目的:肺泡蛋白沉積癥(pulmonary alveolar proteinosis,PAP)是一種少見的肺部疾病,由于臨床醫生認識不足,容易誤診,而PAP通過灌洗治療常常可獲得較好的預后。本文通過分析PAP病例,總結PAP患者的臨床特點、影像學表現和治療方法,以提高該病的診療水平。方法:回顧性分析2003年2月～2008年5月四川大學華西醫院呼吸科經病理確診的15例PAP患者臨床資料,并觀察了全肺灌洗治療PAP的效果。結果:PAP患者常見臨床癥狀為咳嗽和進行性呼吸困難,體征正常或無特異性。胸部CT可表現為“地圖樣”、“鋪路石樣”或間質纖維化改變。全肺灌洗治療的14例患者臨床癥狀明顯緩解。結論:肺泡蛋白沉積癥雖然少見,但只要提高認識,診斷并不困難。支氣管肺泡灌洗和(或)肺活檢是確診PAP的重要方法,全肺灌洗是治療PAP的主要方法。
ObjectiveTo assess the methodological quality of guidelines for bronchoscopic alveolar lavage. MethodsCNKI, VIP, WanFang Data, CBM, Web of Science, PubMed, EMbase databases and medlive.cn, the National Guideline Clearinghouse (NGC), the National Guideline International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Clinical Excellence (NICE), and the World Health Organization (WHO) websites were electronically searched to collect guidelines of bronchoscopic alveolar lavage from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the guidelines by using AGREE Ⅱ tool. ResultsA total of 19 guidelines were included, with 5 from China, 5 from the USA, 3 from Europe, 2 from the UK, 1 from Australia, 1 from Israel, 1 from Spain, and 1 from India. The average standard score rates of the 19 guidelines in the six fields were 50.73% for scope and purpose, 20.02% for participants, 15.13% for formulation rigor, 36.40% for clarity of presentation, 3.51% for applicability, and 22.37% for editorial independence.ConclusionsThe quality of bronchoalveolar lavage guidelines remains relatively low.
ObjectiveTo analyze the microbiological characteristics of airway bacteria in adult patients with bronchiectasis and to analyze their correlation with the clinical features. MethodsPatients diagnosed with bronchiectasis in the Department of Respiratory and Critical Care Medicine of West China Hospital of Sichuan University from October 2017 to April 2018 were classified into the bronchiectasis group, while the control group was those who were found to have pulmonary nodules (diameter less than 10 mm) requiring bronchoscopy by physical examination. All subjects in both groups had not used antibiotics or hormones within 4 weeks and had no other respiratory diseases. Bronchoalveolar lavage fluid (BALF) from the lesion site of the branchial expansion group was collected, and BALF from the basal segment of the contralateral inferior bronchial lobe of the pulmonary nodule was collected in the control group. Bacterial culture and 16S rRNA gene sequencing were performed in both groups. ResultsSeventeen cases and six controls were enrolled in this study and the BALF specimens were collected. Eight cases were in stable period and nine cases were in acute period. The case group was divided into the bacteria-positive group and negative group based on bacterial culture of BALF. Shannon index in the bacteria-positive group was significantly lower than the bacteria-negative group and the control group. And Shannon index showed a negative correlation with positive bacterial culture in BALF. When Shannon index ≤4.5 was used to predict positive bacterial culture, the sensitivity and specificity were 83.3% and 90.9% respectively. The average relative abundance of bacteria was higher and the average sample distribution uniformity was lower in patients with acute period, compared with those in patients with stable period. Shannon index was negatively correlated with the acute exacerbation in patients. When Shannon index <5.0 was used to predict acute exacerbation, the sensitivity and specificity were 77.8% and 100.0%, respectively. ConclusionsShannon index in 16S rRNA gene sequencing results has certain predictive value for acute exacerbation stage. 16S rRNA gene sequencing combined with bacterial culture results can help guide clinicians to provide more precise treatment plans.
目的 研究直腸癌切除后腸吻合前進行腸腔灌洗的臨床作用。方法 對我院2006年6月至2007年2月期間連續56例行直腸癌低位前切除吻合的病例在切除原發灶、行遠端封閉吻合前行生理鹽水遠端腸腔灌洗，收集灌洗前、后2份標本分別涂片行細胞學檢查。結果 灌洗前收集液中觀察到腫瘤細胞或核異形細胞者7例，中性粒細胞者24例，上皮細胞者4例； 灌洗后所有患者的收集液中均未觀察到腫瘤細胞（P＜0.05），19例仍有少許中性粒細胞或上皮細胞。結論 低位直腸癌遠端腸腔有可能存在脫落的腫瘤細胞。對直腸癌患者手術切除病灶后吻合前行遠端腸腔灌洗的方法簡單易行，可以顯著減少或清除腸腔內可能殘留的腫瘤細胞，從而可避免此類原因所致的局部腫瘤復發，值得提倡。
目的 探討急性胰腺炎繼發感染的治療方法。方法 分析總結我院1998～1999年收治的20例胰腺感染患者，采用經后上腰腹膜后引流及灌洗方法治療的資料。結果 術后并發癥： 殘余膿腫2例，消化道出血1例，腸瘺4例，胰瘺6例，經治療后患者全部治愈。結論 該治療方法殘余感染及死亡率低。
ObjectiveTo explore the expression of periostin in bronchoalveolar lavage fluid (BALF) of patients with dermatomyositis-related interstitial lung disease (DM-ILD) and rheumatoid arthritis-related interstitial lung disease (RA-ILD).MethodsA total of 44 patients with DM-ILD and 28 patients with RA-ILD were underwent bronchoalveolar lavage. Cells in BALF were collected and analyzed by absolute different cell counts. The level of periostin and Krebs von den Lungen-6 (KL-6) were tested by enzyme linked immunosorbent assay. Results of high resolution CT of patients were scored. Thirty patients without interstitial lung disease (ILD) served as a control group.ResultsLevels of periostin and KL-6 were significantly increased in BALF of patients with DM-ILD and RA-ILD compared with control group (all P<0.05). Levels of periostin were positively correlated with lymphocyte counts and levels of KL-6 in BALF (allP<0.05). Furthermore, levels of periostin were significantly correlated with high resolution CT scores (P<0.05).ConclusionsLevels of periostin are increased in patients with DM-ILD and RA-ILD. Periostin might be served as an indicator of CTD-ILD.
Objective To investigate the diagnostic value and complications of fibrobronchoscopy and bronchoalveolar lavage in immunocompromised patients with pulmonary infiltrates. Methods Fiberoptic bronchoscopy was performed in 31 immunocompromised patients. The clinical data and results of bronchoalveolar lavage were collected. In addition to conventional microbiological methods, molecular detection for cytomegalovirus( CMV) and respiratory viruses were performed. Results In all cases BAL was performed. The overall diagnostic yield of fibrobronchoscopy was 65% . The diagnosis was more likely to be established by fibrobronchoscopy when the lung infiltrate was due to an infectious agent( 86%) than to a noninfectious process( 25% ) . By molecular detection, CMV was identified in 4 cases, and other respiratory viruses were identified in 3 cases. Fever ( 23% ) was the most common complication. Conclusions Fibrobronchoscopy and BAL are effective and safe for the diagnosis of pulmonary infiltrates in immunocompromised patients. The molecular technique may help to enhance the diagnostic yield of BAL.
目的 探討小兒結腸系膜淋巴管瘤的診斷與治療方法。方法 回顧性分析我院2006年1月至2011年12月期間手術治療的5例小兒結腸系膜淋巴管瘤的臨床資料。結果 3例診斷為腹腔包塊性質待查的患兒，術中發現腹腔腫塊來源于乙狀結腸系膜，其中1例腫塊侵犯到降結腸系膜達結腸脾曲而行左半結腸切除＋腸吻合術，另外2例行乙狀結腸系膜淋巴管瘤切除＋部分乙狀結腸切除＋腸吻合術；1例患兒診斷為急性化膿性闌尾炎合并乙狀結腸系膜淋巴管瘤，行闌尾切除＋乙狀結腸系膜淋巴管瘤切除＋腸吻合術，1例患兒診斷為乙狀結腸系膜淋巴管瘤破裂并彌漫性腹膜炎，行乙狀結腸系膜淋巴管瘤切除＋乙狀結腸造瘺術，術后6個月后再行二期手術。5例患兒手術后恢復良好，未發生吻合口漏等并發癥。術后隨訪5個月～5年， （2.3±1.1）年，1例失訪，余均存活，仍在隨訪中，所有病例均未復發。結論 日常行闌尾手術中，應常規探查小腸、結腸；未進行腸道準備的結腸一期吻合手術中結腸灌洗可減少吻合口漏等并發癥的發生率；腹腔感染嚴重的患兒結腸一期吻合不可取，結腸造瘺安全；小兒結腸系膜淋巴管瘤術前確診困難，反復出現腹痛、腹部包塊的患兒應想到結腸系膜淋巴管瘤的可能性，行充分的腸道準備后擇期手術，手術是腸系膜淋巴管瘤唯一的治療方法。