经纤维支气管镜介入治疗耐多药肺结核疗效观察

目前，全球耐药结核病日趋严重，耐药菌株的出现造成了耐药结核病和耐多药结核病遍及世界的任何角落，特别是耐多药肺结核对结核病控制、人类健康构成严重威胁。由于其耐药的种类和数量多，治疗费用剧增，治疗上又是一个棘手问题，临床治愈率明显下降，病死率明显升高。故探索新的治疗方法刻不容缓，针对我院2007年以来住院病人46例耐多药肺结核分别予介入治疗＋常规化疗，疗效分析和讨论如下。

Value of Fiberoptic Ductoscopy in Diagnosing and Treating Multiporous Nipple Discharge

OBJECTIVE To explore the value of fiberoptic ductoscopy in diagnosing and treating bilateral and polyporous nipple discharge (ND).METHODS Fiberoptic ductoscopy was conducted in 29 patients with bilateral and polyporous ND.After the ductoscopy,the patients with intraductal papilloma (IDP) underwent a surgical procedure,and the others,identified with galactostasis,mammary duct ectasia (MDE) and obstructive galactophoritis (OG),received a ductoscopy-guided interventional therapy. RESULTS Among 29 cases,and with 79 galactophores examined,IDP was found in 11 cases (37.9% of the total cases),or 13.9% of the galactopores examined.IDP was found in 9 of 11 cases with a bloody nipple discharge,while IDP was seen in 2 of the 18 cases with a non-bloody nipple discharge.The excision accuracy achieved 100% in the cases,and postoperative pathological diagnosis accordance rate reached 88.9%. CONCLUSION Fiberoptic ductoscopy has many features such as ability to see the lesion,and accurate preoperative localization,thus eliminating excessive excision of tissue during surgery.For most patients with ND,especially those suffering galactostasis,OG or MDE,washout under fiberoptic ductoscopy and interventional therapy may achieve a thorough cure of the disease.

Successful endoscopic removal of a giant upper esophageal inflammatory fi brous polyp

Giant esophageal inflammatory fibrous polyp （espedally 〉 17 cm in size） is seen rarely. Endoscopic removal has been reported rarely because the procedure is technically demanding and the hemostasis is difficult to ascertain. Here, we describe a case of a giant upper esophageal inflammatory fibrous polyp that was resected successfully by endoscopy.

A case of radiation-induced difficult airway in a patient with nasopharyngeal carcinoma

In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.

The acute remedy of malignant central airway obstruction

Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results: Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion: The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.

Bronchoscopic biopsy for diagnosis of lung cancer in the absence of visible endobronchial abnormalities

Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par- ticularly, malignant diseases. However, endoscopists do not normally perform bronchoscopic biopsy in Case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bron- choscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormali- ties undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The in- clusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage （BAL） according to the images obtained from high-resolution computed tomography （HRCT）. Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion （central, peripheral, or intermediate）; tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen （CEA） value were collected. The Pearson chi-square test or Fisher＇s exact and McNemar tests were used in the univadate analysis. Results Among the 109 patients, the diagnosis of 37 （33.9%） patients was confirmed through bronchos- copy. Brushing and BAL had higher positive detection rates than biopsy （P = 0.004）. There were no differ- ences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value （P〈 0.05 for all groups）. Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscepic examination.

Removal of esophageal benign tumors with gastroscope-assisted thoracoscopic surgery

The purpose of the study was to report our experience in the treatment of benign esophageal tu- mors with fiberoptic gastroscope-assisted thoracoscopic surgery. Methods： We retrospectively analyzed the clinical data of 24 consecutive patients （22 with esophageal leiomyoma and 2 with esophageal mesenchymoma） who underwent gas-troscope-assisted thoracoscopic surgery. There were 17 male and 7 female with a mean age of 36 years. The tumors were located in the upper and middle part of the esophagus in 17 cases and lower part in 7 cases. Results： All 24 procedures were successfully performed. The median operative time was 84 minutes and the median hospital stay was 7.5 days. One esophageal perforation due to dissection of a large lesion occurred intraoperatively, which was repaired by suturing. No deaths or other severe postoperative complications were encountered during the median follow-up period of 20.5 months. Conclusion： Gastroscope-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of benign esophageal tumors.

Use of bronchofiberscopy in management of severe thoracic trauma

Objective： To investigate the diagnos- tic and therapeutic effect ofbronchofiberscopy in the manage- ment of severe thoracic trauma. Methods： A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal inci- sion （282）, nasal cavity （149） and oral cavity （57）. Intensive SaO2 monitoring as well as blood gas analysis were per- formed pre-, intra- and postoperatively. Simultaneously oxy- gen therapy or ventilatory support was given. Sputum cul- ture was done intraoperatively. Results： Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was posi- tive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery （both P〈0.05）. Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death. Conclusion： Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and spu- tum crust in the airway, manage obstructive atelectasis and pneumonia, and signifcantly improve respiratory fimction and treatment outcome.