Obstractive To observe the clinical effects and safety of endobronchial electrocautery treatment for tracheobronchial obstructive lesions in inoperable tracheobronchial squamous cell carcinoma.Methods Ninety-five patients with advanced and inoperable tracheobronchial squamous cell carcinoma were included. Thirty-four patients with central airway obstruction were treated with endobronchial electrocautery plus chemotherapy ( group A) and 61 patients without central airway obstruction were treated with chemotherapy alone ( group B) . The chemotherapy consisted of cisplatin or carboplatin, plus another thirdgeneration chemotherapy agent. Results In groug A, there were mean improvements in FEV1 of 41. 1% and in peak expiratory flow( PEF) of 65. 6% . There was no significant difference in the survival rates of the patients with and without central airway obstruction. Median survival time of group A was 11. 3 months and those of group B was 11. 6 months. 3, 6, and 12-month survival rates in group A were 87% , 68% and 39% respectively, and those in group B were 93% , 76% , and 45% respectively. Conclusion Endobronchial electrocautery is an effective and safe approach for inoperable tracheobronchial obstructive malignancies with few complications.
Objective To evaluate the application value of spiral CT virtual endoscopy and three dimensional imaging in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis. Methods Thirty-three cases of benign tracheobronchial stenosis from June 2004 to November 2008 were checked by spiral CT with airway tracheobronchial reconstruction. For the patients with indications, balloon dilatation was performed under fiberoptic bronchoscope. The three-dimensional reconstruction images were compared with the findings under bronchoscopy. And the preoperative and postoperative three-dimensional reconstruction images were compared for airway diameter. Results Three cases were found stenosis of middle lobe by CT virtual endoscopy and did not undergo balloon dilatation. The remaining 30 cases were confirmed by bronchoscopy findings similar to the images by tracheobronchial reconstruction with CT, with consistent rate of 100% . Immediate postoperative three-dimensional CTreconstruction of tracheal bronchus revealed that diameter of stenotic bronchus increased from ( 2. 7 ±1. 3) mm to ( 6. 9 ±1. 6) mmafter operation. Conclusion Multislice spiral CT virtual endoscopy is helpful in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis and postoperative follow-up.
Objective To investigate the safety and effectiveness of a self-made bronchoscopic catheter ( an improved artificial airway) in bronchoscopic interventional therapy.Methods 126 patients planning to receive bronchoscope between October 2012 and February 2013 were divided into A, B and C groups. Three groups received inhalation of 2% lidocaine 5mL for surface anesthesia, and the venous channel was build up. Then the patients in group A ( n = 45) were treated with conventional bronchoscope. The patients in group B ( n =40) were treated with painless bronchoscope ( received intravenous injection with midazolam0. 06 mg/kg and fentanyl 1μg/kg before operation) . The patients in group C ( n = 41) were treated with painless bronchoscope through improved artificial airway ( after anesthesia similar to group B, the improved artificial airway was implanted through the mouth guided by bronchoscope, then the bronchoscopy was performed through artificial airway) . Blood pressure, respiration rate, heart rate and the pulse oxygen saturation were measured by multi-parameter ECG monitor before and during the operation, and the differences were compared among three groups. Body movement, transient respiratory depression during the operation, and postoperative feelings and reactions after operation were also observed. Meanwhile, the convenience of operation by physicians was evaluated. Results The blood pressure fluctuations in group C and group A had no significant difference ( P gt;0. 05) . Heart rate of three groups was somewhat increased,but there was no significant difference between group C and group A ( P gt; 0. 05) . Body movement and postoperative pain memory in group B and group C were better than those in group A ( P lt; 0. 05) .Respiratory depression of three groups had no significant difference ( P gt; 0. 05) . The operative convenience and the comfort of physicians in group C were better than those in group A and group B ( P lt; 0. 05) .Conclusions Operation safety of bronchoscopic interventional treatment with improved artificial airway is similar to the conventional procedure, but the reaction of the intra-operation and postoperative painful memories are significantly superior to conventional bronchoscopy. The convenience of operation and comfort of physicians are much better than the conventional bronchoscopy. It can be concluded that the improved artificial airways is worthy of clinical application.
ObjectiveTo improve the knowledge of double primary lung cancer. MethodsA case of synchronous double primary lung cancers, who was diagnosed by bronchoscopic examination and immunohistochemical staining in our department in 2012, was analyzed retrospectively. The literatures were review with "double primary, lung cancer, squamous cell carcinoma, small cell lung carcinoma" as the research terms in Wanfang, CNKI and PubMed database. ResultsA 76-year-old male patient complained of intermittent cough, chest pain and wheezing over half a month. Chest computer tomography showed masslike lesion with high density in hilum of right lung. The patient received bronchoscopic examination, the pathological and immunohistochemical findings was squamous cell carcinoma and small cell lung carcinoma. The imaging manifestations and bronchoscopy findings were consistent with pathologic diagnosis. A total of 7 pieces of literature were retrived in above-mentioned databases. Seven patients had long smoke history and 6 were male. Four patients complained about couph and sputum, and 1 patient had chest pain. CT showed masses in the lung or hilus with or without stenosis and obliteration of the bronchus. Five patients were proven by bronchoscopy and biopsy. ConclusionDouble primary lung cancer has characteristics in radiologic features and bronchoscopy performance, so can be early diagnosed by bronchoscopy and histopathology.
Objective To determine the dimensions of trachea and main bronchi by bronchoscopy, and provide theoretical basis for diagnosis and treatment of airway diseases. Methods Thirty consecutive adult patients with minor pulmonary diseases were enrolled for bronchoscopy examination. The lengths of the trachea and main bronchus were determined by bronchoscopy and the transverse diameter and anteroposterior diameter of the fifth and tenth tracheal rings above carina were determined. Results The lengths of the trachea and left and right main bronchus were (13.09±1.40) cm, (4.57±0.51) cm and (1.80±0.72) cm, respectively. Magnification times was 10.72 when apex of Olympus BF-260 was 1 cm from measuring object. Based on the magnification times determined in our study, the transverse diameter and anteroposterior diameter of the fifth tracheal ring were (2.76±0.32) cm and (2.44±0.27) cm. Similarly, the transverse diameter and anteroposterior diameter of the tenth tracheal ring were (2.97±0.33) cm and (2.72±0.36) cm. The transverse diameter and anteroposterior diameter of the tenth tracheal ring were significantly larger than those of the fifth tracheal ring (allP＜0.05). Conclusion Based on the magnification times determined in our study, dimension measurement of the trachea and main bronchi by bronchoscopy can objectively reflect anatomic structure of airway in physiological quiet breathing status.
ObjectiveTo evaluate the efficacy and safety of bronchoscope in the treatment of transbronchial broncholiths.MethodsThe clinical data, treatment methods, clinical efficacy and complications of 18 patients who were diagnosed with transbronchial broncholiths were etrospectively reviewed in the Respiratory Department of the Second Hospital of Lanzhou University during January 2010 to December 2017.ResultsEighteen patients were diagnosed by bronchoscopy with a total of 22 pieces of stone for transbronchial broncholiths. An elective surgical procedure was performed in 2 cases. Six cases were treated with removing broncholiths once by foreign body forceps under bronchoscope. Repeated treatments were performed in 10 patients. Two cases underwent massive hemorrhage in the process of one-time broncholiths removal by foreign body forceps under bronchoscope, and one case suffered from bronchial fistula after the broncholiths removal, all of the above 3 patients underwent surgical treatment. All patients were followed up for 5 months without any long-term complications.ConclusionsRemoval of broncholithiasis by bronchoscopic forceps can effectively treat transbronchial broncholiths with low complication and high safety. If the broncholiths cause severe distal lung tissue injury, massive hemoptysis, bronchial fistula, or the diagnosis is unclear, surgical treatment is required. When the transbronchial broncholith is difficult to remove completely at once, batch could be chosen. First, to remove one portion which causes the obstruction of airway; and then, to remove the left part of the transbronchial broncholith by stages.
The specificity of the clinical characteristics and examination results of adult tracheobronchial foreign bodies may not be obvious, which may lead to delay in diagnosis, thereby reducing patients’ quality of life and even life-threatening. However, the current clinicians’ understanding of the disease is still insufficient. Based on the current status of relevant research at home and abroad, this article introduces the medical history collection, clinical features and examination methods (including chest X-ray, chest CT and bronchoscopy), and the treatment and precautions of adult tracheobronchial foreign bodies, and aims to deepen doctors’ understanding of the disease, so as to minimize missed diagnosis and misdiagnosis.
ObjectiveTo assess the methodological quality of guidelines for bronchoscopic alveolar lavage. MethodsCNKI, VIP, WanFang Data, CBM, Web of Science, PubMed, EMbase databases and medlive.cn, the National Guideline Clearinghouse (NGC), the National Guideline International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Clinical Excellence (NICE), and the World Health Organization (WHO) websites were electronically searched to collect guidelines of bronchoscopic alveolar lavage from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the guidelines by using AGREE Ⅱ tool. ResultsA total of 19 guidelines were included, with 5 from China, 5 from the USA, 3 from Europe, 2 from the UK, 1 from Australia, 1 from Israel, 1 from Spain, and 1 from India. The average standard score rates of the 19 guidelines in the six fields were 50.73% for scope and purpose, 20.02% for participants, 15.13% for formulation rigor, 36.40% for clarity of presentation, 3.51% for applicability, and 22.37% for editorial independence.ConclusionsThe quality of bronchoalveolar lavage guidelines remains relatively low.
ObjectiveTo explore the safety and efficacy of the treatment of peripheral bronchopleural fistula with customized silicone plug through bronchoscope. MethodsA total of 19 patients with BPF admitted to Hunan Provincial People’s Hospital from July 2017 to May 2023 were included. Detailed medical records of the patients were collected, including etiology, fistula location, treatment methods, complications, and effective rates, to assess the safety and efficacy of customized silicone plug occlusion. ResultsThe average age of the 19 patients was 61.58 years (range from 42～84 years). The fistulas were located at the right upper lobe in 8 cases, the right middle lobe in 2 cases, the right lower lobe in 2 cases, the left upper lobe in 2 cases, and the left lower lobe in 5 cases. Causes included 9 cases after pneumonectomy, 6 cases of spontaneous pneumothorax, 1 case post Microwave Ablation Therapy for lung nodule, 1 case of advanced lung cancer under radiotherapy and chemotherapy, 1 case of candidal pneumonia, and 1 case of pulmonary tuberculosis. 15 patients were successfully occluded for the first time, 1 case failed to place the plug, and 3 cases had silicone plug dislodgement within 1 week after the procedure, with a short-term effective rate of 73.68% (14 cases). A total of 40 customized silicone plugs were placed, with an average of (2.10±0.74), and the mean diameter of the plugs used was 6.4 mm, with a range of 3 to 9 mm. Fifteen patients were recruited for long-term follow-up, with a median follow-up time of 15 months (range from 1.5 to 53 months). One patient developed a new fistula on the 45th day, who was treated with a combined small Y-type single bullet-covered stent for occlusion. One patient died of severe pneumonia 3 months postoperatively, and one died of type II respiratory failure at the 30th month, both deaths were unrelated to the interventional procedure. The long-term effective rate was 68.42% (13 cases). ConclusionPlacing customized silicone plugs through bronchoscopy can rapidly and effectively occlude peripheral BPF, with satisfactory long-term outcome.