国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2012年
23期
1795-1798
,共4页
支气管镜%气道阻塞%病因诊断%治疗
支氣管鏡%氣道阻塞%病因診斷%治療
지기관경%기도조새%병인진단%치료
Bronchoscopy%Airway obstruction%Etiological diagnosis%Treatment
目的 探讨中央气道阻塞性病变的病因、临床特点及支气管镜检查、治疗的必要性和价值.方法 回顾性分析2008年2月至2011年12月就诊于我院呼吸科的中央气道阻塞性病变患者42例,归纳其临床特点、影像学表现、支气管镜镜检及活检病理.结果 42例气道阻塞性病变患者中,男30例,女12例,年龄19～81岁,中位年龄56岁,其中支气管鳞癌12例(12/42),腺癌6例(6/42),小细胞肺癌10例(10/42),气管、支气管内膜结核4例(4/42),慢性炎症导致黏液痰栓4例(4/42),食管鳞癌2例(2/42),管腔内异物1例(1/42),支气管结石2例(2/42),肺囊肿并出血包裹1例(1/42);42例患者中有咳嗽症状38例,咯血16例,气短或呼吸困难14例,胸痛8例；所有患者均行胸部CT检查,18例行气道三维重建,40例发现病灶或病灶间接征象;42例患者均行支气管镜检查,发现病变或可疑病变,34例为气道内器质性病变,在支气管镜检查中使用活检钳取得组织标本,初次病理阳性率为100％;38例行肺功能检查,其中26例可见阻塞性或混合性通气功能障碍,6例见流速-容量环平台.结论 中央气道阻塞病因复杂,以恶性病变为主,常见症状为咳嗽、呼吸困难、咯血、胸痛、消瘦、乏力,无特异性表现；胸部CT联合气道重建表现为阻塞性肺炎,阻塞性肺不张,阻塞性肺气肿为主；气管镜及活检病理为诊断提供准确信息,对病因诊断有无可替代的价值；根据不同病因及不同病变部位选择不同的内、外科治疗方法.
目的 探討中央氣道阻塞性病變的病因、臨床特點及支氣管鏡檢查、治療的必要性和價值.方法 迴顧性分析2008年2月至2011年12月就診于我院呼吸科的中央氣道阻塞性病變患者42例,歸納其臨床特點、影像學錶現、支氣管鏡鏡檢及活檢病理.結果 42例氣道阻塞性病變患者中,男30例,女12例,年齡19～81歲,中位年齡56歲,其中支氣管鱗癌12例(12/42),腺癌6例(6/42),小細胞肺癌10例(10/42),氣管、支氣管內膜結覈4例(4/42),慢性炎癥導緻黏液痰栓4例(4/42),食管鱗癌2例(2/42),管腔內異物1例(1/42),支氣管結石2例(2/42),肺囊腫併齣血包裹1例(1/42);42例患者中有咳嗽癥狀38例,咯血16例,氣短或呼吸睏難14例,胸痛8例；所有患者均行胸部CT檢查,18例行氣道三維重建,40例髮現病竈或病竈間接徵象;42例患者均行支氣管鏡檢查,髮現病變或可疑病變,34例為氣道內器質性病變,在支氣管鏡檢查中使用活檢鉗取得組織標本,初次病理暘性率為100％;38例行肺功能檢查,其中26例可見阻塞性或混閤性通氣功能障礙,6例見流速-容量環平檯.結論 中央氣道阻塞病因複雜,以噁性病變為主,常見癥狀為咳嗽、呼吸睏難、咯血、胸痛、消瘦、乏力,無特異性錶現；胸部CT聯閤氣道重建錶現為阻塞性肺炎,阻塞性肺不張,阻塞性肺氣腫為主；氣管鏡及活檢病理為診斷提供準確信息,對病因診斷有無可替代的價值；根據不同病因及不同病變部位選擇不同的內、外科治療方法.
목적 탐토중앙기도조새성병변적병인、림상특점급지기관경검사、치료적필요성화개치.방법 회고성분석2008년2월지2011년12월취진우아원호흡과적중앙기도조새성병변환자42례,귀납기림상특점、영상학표현、지기관경경검급활검병리.결과 42례기도조새성병변환자중,남30례,녀12례,년령19～81세,중위년령56세,기중지기관린암12례(12/42),선암6례(6/42),소세포폐암10례(10/42),기관、지기관내막결핵4례(4/42),만성염증도치점액담전4례(4/42),식관린암2례(2/42),관강내이물1례(1/42),지기관결석2례(2/42),폐낭종병출혈포과1례(1/42);42례환자중유해수증상38례,각혈16례,기단혹호흡곤난14례,흉통8례；소유환자균행흉부CT검사,18례행기도삼유중건,40례발현병조혹병조간접정상;42례환자균행지기관경검사,발현병변혹가의병변,34례위기도내기질성병변,재지기관경검사중사용활검겸취득조직표본,초차병리양성솔위100％;38례행폐공능검사,기중26례가견조새성혹혼합성통기공능장애,6례견류속-용량배평태.결론 중앙기도조새병인복잡,이악성병변위주,상견증상위해수、호흡곤난、각혈、흉통、소수、핍력,무특이성표현；흉부CT연합기도중건표현위조새성폐염,조새성폐불장,조새성폐기종위주；기관경급활검병리위진단제공준학신식,대병인진단유무가체대적개치；근거불동병인급불동병변부위선택불동적내、외과치료방법.
Objective To analyse the cause and clinical characteristics of central airway G and assess necessity and value of bronchoscopy.Methods We performed retrospective analytical study in the patients with central airway obstruction enrolled at the Department of respiratory disease in our hospital from February 2008 to December 2011 by summarizing the clinical features,imaging,bronchoscopy and biopsy.Results Within 42 cases there were male 30 cases,female 12 cases,aged 19-81 years old,the median age 56 years,12 cases of bronchial squamous cell carcinoma (12/42),6 cases of adenocarcinoma (6/42),10 cases of small cell lung cancer (10/42),4 cases of tracheal or endobronchial tuberculosis in (4/42),4 cases of chronic inflammation induced mucus phlegm bolts (4/42),2 cases of esophageal squamous cell carcinoma (2/42),1 case of foreign body (1/42),2 cases of bronchial calculus (2/42),1 case of pulmonary cyst and bleeding package (1/42).There were 38 cases of cough in the 42 patients,16 cases of hemoptysis,14 cases of shortness of breath or difficult breathing,8 cases of chest pain.All patients were underwent chest CT including 18 patients with a routine three-dimensional reconstruction of the airway,40 cases were found direct lesions or indirect signs of lesions.All patients were underwent bronchoscopy.Lesions or suspicious lesions were found.There were 34 cases with airway organic disease.Biopsy forceps were used to obtain tissue samples with the initial pathological positive rate 100％.Pulmonary function were checked in 38 patients.26 of them had obstructive or mixed ventilatory dysfunction,6 cases had flow-volume loop platform.Conclusions Central airway obstructive diseases have complex causes which mainly were malignant lesions.Its common symptoms are cough,dyspnea,hemoptysis,chest pain,weight loss,fatigue,or no specific performance.By chest CT scan jointed airway remodeling,obstructive pneumonia,obstructive atelectasis,obstructive emphysema could be mainly observed.Brochoscopy and biopsy provide accurate information for diagnosis,and have irreplaceable value for pathogenesis diagnosis.Different treatment should be chosen according to different causes and different pathological changes.
