原发性气管支气管淀粉样变1例及文献复习

目的:探讨原发性气管支气管淀粉样变的流行病学特征、临床表现及诊断和治疗方法。方法:回顾1例原发性气管支气管淀粉样变病例的临床特点,并结合文献进行分析。结果:患者主要表现为咳嗽、咳痰、咯血及呼吸困难,经纤支镜活检标本刚果红染色阳性。经治疗后患者症状明显缓解。结论:原发性气管支气管淀粉样变临床上发病率极低,容易误诊,组织病理学检查是气管支气管淀粉样诊断的金标准,目前缺乏特异性治疗方法。     

气管支气管淀粉样变3例病例报道及文献复习

目的 总结气管支气管淀粉样变的临床表现、影像表现、鉴别诊断及治疗方法。 方法 报道就诊于山东大学附属省立医院经支气管镜活检病理确诊为气管支气管淀粉样变的3例病例,复习相关文献。 结果 气管支气管淀粉样变临床症状及影像学无特异性,临床症状主要为:咳嗽、胸闷、憋气、呼吸困难、咯血等,影像学上可出现管壁钙化或增厚,管腔狭窄,增强扫描可见病灶有强化,其中管壁钙化为较特异性的特征,临床误诊及漏诊常见,局限的气管支气管淀粉样变容易漏诊,病变较弥漫的可伴有肺门淋巴结肿大及钙化、肺部结节状或斑片状高密度影,容易误诊为支气管哮喘、肺结核、慢性支气管炎等疾病。 结论 气管支气管淀粉样变临床少见,症状无特异性,由临床医师对影像学观察及认识不足导致误诊漏诊常见。提高对本病的认识,对其影像学表现及临床特征综合分析,并及时行支气管镜检查,病理学显示淀粉样物质沉积,刚果红染色阳性可明确诊断,有助于减少误诊。     

气管及支气管结核误诊病例分析

目的：为提高气管、支气管结核诊断率，减少误诊率。方法：回顾性分析20例气管、支气管结核患者误诊的临床资料。结果：20例误诊患者经纤维支气管镜检查确诊，并经抗痨治疗痊愈证实。结论：20例病人有85％误诊，后经反复纤维支气管镜检查确诊，对疑似气管、支气管结核病例应做详细检查，避免误诊。     

气管,支气管结核20例临床分析

目的：认识纤维支气管镜检查在气管、支气管结核诊断中的重要价值。方法：对２０例气管、支气管结核病例临床分析。结果：２０例病人中３例经痰查结核菌阳性确诊，１５例误诊为肺癌，２例误诊为阻塞性肺炎，经反复做纤维支气管镜检查确诊，１例经抗痨动态观察确诊。各例经正规抗痨治疗９月后，１９例全愈，１例化疗１５年全愈。结论：２０例病人有８５％误诊，后经反复纤维支气管镜检查确诊，可见此法在气管、支气管结核的诊断中有重要价值     

儿童气管支气管软化症研究现状

气管支气管软化症(TBM)作为小儿慢性咳嗽、反复喘息、反复呼吸道感染的病因之一,临床表现缺乏特异性,常规检查方法亦无法明确诊断,在临床工作中,该病易被误诊为支气管哮喘、反复呼吸道感染、支气管异物等疾病,因此延误了正规治疗。目前纤维支气管镜检查被认为是诊断小儿TBM的金标准。为了提高临床医生对该病的认识,本文就小儿TBM的流行病学、分类及病因、病理生理、临床症状、诊断、治疗及预后研究现状作一综述。     

原发性支气管肺淀粉样变9例临床分析

目的：探讨原发性支气管肺淀粉样变的临床表现、影像学特征和治疗措施。方法回顾分析我院1994-2012年收治的9例原发性支气管肺淀粉样变患者的临床资料并结合文献进行分析。结果9例中男6例,女3例,平均年龄54岁。肺实质结节型和气管支气管淀粉样变主要表现为咳嗽、咳痰,可伴咯血或无症状。肺间质弥漫型主要表现为胸痛、痰中带血。肺实质结节型胸部CT均表现为肺部结节影,气管支气管淀粉样变表现为气管、支气管管壁增厚,可伴有钙化,肺间质弥漫性淀粉样变表现为双肺弥漫分布小结节影、斑片影。肺实质结节型通常预后较好。气管支气管型病变者常反复感染加重,需间断气管镜下介入治疗,抗炎、止咳化痰、平喘等综合治疗有一定疗效。呈肺间质弥漫型病变者预后较差。结论原发性支气管肺淀粉样变临床和影像学表现无特异性,确诊依据病理学检查,抗炎等对症治疗可以缓解症状。     

原发性气管支气管肺淀粉样变1例

原发性气管支气管肺淀粉样变临床非常罕见,至今病因未明,极易误诊.现将我们近期遇到的1例原发性气管支气管肺淀粉样变报告如下,以提高临床医师对该病的诊断水平.     

支气管结核74例误诊分析

目的：探讨气管、支气管结核纤维支气管镜下临床特点与误诊情况，及早发现和治疗气管、支气管结核。方法：分析2002年7月1日-2007年6月30日收治气管、支气管结核并经纤维支气管镜检查病理证实的患者74例，从年龄、性别、临床诊断、X线情况、误诊原因及纤维支气管镜下所见的相关情况进行分析。结果：气管、支气管结核中青年女性较为多见，临床症状与X线胸片表现无特异性。结论：对气管、支气管结核早发现、早治疗，提高认识，以免漏诊、误诊。     

气管支气管淀粉样变性病例报告及误诊分析

目的分析气管支气管淀粉样变性的误诊原因,并提出防范措施。方法回顾性分析我科1例被长期误诊为慢性阻塞性肺疾病的TBA临床资料,复习相关文献,归纳TBA的影像学、内镜、病理特点。结果患者因反复咳嗽、咳痰、咯血、气短20年,复发加重10天入院。曾被误诊为"COPD"治疗效果欠佳,多次行支气管镜检查均未确诊。入院后完善胸部CT、支气管镜等检查,根据支气管粘膜活检及刚果红染色阳性诊断为TBA。予以抗菌素、糖皮质激素等治疗后症状好转。出院后继续口服泼尼松片,90天电话随访,患者病情稳定,无复发加重。结论医生认识不足、临床表现及影像学检查不典型、支气管镜检查局限性是导致TBA误诊的主要原因。     

原发性气管肿瘤误诊为支气管哮喘6例临床分析

近几年临床研究发现,原发性气管肿瘤易被误诊为支气管哮喘,从而延误患者的最佳治疗时间。本文回顾分析6例由本院收治的气管肿瘤患者的临床资料,并对所有患者进行纤维支气管镜检查,其中5例作病理组织学检查,5例行外科手术治疗,1例确诊后自动出院。研究发现,疑似气管肿瘤者应及时行纤维支气管镜检查,纤维支气管镜检查是确诊气管肿瘤的重要手段。     

Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.     

以弥漫性病变为表现的肺黏膜相关淋巴组织淋巴瘤两例报告并文献复习

目的报告2例以弥漫性病变为影像学特点的肺黏膜相关淋巴组织（MALT）淋巴瘤病例,结合文献复习了解该特殊类型的影像学特点及其病理基础。方法回顾2例肺MALT淋巴瘤的临床表现、影像学特点及病理资料,结合有关文献进行回顾性分析。结果患者男性,59岁,临床主要表现为反复咳嗽5年,加重半年,病程长,抗感染、抗结核治疗无效;胸部CT示两肺弥漫性病变,胸膜增厚,两肺多发实变影、磨玻璃影,可见散在小结节影及牵拉性支气管扩张。胸腔镜肺活检病理示黏膜相关淋巴结外边缘区淋巴瘤（MALT淋巴瘤）,检测到免疫球蛋白IGH-FR1克隆性基因重排。患者女性,50岁,反复发热、咳嗽,伴有活动后气促;胸部CT示两肺多发大片实变影,内见支气管充气征。外周血嗜酸细胞显著升高。诊断为嗜酸细胞性肺炎,予激素正规治疗,症状改善,但肺部病变无明显吸收,后经皮肺穿刺活检病理诊断为MALT淋巴瘤。结论以弥漫性病变为表现的肺MALT淋巴瘤较为罕见,容易误诊。对于少见病及病灶散在者,支气管镜检查阳性率低,肺穿刺活检或胸腔镜活检能获得理想标本,有助于诊断。     

隐球菌肺炎误诊肺结核一例并文献复习

目的探讨隐球菌肺炎的临床特点,提高对隐球菌肺炎的认识。方法报道1例误诊为继发性肺结核的隐球菌肺炎的诊治经过。结果患者男性,32岁,因反复咳嗽、咳痰3月,规范抗结核治疗1月,咳嗽、咳痰无改善入院。实验室检查:经皮肺穿刺活检病理提示真菌感染,支气管肺泡灌洗液培养见新型隐球菌生长,对两性霉素、氟康唑、伏立康唑敏感。予氟康唑抗真菌治疗2周后,患者病情明显好转。结论隐球菌肺炎的临床症状与影像学表现无特征性,确诊需依靠病原学检查及病理活检。     

原发性气管平滑肌瘤的误诊分析

原发性气管平滑肌瘤临床少见,极易误诊、漏诊。本文回顾1例气管平滑肌瘤患者的诊治经过,分析误诊原因。患者女,59岁,反复咳嗽、气促2年,长期诊断支气管炎、哮喘,但疗效不佳。后因病情加重,经胸部CT、支气管镜检查确诊气管平滑肌瘤,手术治愈。因此,对于疗效不佳的＂支气管炎＂、＂哮喘＂,需警惕气管平滑肌瘤等少见大气道肿瘤,及时进行胸部CT、支气管镜等检查,以免误诊、漏诊。     

原发于纵隔的男性绒癌1例并文献复习

男性原发性纵隔绒癌并不多见，无特异性临床表现，体格检查可发现男性乳腺女性化、睾丸缩小，血清 人绒毛膜促性腺激素常显著升高，肺部CT主要表现为纵隔巨大肿块伴双肺多发转移灶，确诊需依靠病理活检，目前 的治疗方法包括化学治疗、放射治疗、手术治疗在内的综合治疗。中南大学湘雅二医院收治1例原发于纵隔的男性绒 癌患者，以“咳嗽、咯血”就诊，经多次穿刺活检确诊。本病预后差，定期全面体检、早期发现及诊断对于改善疾 病的预后有重要的作用。     

慢性咳嗽68例纤维支气管镜检查结果分析

目的评价纤维支气管镜对慢性咳嗽的诊断价值。方法对慢性咳嗽8周以上的68例患者,经临床检查排除咳嗽变异性哮喘、鼻后滴漏综合征、胃食管反流后,予以纤维支气管镜检查。结果发现支气管粘膜慢性炎症42例,支气管肺癌6例,气管或支气管内膜结核7例,支气管息肉1例,支气管异物2例,支气管真菌感染1例,正常9例。结论纤维支气管镜检查是原因不明的慢性咳嗽患者必要的有创检查之一。     

影响隐球菌性脑膜炎确诊的因素分析

目的分析影响隐球菌性脑膜炎确诊的因素方法回顾性分析9例经病原学证实的隐球菌性脑膜炎的临床表现及误诊情况,结果9例患者中男性5例,女性4例首发症状表观为口角歪斜1例,咳嗽、咳痰1例,头昏、双下肢震颤1例,其余6例均表现有头痛,其中2例出现呕吐,3例出现发热9例患者中7例误诊(77.8%),3例误诊为结核性脑膜炎,2例误诊为病毒性脑膜炎,1例误诊为面神经炎、脑干肿瘤,1例误诊为枕神经痛结论隐球菌性脑膜炎临床表现复杂多样,颅脑CT和MRI无特异性,早期易误诊,提高对该病的认识及多次脑脊液查找隐球菌是防止漏诊、误诊的关键。     

Congenital vascular rings: a rare cause of respiratory distress in infants and children

Background Congenital vascular rings may often cause unexplained respiratory symptoms in infants and young children. Their diagnosis and treatment are often delayed. Few studies of vascular rings have been reported in China. The aim of this study was to describe the clinical presentation, diagnosis and surgical management of infants and children with congenital vascular rings.Methods Clinical histories, physical examinations, investigations, image studies and surgical interventions were retrospectively evaluated in 7 children (age range: 2 months– 4 years, mean 7 months) with congenital vascular rings. Chest radiography was performed in all patients. Echocardiography and computed tomography (CT) with 3-dimensional (3D) reconstructions were performed in 6 patients. Esophagography, cardiac catheterization and angiography, and bronchoscopy were performed in 1, 1 and 4 children, respectively. Results Six of the 7 patients had respiratory symptoms, including recurrent cough, stridor and wheeze. Age at onset of symptoms ranged from 1 month to 11 months. Chest X-ray showed nothing important on the vascular rings, besides bronchitis and pneumonia. Contrast-enhanced CT diagnosed vascular rings in 6 patients. Four patients had double aortic arches, two had balanced arches and two were right arch dominant. One patient had a right aortic arch with left ligament and 1 patient had a pulmonary artery sling. Echocardiography failed to diagnose vascular rings in 2 patients. The esophagogram of 1 patient showed esophageal compression. Bronchoscopy of 4 patients showed compression of the distal trachea. Five of the 7 patients underwent surgical division of the vascular rings. Surgical observation confirmed the CT findings in each patient.Conclusions Patients, especially infants or young children, with recurrent respiratory symptoms such as chronic cough, stridor and wheeze, should be examined for the possible presence of congenital vascular rings. Contrast-enhanced CT can clearly show the anatomy of vascular rings. As a noninvasive technique, echocardiography is helpful for diagnosis. Early surgical management in symptomatic patients is effective.     

儿童上气道咳嗽综合征48例临床分析

目的:总结上气道咳嗽综合征(upper airway cough syndrome,UACS)引起儿童慢性咳嗽的临床特点,提高对该病的认识。方法:确诊后采用抗炎、抗变态反应、局部使用减充血剂、抗感染等系统治疗。结果:48例UACS患儿中误诊26例,误诊率54.17%。42例患儿在2周内症状明显减轻或消失,治疗有效率87.50%。结论:UACS均以慢性咳嗽为主诉,伴随症状复杂,易被误诊误治。详细询问病史、合理检查、专科会诊有助于明确诊断。给予针对性治疗,绝大部分疗效好。     

无痛纤维支气管镜检术在小儿肺部疾病诊断与治疗中的应用

目的：总结无痛纤维支气管镜检术在小儿肺部疾病诊断与治疗中的应用;方法：在麻醉科医生使用异丙酚基础麻醉下,应用Olympus BF3c-20纤维支气管镜对45例肺炎合并肺不张、慢性咳嗽、难治性喘息的患儿进行纤维支气管镜检查治疗.结果：45例中男性26例,女性19例,年龄在4个月至13岁.其中17例肺不张,纤维支气管镜下大多表现为支气管粘膜充血、水肿,病变支气管炎性狭窄,粘稠分泌物阻塞,灌洗后10例复张.7例难治性喘息病例中,4例镜下证实为支气管异物,3例存在气管-支气管软化和支气管开口异常.结论：无痛纤维支气管镜检术减少或避免了因患儿不合作造成气道远端损伤的风险,对复杂的病例观察更为细致,解决了患儿的不合作,增加了安全性.