闭合性气胸肺漏气靶支气管定位研究

Location of target bronchus with air leakage in closed pneumothorax

目的 探讨有色盐水气道内注射,定位闭合性气胸肺漏气靶支气管的方法,并评价其有效性和安全性.方法 闭合性自发性气胸34例,其中原发性25例,继发性9例,均经胸腔闭式引流术治疗2～6周[平均（3.0±1.6）周]无效.纤支镜直视下,将适量有色盐水缓缓注射到可疑肺漏气段支气管,注射结束后清理溢出的有色盐水,退出纤支镜.若胸腔引流管出现有色盐水,提示肺漏气靶段支气管.结果 肺漏气靶支气管定位成功24例,定位单段支气管21例,累及相邻多段3例.靶支气管定位平均（11±7）h.有色盐水平均（40±15） ml/段支气管.定位操作后靶支气管黏膜完整,无黏膜充血、水肿、出血等损伤,生命体征平稳.有色盐水定位后气胸自愈3例,生物蛋白胶封堵成功21例.生物蛋白胶靶性咳嗽、肺不张各2例,胸腔出血1例,盐水定位靶性发热2例.结论 支气管镜直视下,经导管气道内有色盐水注射,能准确定位闭合性气胸肺漏气靶支气管.该方法简单、价廉、安全和有效.

Objective To establish a new method for locating the target bronchus with air leakage in closed pneumothorax injecting colored saline and to evaluate its efficacy and safety.Method 34 patients with closed pneumothorax,25 with spontaneous pneumothorax and 9 with secondary pneumothorax,were included for this study.All cases had been undergoing closed thoracic drainage for 2-6 （3.0 ± 1.6） weeks with no effect.Appropriate volume of colored saline was injected into suspicious segmental bronchi with air leakage through a catheter under bronchoscope;the overflowed colored saline was cleaned;then the bronchoscope was withdrew.The target bronchus with air leakage was located successfully if colored saline was observed in the intercostal drainage tube.Results The target bronchus with air leakage had been successfully located in 24 cases;of which,single segmental bronchi were located in 21 cases and adjacent multi-segmental bronchi in 3 cases.The average time of locating the bronchus with air leakage was （11±7） h.The average dose of colored saline injecting into one segmental bronchi was （40±15）ml.After the procedure of location,the bronchial mucosa showed integrity,with no mucosal hyperemia,edema,or hemorrhage,and vital signs of all cases were stable.3 cases were self-cured after injecting colored saline and 21 cases were successfully occluded by fibrin glue.Cough associated with biological protein occurred in 2 cases,atelectasis in 2,fever associated with colored saline in 2,and pleural hemorrhage in 1.Conclusions Injecting colored saline into airway through catheter under bronchoscope can locate the target bronchus with air leakage in closed pneumothorax precisely.It is simple,cheap,safe,and effective.