16层CT和纤维支气管镜对小体积中央型肺癌与肿瘤样EBTB鉴别诊断价值

目的探讨16层CT及纤维支气管镜在小体积中央型肺癌与肿瘤样EBTB鉴别诊断中的应用价值。方法小体积的中央型肺癌共22例,肿瘤样EBTB25例,所有病例均行16层CT及纤维支气管镜检查,然后进行CT后处理并行相关数据测量及分析。结果根据肿瘤形态、位置,小体积中央型肺癌与肿瘤样EBTB均可分为5种类型：支气管腔内结节型;支气管腔内团块型;支气管腔外压迫型;肺门区团块型;肺不张型。16层CT的分型可以与纤维支气管镜所得的病理分型相对应。16层CT轴位扫描结合后处理重建图像能整体显示气管、支气管及叶段支气管改变,可以进行患病气管支气管长度、厚度的测量,揭示管壁表现与纤维支气管镜下病理分型对应,即不同的病理类型有其相应的CT表现。16层CT尚可反映2种疾病影像学上的不同点。纤维支气管镜可观察病变表面并进行病理分型。结论 16层CT与纤维支气管镜在小体积中央型肺癌与肿瘤样EBTB鉴别诊断中有着各自不同的价值。     

纤维支气管镜冷冻治疗气管支气管肿瘤39例

[目的]探讨纤维支气管镜冷冻治疗气管支气管肿瘤的疗效。[方法]经纤维支气管镜对39例气管支气管肿瘤进行冷冻治疗。[结果]患者咳嗽症状改善76．9％，咯血91％，呼吸困难92.3％，胸痛50％，均有缓解。显效61．5％，有效30．80%，总有效率92.3％。[结论]内镜下冷冻治疗管腔内生长的中央型支气管肺癌，患者症状得到控制，生活质量明显提高。     

纤维支气管镜刷片细胞学检查在肺癌诊断中的应用价值

本组纤维支气管镜刷片确诊，经闰理及临床证实为肺癌的９４例，就纤维支气管镜下表现与细胞分型进行了对照观察，鳞癌４７例，腺癌２０例，未分化癌１５例，未分型癌１２例。纤维支气管镜下所见；粘膜充血肿胀２３例，管腔狭窄１３例，分泌物多，溢血７例，未见异常改变５１例。     

体积较小的中央型肺癌与增殖型支气管内膜结核的CT鉴别诊断

目的分析与对比体积较小的中央型肺癌与增殖型支气管内膜结核的CT的影像学特征,评价CT对体积较小的中央型肺癌与增殖性支气管内膜结核的诊断价值,提高对支气管内膜与中央型肺癌的认识水平及诊断水平。方法回顾性对比分析52例体积较小中央型肺癌与123例增殖型气管支气管内膜结核的CT片表现,并总结各自的影像特征,以上所有病例均经手术切除、痰检、纤维支气管镜活检、穿刺组织病理证实。所有中央型肺癌患者均行平扫和增强检查,支气管内膜结核患者中所有患者行平扫,其中的107例病同时行增强检查。结果发现增殖型支气管内膜结核与体积较小的中央型肺癌与的CT的影像学对比,有以下特异点:①病变范围较广,常见多个支段受累,本组病例中有60例累及2叶段以上;②病变支气管范围长,多为主支气管、叶支气管、段支气管连续或间断受累;③管腔多为不规则狭窄,有串珠状改变;④管壁多为不规则增厚,但其管壁外径未见增大,即中心性增厚,内径缩小;以上病例管壁密度增高或钙化;⑤肺部多见结核并发灶;⑥肺门纵膈一般无肿块影。结论增殖型气管支气管内膜结核与中央型肺癌CT上有一些不同点,对这些征象表现进行细致的分析,可以提高支气管内膜结核与中央型肺癌的诊断准确率。     

应用记忆镍钛合金支架治疗气道狭窄

目的用记忆镍钛合金支架治疗气道狭窄疗效观察方法，选择气管癌或其他疾病致气道狭窄病人４２例，用纤维支气管镜导引、在Ｘ线监视下，置入记忆镍钛合金支架。结果：显效，气管管腔直径≥１．７ｃｍ或主支气管管腔直径≥１．３ｃｍ者３２例。有效，气管管腔直径≥１．２ｃｍ或主支气管管腔直径≥０．８ｃｍ者１０例，总有效１００％。结论：应用纤维支气管镜置入记忆镍钛合金支架治疗气道狭窄是一种简单、安全、有效的新方法。     

纤维支气管镜下介入冷冻治疗支气管腔内恶性肿瘤

气管、支气管肿瘤是临床上常见的疾病，目前常用的治疗方法有手术、化疗和放疗等。为探讨新的治疗方法以提高疗效、减轻患者痛苦、提高生活质量、延长生存期，我院自2003年开始，应用纤维支气管镜(以下简称纤支镜)下冷冻治疗支气管腔内中央型肺癌28例，取得了良好的近期疗效，现报道如下。     

管支架治疗肺癌引起的气管支气管狭窄5例报告

管支架治疗肺癌引起的气管支气管狭窄５例报告李留树董生朱顺荛刘天星白杨袁瑞康朱建华关键词肺肿瘤管支架气管支气管狭窄中图号Ｒ７３４，１原发性支气管肺癌约１／３患者肿块位于支气管腔内引起阻塞性肺炎或肺不张，严重者可导致呼吸道梗阻。我们采用镍钛合金支架治疗５...     

上叶肺癌术后支气管切缘癌残留相关因素分析

目的　探讨肺癌术后支气管切缘癌残留的相关形成因素 ,确立避免和减少切缘癌发生的策略和方法。方法　分析1994年至 2 0 0 2年经手术治疗的 60例上叶肺癌 ,在不同肿瘤分期、病理类型、手术适应证与扩大的手术适应证、术前纤维支气管镜所见、不同手术方式、支气管残端不同缝合方法及术中是否行残端快速冷冻病理检查等诸因素 ,对术后支气管残端癌残留形成的影响。结果　在 60例中手术后出现残端癌残留 10例 ,残端癌发生率 16.7% ,术前纤维支气管镜检查 ,能够在支气管腔内观察到肿瘤的 19例为中心型肺癌 ,其中残端癌残留 7例 ,阳性率高达 3 6.8% ,术前支气管镜检查阴性 41例为周围型 ,其中出现残端残留 3例 ,支气管残端癌发生率在中心型肺癌比周围型高 (P <0 .0 5 ) ;手术中未做残端冷冻病理检查的 5 6例 ,术后残端癌残留阳性 10例 ,其中 6例肺叶切除术后残端阳性者 ,分析其为支气管袖状肺叶切除术的手术适应证 ;在肺叶切除术中通过冷冻病理检查发现支气管残端阳性 2例 ,术式改变为支气管袖状肺叶切除术。结论　严格掌握肺癌手术的适应证并选择合理术式 ,术中支气管残端快速冷冻病理检查应作为肺癌外科的手术常规     

镍钛记忆合金支架置入在肿瘤性气道狭窄中的治疗应用

我院呼吸内科利用纤维支气管镜 (纤支镜 )直视下放置镍钛记忆合金支架 (NI TI支架 ;自膨胀网状气道专用支架 ,带导引鞘的三套管支架输送器放置支架 ) ,治疗气管内外肿瘤造成的气道狭窄 ,取得了良好的疗效 ,总结报道如下。1　临床资料1.1　一般资料2 0 0 2年 5月～ 2 0 0 4年 6月 ,2 9例肿瘤性气道狭窄患者 ,男2 3例 ,女 6例。年龄 3 2～ 78岁 ,平均年龄 60岁 ,中位年龄 5 5岁。气管肿瘤 9例 ,肺癌支气管狭窄 12例 ,食管癌侵犯气管 6例 ,甲状腺肿瘤致气管狭窄 2例。狭窄部位 :气管 12例 ,气管及支气管 3例 ,支气管 9例 ,气管、支气管、食管…     

经纤维支气管镜插管腔内放射治疗肺癌

目的 高剂量率腔内放射治疗肺腔内侵犯疗效观察、方法 选择肺癌腔内侵犯患者１６例，经纤维支气管镜插和后浆治疗管，与ＳＫ－Ⅱ型近距离后装治疗机连进行放疗。剂量为每闪５Ｇｙ，每周１次，共照４次。结果 纤维支气管镜检查示肿瘤消退，管腔通畅１２例，癌肿部分消退，管腔增宽４例，总有效率１００％。结论 高剂量率腔内放射治疗肺癌腔内侵犯 ，可快速消除梗阻，缓解症状，是一种简单、安全、有效的治疗方法。     

The Value of Multislice Spiral Computed Tomography in Demonstrating the Relationship between Bronchial and Peripheral Lung Cancer

OBJECITVE To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchial and peripheral lung cancer.METHODS MSCT was used to conduct volumetric targeted scans of 0.5 mm collimation for 53 cases of peripheral lung cancer and to demonstrate the relationship between bronchial and peripheral lung cancer by multiplanar reconstrUctions(MPR) images, curved multiplanar reformations(CMPR) and surface shaded display(SSD). The results were compared with macroscopic and microscopic specimens.RESULTS 1) All the bronchi at the 3rd to 7th order were displayed clearly and completely with this CT protocol. The tumors that were related to the bronchus included 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistical analysis showed that there was no significant difference between the two groups (x2 =2.8, P ＞0.05). 2) The tumorbronchus relationship was divided into four subtypes, i.e. type Ⅰ: the bronchus was obstructed by a tumor, type Ⅱ: the bronchus was obstructed when penetrated by a tumor with tapered narrowing; type Ⅲ: the bronchial lumen shown within the tumor was unobstructed and intact, type Ⅳ: the bronchus ran at the periphery of a tumor, with an intact or narrowed lumen.3) Type Ⅰ occurred in 58.5% (31 cases), in which squamous-cell carcinoma was slightly more common than adenocarcinoma. Both type Ⅱ and type Ⅲ were seen in 15.1%(eight cases of each), of which all were adenocarcinomas. The incidence rate of type Ⅳ was 28.3% (15 cases), of which adenocarcinoma was slightly more frequent than squamous-cell carcinoma. 4)Squamous-cell carcinoma was more common than adenocarcinoma in the tumors in the fourth-order bronchus, whereas adenocarcinoma was more common than squamous-cell carcinoma in tumors with a relationship to the sixth-order bronchus.CONCLUSION MSCT with volumetric targeted scans of ultra-thin sections were conducted followed by MPR,CMPR and SSD reconstruction. This procedure can accurately demonstrate the relationship between the nature of tumors and bronchus and thereby to some extent reflect pathological changes.     

A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma.

BACKGROUND: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. The authors prospectively compared the sensitivity of endobronchial needle aspiration (EBNA) and immediate cytologic assessment with bronchial biopsy and bronchial washing in the diagnosis of endobronchial malignancy. METHODS: A prospective trial comparing the sensitivity of EBNA, bronchial biopsy, and bronchial washings during fiberoptic bronchoscopy for endobronchially visible lung tumor was conducted. The authors enrolled 65 consecutive patients with endobronchial abnormalities identified during bronchoscopy. All patients in the study underwent fiberoptic bronchoscopy that included EBNA, bronchial biopsy, and bronchial wash. The sensitivities of the individual techniques were compared. The sensitivities of bronchoscopy were also prospectively compared when multiple sampling techniques were employed. RESULTS: Malignancy was present in 57 of 65 study patients. Cancer was diagnosed in 47 patients by EBNA, 42 patients by bronchial biopsy, and 36 patients by bronchial washing. The sensitivity of a strategy employing bronchial biopsy and bronchial washings was 0.82 (95% CI, 0.70-0.90). The addition of EBNA to bronchial biopsy and bronchial washings significantly increased the sensitivity to 0.95 (95% CI, 0.85-0.98; McNemar P = 0.02). Subset analysis revealed that this strategy was especially useful in cases in which lesions were submucosal or causing extrinsic compression. CONCLUSIONS: There is a modest increase in the sensitivity of fiberoptic bronchoscopy in diagnosing endobronchial cancer with the addition of EBNA to bronchial biopsy and bronchial washings, especially for patients with submucosal abnormalities. Collection of EBNA, followed by biopsy and washings only if immediate interpretation of EBNA is negative or inadequate, may be the most effective bronchoscopy strategy for evaluating visible endobronchial abnormalities.     

Optical coherence tomography in the diagnosis of bronchial lesions

PURPOSE: Optical coherence tomography (OCT) can obtain high-resolution, cross-sectional microscopic images of tissue, potentially enabling optical biopsy to substitute for conventional excisional biopsy. We sought to investigate the capability of OCT to image the microstructure of normal and abnormal bronchial tissue. MATERIALS AND METHODS: Equipment: The OCT system was produced by Light Lab Imaging (Boston, U.S.A.) and Pentax. (Tokyo, Japan). Preliminary examination: the OCT system was used to image-resected lung specimens from patients who had given written informed consent for this study. We inserted the OCT catheter via the working channel of the bronchoscope to evaluate the bronchial lumen. The catheter delivers a radial OCT beam and scans circumferentially to generate a transluminal image. We collected OCT images of normal bronchus, primary tumors and alveoli. All images were saved and labeled according to the patient and type of tissue imaged for later correlation with histologic studies. Clinical examination: five other patients, all of whom had given written informed consent, were examined with the OCT system under local anesthesia. The OCT catheter was inserted into the working channel of the bronchoscope for evaluation of the bronchial lumen. We collected OCT images of the normal bronchus and tumors in vivo. RESULTS: (1) Normal bronchus: the bronchial mucosal and submucosal layers appear homogeneous in OCT images. The submucosal layer is relatively reflective due to the presence of an extracellular matrix. A membrane can be seen between the submucosal and the smooth muscle layer, and areas of cartilage show high levels of scattering. (2) Alveoli: OCT images show the uniform appearance of the bronchial wall and the structure of air-containing alveoli. (3) Central type lung cancers: in preliminary and clinical examinations, the tumors showed unevenly distributed high backscattering areas and resultant loss of the normal layer structure. CONCLUSIONS: This study was the first report of the endobronchial OCT for lung cancer in clinical practice. Layers of the bronchial wall were distinctly observed in the normal bronchus on the OCT images, as opposed to bronchial tumors which lacked a layered structure. The ability of OCT to identify abnormal areas may well revise present methods for early diagnosis endoscopically.     

Proximal bronchial invasion of lung cancer: A clinicopathological study

FromJanuary1994toDecember1996,151operativelyresectedspecimensfromhilarlungcancercasesorpatientsweresubjecttohistopathologicalstudyinHenanCancerHospital.Thepurposewastoexplorepathologicallythecharacteristicsofproximalbronchialinvasionoflungcancerwithvarioushistopathologictypes,andthentoprovidetherationalbasisforthedeterminationofsaferesectionsizeofbronchusandtheselectionofaproperoperationmode.MATERIALSANDMETHODSClinicalDataThe151specimenswereallnewlyresectedduringpneumonectomyfrompati…     

Occult lung cancer with positive cytology and normal chest film--an analysis of 54 cases

From 1973 to 1980 and 1982 to 1984, mass annual screening was carried out in Yunnan Tin Corporation. Chest X-ray and sputum cytology were used to detect lung cancer among subjects with an underground work history over 10 years and over 40 years of age. 54 cases of occult lung cancer with positive cytology and negative X-ray plain film were found, 48 out of 100,725 subjects and 6 out ot 8,808 out-patients. 42 lesions were located by bronchoscopy and 12 by various roentgenologic examinations. Among these 54 cases, 52 (96.3%) were central type lung cancers. Squamous cell carcinoma was found in 53 and small cell anaplastic carcinoma in only 1. Diagnosis was established by pathology in 35 and by cytology in 19. In 18 cases treated by surgery, there were 15 Ia stage and 3 Ib (UICC staging system). 3 Ib died of recurrence 33, 62 and 101 months after operation. 1 Ia died of residual cancer recurrence 21 months after sleeve-resection. The overall 5 year survival rate was 91.6% (11/12). The authors believe that X-ray plain films sometimes fail to detect the early stage central type lung cancers. Bronchoscopy, in particular fiberoptic bronchoscopy is one of the most effective means in diagnosis and location. By bronchoscopy, in general, the tumor could be detected and the extent of involvement in the bronchus assessed. Finally, the authors emphasize that mass screening is a useful method to detect early lung cancer among the high risk population.     

肺癌侵袭近端支气管壁的临床病理探讨

目的探讨不同组织类型肺癌向近端支气管壁侵袭的规律。方法对１５１例中心型肺癌手术切除标本近端支气管进行不同断面的病理学研究。其中,全肺切除标本４１例,肺叶切除标本１１０例。结果癌细胞沿管壁粘膜下层或多层面直接侵袭是癌扩延的主要方式,９６．６％的癌侵袭发生在距瘤缘１．５ｃｍ以内的管壁上。其侵袭距离与病理类型、侵袭方式及ＴＮＭ分期因子（ｐＴ、ｐＮ）相关。转移淋巴结对管壁的侵袭也是癌扩延不容忽视的形式。结论为获得根治切除,支气管切端距瘤缘的安全界限原则上应超过１．５ｃｍ,并须彻底清除肺门纵隔淋巴结     

The curative potential of intraluminal bronchoscopic treatment for early-stage non-small-cell lung cancer

Bronchoscopic treatment modalities such as lasers, electrocautery, cryotherapy, photodynamic therapy, and brachytherapy are potentially curative for patients with very-early-stage non-small-cell lung cancer (NSCLC) in the central airways. Previously, studies had primarily focused on the effectiveness of surgery, surgical bronchoplasty, and photodynamic therapy. The cure rate of intraluminal bronchoscopic treatment is strongly related to the patient's functional status and tumor stage. Intraluminal tumors are curable bronchoscopically when they are accessible to the fiberoptic bronchoscope, strictly intraluminal, and superficial with visible proximal and distal tumor margins. Early-stage cancer infiltrating deeper into the bronchial wall may already harbor metastases to the regional lymph nodes; hence, curative intraluminal treatment is not feasible. The use of new diagnostic tools (eg, high-resolution computed tomography, autofluorescence bronchoscopy, and endobronchial ultrasound) may improve staging to select the category of patients in whom intraluminal bronchoscopic therapy with curative intent is appropriate. An accurate intraluminal tumor staging will improve our ability to exploit the curative potential of many bronchoscopic techniques for complete tumor eradication in patients with very-early-stage intraluminal NSCLC in their central airways. The use of bronchoscopic treatment as a less morbid alternative than surgical resection will benefit patients most when tumor is detected at the earliest stage possible.     

经支气管镜活检孔道注水法观察直径小于支气管镜口径的支气管腔内病变的可行性

目的:探讨经支气管镜活检孔道注水法观察直径小于支气管镜口径的支气管腔内病变的安全性及可行性。方法:2017年6月至2019年6月我院内镜科气管镜室行活检孔道注水法观察直径小于支气管镜口径的支气管腔内病变共50例,常规支气管镜检查目标支气管口径小于支气管镜口径,支气管腔内病变表覆气泡或黏液,支气管镜无法深入,病变观察不清晰。经活检孔道注水后,清除病变表面气泡或黏液,扩张目标支气管,使病变视野变得更清晰,活检取样避开血管丰富区域,使操作更准确,安全。结果:50例患者均经气管镜活检取样证实为肺癌,其中鳞癌25例,小细胞肺癌15例,腺癌10例,无一例患者因出血而镜下应用止血药或因大出血而行抢救治疗,患者检查后均可自行离开检查室。结论:经支气管镜活检孔道注水观察直径小于支气管镜口径的支气管腔内病变是安全可行的,结果满意。     

A case of synchronous bilateral double primary lung cancer successfully treated by Nd-YAG laser therapy and chemotherapy

A 61-year-old man was admitted to our hospital with the chief complaint of hemosputum. He was a heavy smoker. A chest radiograph revealed a tumor shadow in right S3 which invaded the pulmonary artery. There was also an associated patchy shadow in the periphery as well as ipsilateral pleural effusion. Bronchoscopy revealed a near occlusion with superficial infiltration at the right B3 bronchus and a nodular tumor at the bifurcation between the left upper and lingual division bronchi, which was consistent with endoscopic early lung cancer. Although both tumors were histologically diagnosed as squamous cell carcinoma, this was considered to be a case of synchronous double primary lung cancer due to their mutual isolation. The left tumor was subsequently diagnosed as carcinoma in situ. Following Nd-YAG laser therapy for carcinoma in situ and 4 courses of systemic chemotherapy using TXT and CDDP, bronchoscopy revealed no residual cancerous tissue and no tumor apart from the nodular shadow in right S3 was seen on a radiograph. Subsequent right upper and middle lobectomy and lymph node (R2a) dissection revealed no residual tumors.