镜等技术的应     

电磁导航支气管镜联合径向超声对肺外周病变的诊断价值

目的 探讨电磁导航支气管镜(ENB)联合径向超声(EBUS)对肺外周病变的诊断价值.方法 纳入2018年1月至2019年7月就诊唐都医院呼吸科的肺外周病变32例,筛除最终诊断不明确的和未探及活检的6例,对比入选26例诊断率及确诊病例临床特征分层关系和未确诊病例临床特征.结果 ENB+EBUS确诊17例,诊断率65.4％...     

经支气管镜肺活检对弥漫性肺实质疾病的诊断价值

目的 评价经支气管镜肺活检(TBLB)在弥漫性肺实质病变诊断中的作用.方法 回顾性分析2001年1月至2006年10月在北京协和医院住院、经TBLB检查且具有完整临床资料的肺部弥漫性疾病患者416例,男157例,女259例,平均年龄(42.6±18.9)岁.结果 416例中124例(29.8%)经支气管镜肺活检确诊,其中结节病52例(41.9%),闭塞型细支气管炎伴机化性肺炎(BOOP/OP)28例(22.6%),肺泡蛋白沉积症(PAP)19例(15.3%),肺部肿瘤12例(9.7%),肺血管炎5例(4.0%),肺结核3例(2.4%),肺孢子菌肺炎、曲霉肺炎、嗜酸细胞肺炎、淋巴管肌瘤病(LAM)及肺淀粉样变各1例.经支气管镜肺活检未确定诊断的患者中104例进行了开胸或胸腔镜活检,98例确诊,其中非特异性间质性肺炎37例(37.7%),寻常型间质性肺炎18例(18.4%),结节病11例(11.2%),BOOP/OP 6例(6.1%),肿瘤5例(5.1%),外源性过敏性肺泡炎4例(4.1%),曲霉肺炎、PAP、淋巴细胞间质性肺炎、肺动脉高压及LAM各2例(各占2.0%),结核、肺血管炎、组织细胞增生症X、呼吸细支气管炎伴间质性肺炎、脱屑性间质性肺炎、弥漫性泛细支气管炎、气道中心性纤维化各1例(各占1.0%).结论 TBLB可对约30%的肺部弥漫性肺疾病确诊,可作为开胸之前的常规筛查手段.     

超声支气管镜引导下经支气管针吸活检70例临床分析

目的 评价超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)对纵隔和肺门淋巴结肿大和肺内肿块的诊断价值和安全性.方法 对2009年7月至2010年1月上海市肺科医院胸部CT检查显示胸腔内肿物和(或)纵隔-肺门淋巴结肿大的门诊或住院患者行EBUS-TBNA,观察诊治效果.结果 入选患者70例,男47例,女23例,年龄22～84岁,平均55.7岁.其中门诊患者25例,住院患者45例.穿刺肺门淋巴结120组,肺内肿块11例次.70例患者中,在没有采用现场细胞学诊断的条件下,46例初诊肺癌患者通过EBUS-TBNA明确诊断44例,假阴性2例,诊断肺癌的敏感度为96%,特异度为100%,阳性预测值为100%,阴性预测值为92%,准确率为97%;10例临床诊断为结节病的患者中,5例镜下可见上皮细胞形成的非干酪样肉芽肿改变;4例结核患者中,1例淋巴结涂片中找到抗酸杆菌,淋巴结活枪病理示凝固性坏死.所有患者手术期间未发生并发症.结论 EBUS-TBNA是诊断肺癌和其他不明因纵隔-肺门淋巴结肿大的一种安全、有效的方法.     

经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性肺间质性疾病的诊断价值。方法51例弥漫性肺问质性疾病患者,在无X线电视透视下行TBLB,对临床资料及病理诊断结果进行分析。结果51例弥漫性肺疾病中有16例明确了病因学诊断,确诊率达31．4％。临床诊断病例共28例,诊断率达54．9％,未能明确诊断7例（13．7％）。结论纤维支气管镜肺活检对弥漫性肺间质性疾病的诊断是一种可靠、安全、简便、经济的方法,特别是在弥漫性肺疾病诊断中除外结节病、肿瘤和某些特殊类型的感染有重要价值。     

虚拟支气管镜导航软件——DirectPath的初步应用

目的 探索虚拟支气管镜导航软件(DirectPath)使用不同重建层厚的CT图片数据重建出三维支气管树的效果,评估该软件引导常规/超细支气管镜进入肺外周目标支气管的能力.方法 入选行胸部CT扫描发现肺孤立性结节者60例,其中8排螺旋CT扫描组(8排组)30例,64排螺旋CT扫描组(64排组)30例.8排组获取的图片可以刻录成1.25 mm层厚的重建数据,64排CT组图片可分别刻录成1.25 mm和0.625 mm两组层厚的重建数据.将所有入选者的重建数据导入DirectPath导航软件中,软件自动重建出三维支气管树,并模拟出目标支气管的图像,记录所有入选者重建出的三维支气管树及右B1a、右B6a、右B10a 3支支气管最远端所在的支气管级别和最短直径.结果 所有入选者均重建出了三维支气管树.1.25 mm层厚时,64排组重建出的三维支气管树优于8排组(Z＝-2.849,P=0.004),且64排组重建出的右B1a、右B6a级别更远.64排组中,0.625 mm层厚较1.25 mm层厚能重建出级别更远、直径更小的支气管,但2种层厚重建出的三维支气管树差异无统计学意义(Z＝-1.732,P=0.083).60例入选者,1.25 mm层厚时,重建出右B1a、右B6a、右B10a 3支支气管的最远级别及最短直径差异无统计学意义(P值均＞0.05),3支支气管重建出级别大于6级(含6级)的比例分别为66.7％、60.0％、65.0％,而当64排组0.625 mm层厚时,上述比例分别为90.0％、90.0％、88.3％.结论 虚拟支气管镜导航软件(DirectPath)使用64排CT扫描0.625 mm层厚的数据可以重建出较好的支气管树,其具备引导常规/超细支气管镜进入肺外周目标支气管的能力.     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

肺癌在支气管镜下的特征

目的深入了解肺癌在支气管镜下的特征。方法采用纤维支气管镜、痰细胞学及病理学等方法对１１０５例患者进行了观察。结果经纤维支气管镜确诊支气管肺癌１１０５例，占同期支气管镜检查的２５５％。其中６３８例（５７７％）可见肿瘤直接征象，即新生肿物；４１２（３７３％）例可见肿瘤的间接征象。２７例（２４％）镜下符合黏膜炎性改变，但黏膜病理活检确诊为肺癌。此外，２８例（２５％）镜下未见明显异常，但支气管黏膜盲目活检得到肺癌的病理诊断。在可见肿瘤直接和间接征象的１０５０例中鳞癌４２１例（４０１％），小细胞癌３２２例（３０７％），腺癌１７６例（１６８％），大细胞未分化癌２０例（１９％），肺泡细胞癌１７例（１６％）。此外还有鳞腺癌４例（０４％），细胞类型不明确者９０例（８６％）。然而，１０５０例中３２例镜下虽显示新生物肿块，５４例可见癌的间接征象，但第一次支气管镜下病理活检报告为急性和慢性炎症。结论（１）肺腺癌患者中男性仍稍多于女性；（２）绝大部分肺泡细胞癌在支气管镜下仅显示管腔狭窄、黏膜肿胀等非特异的间接征象；（３）各肺叶前侧段支气管癌的发生率与后侧段没有显著差别。     

经支气管镜介入治疗的新技术

近年来,随着肺脏介入医学在呼吸内科领域的发展,作为介入性肺病学的一个重要组成部分—经支气管镜介入治疗已经成为呼吸系统疾病治疗的重要手段。各种气道狭窄性病变都可以通过经支气管镜介入技术来治疗,其创伤小、疗效可靠,良性病变可以治愈、对于无法手术及无法耐受手术的恶性肿瘤患者可以达到缓解症状、姑息治疗的目的。本文就经支气管镜介入治疗的新技术进行综述。     

Recent advances in schistosomiasis

Schistosomiasis is a major parasitic disease, affecting nearly 200 million persons, worldwide. Major advances in our knowledge-in terms of pathogenesis, improved diagnosis, therapeutics (both drugs and strategies), and morbidity assessment-now make schistosomiasis a curable, often preventable disease. In contrast to most other illnesses, most schistosomiasis pathology appears to be reversible over time. For the future, several promising vaccine candidates are already in phase-I or phase-II testing. On the other hand, the range of this disease has been increasing, as water resources are developed in several newly industrialized countries and much of schistosomiasis in sub-Saharan Africa remains largely untreated.     

Recent advances in hemodynamics

The use of the pressure sensor coronary guidewire is expanding into the peripheral circulation as well as into the realm of valvular heart disease. Small mechanistic studies and case reports have described the use of pressure wire technology in the renal and femoral arteries as well as in mechanical aortic valves. The use of this technology to measure hemodynamically significant stenoses in noncoronary locations will be discussed and a review of basic and more advanced hemodynamics in relation to problems encountered in clinical practice will be provided. © 2008 Wiley‐Liss, Inc.     

Recent advances in hemophilia

Classical sex-linked hemophilia (Hemophilia A) has been described as due to deficiency in the synthesis of Factor VIII procoagulant activity (VIII:C). The availability of immunological techniques provided the means of identifying Factor VIII-Related Antigen(VI-IIR:Ag) detectable by rabbit antibodies to F VIII, which is distinct from VIII:C detected by human anti-F VIII available from multitransfused patients. Hemophilia A is lacking in VIII:C but not VIIIR:Ag. Recently, a third function of the F VIII "complex" was discovered with the help of ristocetin (von Willebrand's Factor, VIIIR: RCo). This activity is reduced in von Willebrand's syndrome. Estimation of the titers of VIII:C and VIIIR:Ag provides a method for more accurate detection of hemophilic carriers. Newly available chromogenic substrates perhaps will give rise to more simplified assays of VIII:C. The development of cryoprecipitates and stable lyophilized concentrates of F VIII has greatly simplified and intensified maintenance therapy, and has opened a new era in treatment. Prophylactic therapy has been shown to be very helpful in certain "high risk" cases. The impact and benefits of home care and self-administration has been tremendous. However, the varying quality of cryoprecipitates and the high cost of more purified concentrates are still stumbling blocks in treatment regimes. Other problems exist. Spontaneous bleeding, especially central nervous system bleeding, account for the majority deaths by haemorrhage. Inhibitor kinetics have been well characterized. It is clear that there exists "low" and "high" responders. For the "high" responders, plasmapheresis, immunosuppressives and the infusion of Factor IX concentrates have been utilized with varying success. The prevention of hemophilic arthropathy and its progression by maintenance therapy seems to be still inadequate. The results of trials with more vigorous regimes are awaited. The complications of therapy still remain to be solved. Apart from the well-known complications wuch as hepatitis, haemolytic disease and F VIII inhibitors, the existence of previously unnoticed complications as splenomegaly, hypertension, renal disease and paradoxal bleeding have been recently realized. The role of altered fibrinogen, fibrin degradation products (FDP) and unclassified fibrinogen derivatives (UFD) present in cryoprecipitates and F VIII concentrates in the above complications needs to be further clarified. In conclusion, tremendous progress in various aspects of hemophilia has been achieved in developed countries. Comprehensive care can now be carried out in various centers. On the other hand, developing countries still face a number of basic problems. The concept that hemophilia is a "manageable" disease and that chronic crippling and death from exsanguination can be prevented, should be disseminated widely by various means...