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Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.

以發熱并發氣促、咯血為表現的鸚鵡熱衣原體肺炎一例報告并文獻復習

目的 總結鸚鵡熱衣原體感染的臨床特征，探討鸚鵡熱衣原體感染出現咯血的發生機制及治療手段，提高臨床對本病的認識。方法 報道國內首例經支氣管鏡冷凍技術治療鸚鵡熱衣原體感染出現咯血患者的診療經過，并回顧國內外數據庫建庫至今，篩選及總結分析鸚鵡熱衣原體感染導致咯血的文獻報道。結果 患者為38歲女性，以發熱并發氣促、咯血為主要表現，經肺泡灌洗液宏基因組二代測序（metagenomics next-generation sequencing，mNGS）檢測診斷為鸚鵡熱衣原體肺炎。通過藥物對癥處理以及經支氣管鏡冷凍治療后病情好轉。結合相關文獻和該病例，共10例患者因鸚鵡熱衣原體感染出現咯血的表現。結論 鸚鵡熱衣原體感染早期臨床表現無特異性，臨床問診需追溯鳥類及家禽接觸史，mNGS能較為精準鑒定病原體。現鸚鵡熱衣原體感染治療首選四環素類藥物，大環內酯類及喹諾酮類抗生素也有效。本例通過支氣管鏡冷凍技術治療后病情好轉，為臨床治療鸚鵡熱衣原體感染出現咯血提供經驗參考，但關于發生機制及其他診療思路仍值得深入研究。

Therapeutic Evaluation of Selective Bronchial Artery Embolization in Massive Hemoptysis of Bronchiectasis

目的:對選擇性支氣管動脈栓塞術(SBAE) 治療支氣管擴張大咯血的療效做客觀評價,并就該技術的操作要點、注意事項等諸方面的技術問題做進一步探討總結。方法:對32例內科保守治療無危急生命的支氣管擴張大咯血患者行介入法供血支氣管動脈栓塞, 其中男18例, 女14例, 平均年齡46歲.結果:所有病例都成功實施了供血動脈栓塞, 術后除1例無效外均出血停止, 無嚴重并發癥發生。結論:SBAE作為治療支氣管擴張大咯血的急救手段之一,具有創傷輕微、可重復性強、療效高、見效快、并發癥少、簡便易行等特點,極具推廣應用價值。

支氣管擴張癥138例

目的 總結支氣管擴張癥外科治療的臨床診斷和治療經驗. 方法 回顧性分析1985～ 1999年手術治療138例支氣管擴張癥患者的診斷和治療情況. 結果 全組無1例手術死亡,94例單葉或雙葉支氣管擴張患者癥狀消失;13例雙側或廣泛支氣管擴張患者,癥狀均改善. 結論 把握好手術適應證和肺的切除范圍,可降低手術死亡率和并發癥發生率,提高治療效果.肺切除術對治療單葉或雙葉支氣管擴張療效十分顯著,盡可能完全切除病灶是獲得最佳治療效果的前提.

Management of massive hemoptysis and application experience of computer tomography in vascular intervention of hemoptysis

Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.

Efficacy of Bronchial Arterial Embolization in Treatment of Massive Hemoptysis due to Bronchiectasis: 205 Cases Analysis

Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.

兩例大咯血患者手術中麻醉處理的體會

A Clinical Comparison on the Treatment of lntractable Hemoptysis Tubentolosis by Using Thrombin Combined with Phentolamine and Pituitrin

目的:觀察凝血酶霧化吸入聯用酚妥拉明治療肺結核頑固性咯血的臨床效果。方法:將47例住院肺結核頑固性咯血患者隨機分為兩組,治療組采用凝血酶超聲霧化吸入聯用酚妥拉明靜滴,對照組采用垂體后葉素靜滴。結果:治療組總有效率87.50%,對照組總有效率86.96%。結論:在常規止血治療無效的基礎上,加用凝血酶超聲霧化吸入聯用酚妥拉明止血快,副作用少,是治療肺結核頑固性咯血的有效藥物。

支氣管鏡聯合胸腔鏡手術治療大咯血32例臨床體會

目的探討支氣管鏡聯合胸腔鏡手術治療大咯血的可行性、安全性和有效性。 方法回顧性分析九江市第一人民醫院胸外科自2009年5月至2013年4月完成的32例經支氣管鏡聯合胸腔鏡手術治療大咯血患者的臨床資料。其中男19例、女13例，年齡24～60（40.2±9.1）歲；因支氣管擴張致大咯血24例，肺癌合并咯血6例，肺結核咯血2例。 結果2例（6%）因胸腔粘連嚴重而中轉開胸。1例因氣管內出血量大，纖維支氣管鏡無法準確定位，終止手術，最終死亡。余29例在全胸腔鏡下完成肺葉切除術，包括右肺上葉切除4例，右肺下葉12例，左肺下葉10例，左肺上葉3例。其中6例術中冰凍病理檢查提示癌，加做淋巴結清掃術；1例右肺上葉支氣管擴張行右肺上葉切除術后第3 d再次出現大咯血，手術證實為右肺中葉再次出血，行右肺中葉切除術；其余22例術后均無咯血。 結論支氣管鏡聯合胸腔鏡手術治療大咯血是一種安全有效的方法。

Coopdech 支氣管封堵器在搶救大咯血窒息中的應用

目的 探討Coopdech支氣管封堵器用于大咯血窒息搶救的可行性及療效。方法 在患者發生大咯血窒息時, 特別是無條件行雙腔支氣管插管或雙腔支氣管插管困難時, 在支氣管鏡引導下對2 例患者置入Coopdech 支氣管封堵器。結果 2 例大咯血患者Coopdech 支氣管封堵器置入后, 1 例保守治療成功,1 例為支氣管動脈栓塞術贏得時間。結論 Coopdech 支氣管封堵器可以有效替代雙腔支氣管導管用于搶救大咯血患者, 值得進一步臨床應用。