CAJ | 학술논문

目的探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法收集福建省5家三级医院2000年8月至2007年lO月期间进行球囊探查加选择性支气管封堵术的住院患者.40例中男39例,女1例,年龄20～84岁,平均(59±17)岁.接受本方法治疗的40例患者均为经负压闭式胸腔引流7 d以上无效者.在常规支气管镜检查基础上采用Olympus B7-2C双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探杳定位,然后向确认的支气管注入不同剂量的自身全血加凝血酶.治疗组10例及常规支气管镜检查10例(对照组)采用美国Heahhdyne920M型记录仪动态记录,比较两组的血氧饱和度.治疗组10例术后复查胸部CT,20例术后复查静脉血白细胞总数.统计学方法采用t检验进行处理.结果 40例均经球囊探查,其中34例确定了引流支气管进行封堵术.34例中4例第1次封堵时不成功,转而接受其他治疗,其余30例经封堵后引流瓶气泡明显减少或完全停止.30例中5例于72 h内复发,其中3例行第2次封后例封堵成功,2例接受外科胸腔镜治疗,最终封堵成功率为82%(28/34).操作期间治疗组最低SaO2为(89.0±2.8)%,对照组为(78.2±2.7)%;治疗组平均SaO:为(93.4±2.6)%,对照组为(92.2±1.4)%;治疗组SaO2＜90%占检查时间的百分比为(10.7±17.5)%,对照组为(2.1±1.1)%;各指标2组比较均无统计学意义.术后10例复查胸部CT均未见阻塞性肺不张.术后3/20例患者外周血白细胞计数高于10×109/L,术前均合并肺部感染,且其中2例术前白细胞计数升高.34例接受封堵者有5例出现中、低热,均易得到控制.结论球囊探查加支气管封堵术对难治性气胸是一种安全、有效的治疗方法 ,尤其适用于全身情况差、肺功能明显减退以及暂不愿接受手术者.
목적 탐토구낭탐사가선택성지기관봉도술치료난치성기흉적료효、안전성급병발증.방법 수집복건성5가삼급의원2000년8월지2007년lO월기간진행구낭탐사가선택성지기관봉도술적주원환자.40례중남39례,녀1례,년령20～84세,평균(59±17)세.접수본방법 치료적40례환자균위경부압폐식흉강인류7 d이상무효자.재상규지기관경검사기출상채용Olympus B7-2C쌍강구낭도관대장층흉막루구소속적인류지기관진행탐묘정위,연후향학인적지기관주입불동제량적자신전혈가응혈매.치료조10례급상규지기관경검사10례(대조조)채용미국Heahhdyne920M형기록의동태기록,비교량조적혈양포화도.치료조10례술후복사흉부CT,20례술후복사정맥혈백세포총수.통계학방법 채용t검험진행처리.결과 40례균경구낭탐사,기중34례학정료인류지기관진행봉도술.34례중4례제1차봉도시불성공,전이접수기타치료,기여30례경봉도후인류병기포명현감소혹완전정지.30례중5례우72 h내복발,기중3례행제2차봉후례봉도성공,2례접수외과흉강경치료,최종봉도성공솔위82%(28/34).조작기간치료조최저SaO2위(89.0±2.8)%,대조조위(78.2±2.7)%;치료조평균SaO:위(93.4±2.6)%,대조조위(92.2±1.4)%;치료조SaO2＜90%점검사시간적백분비위(10.7±17.5)%,대조조위(2.1±1.1)%;각지표2조비교균무통계학의의.술후10례복사흉부CT균미견조새성폐불장.술후3/20례환자외주혈백세포계수고우10×109/L,술전균합병폐부감염,차기중2례술전백세포계수승고.34례접수봉도자유5례출현중、저열,균역득도공제.결론 구낭탐사가지기관봉도술대난치성기흉시일충안전、유효적치료방법 ,우기괄용우전신정황차、폐공능명현감퇴이급잠불원접수수술자.
Objective To evaluate the effect,complications and safety of transbronchoscopic balloon detection(TBD)and selective bronchus occlusion(SBO)for intractable pneumothorax.Methods Forty cases of pneumothorax from 5 teaching hospitals in Fujian province were included for this study.TBD was performed in all the 40 cases for whom chest tube drainage had lasted for more than 7days but failed to close the pleura fistulae.Bronchi leading to pleura fistulae(the target bronchus)were detected by balloon catheter(Olympus B7-2C)through bronchoscope.After the target bronchus was located,SBO procedures were performed.Autologous blood(20 ml to 30 ml)was injected into the target bronchus and followed by thrombin solution(1000 U)through balloon-catheter.In 10 cases,oxygenation and pulse rate were recorded by pulse-oxymeter(Healthdyne 920M)during TBD and SBO.Another 10 cases undergoing bronchoscope without performing TBD and SBO served as the controls.Thorax CT,white blood cell count,neutrophil count and body temperature were measured after SBO.Results Bronchi leading to pleura fistulae were located by TBD in 34 out of the 40 cases.Air leakage was stopped after the first occlusion in 30 cases,but 5 of which underwent a second occlusion because of reculTence in 72 h.Of the 5 cases.air leakage was stopped in 3,and surgery wag required in 2.Taken together.28 of the 34 cases were cured by SBO and 6 failed.There were no statistically diffeFences between the treatment group and the control group in oxygenation changes during TBD and SBO procedures.In 10 cases thorax CT scan was followed up in 7 days after SBO.and no obstructive atelectasis was found.In 20 cases peripheral white blood cell count was followed up 72 hours after SBO.Leukoeytosis(＞10.0×109/L)was found in 3,in which pulmonary infection was diagnosed,and leukocytosis was present in 2 cases before the procedure.Five patients(5/34)experienced mild to moderate fever,which resolved quickly.Conclusion TBD/SBO are safe and effective procedures for intractable pneumothorax.