Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
Objective To evaluate the diagnostic yield and safety of two biopsy methods, electromagnetic navigational bronchoscopy (ENB) and transthoracic needle biopsy (TTNB), in peripheral pulmonary lesions. To select a low-risk and high-benefit biopsy method based on the clinical characteristics of the lesions and patients. Methods A retrospective analysis was conducted on inpatients who underwent ENB and/or TTNB for peripheral pulmonary lesions in Huadong Hospital Affiliated to Fudan University. Propensity score matching was used to compare the diagnostic yield and safety of the two biopsy methods. Results A total of 126 patients were included in the ENB group, and 104 patients in the TTNB group. After propensity score matching, 83 matched pairs were obtained. The TTNB group exhibited a significantly higher diagnostic yield compared with the ENB group (90.4% vs. 48.2%, P<0.001), but it was also associated with a higher incidence of pneumothorax (1.2% vs. 21.7%, P<0.001). In the ENB group, the diagnostic efficacy was correlated with lesion diameter (P<0.001, OR=0.183, 95%CI 0.071 - 0.470), but there was no statistically significant difference in the diagnostic yield among different lung segments (P>0.05). In the TTNB group, lesion characteristics did not significantly affect the diagnostic yield, but a lesion diameter ≤30 mm (P=0.019, OR=5.359, 95%CI 1.320 - 21.753) and a distance from the pleura ≥20mm (P=0.030, OR=6.399, 95%CI 1.192 - 34.360) increased the risk of pneumothorax. When stratified based on lesion and patient blood characteristics, no significant difference was found in the diagnostic yield between the two groups for characteristics such as left upper lobe (P=0.195), right middle lobe (P=0.333), solid with cavity (P=0.567), or abnormal serum white blood cell count (P=0.077). However, the incidence of pneumothorax in the TTNB group was higher than that in the ENB group. Conclusions The diagnostic yield of ENB is affected by the size of the lesion, while the incidence of pneumothorax in TTNB is influenced by both lesion size and distance from the pleura. In cases with lesions located in the left upper lobe, right middle lobe, solid with cavity, or with abnormal serum white blood cell count, selecting ENB for biopsy is considered preferable to TTNB.
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.
Abstract： Objective To evaluate clinical outcomes of painless flexible fiberoptic bronchoscopy in the treatment for pulmonary complications in postoperative pediatric patients with congenital heart diseases. Methods We retrospectively analyzed clinical data of 58 patients who received fiberoptic bronchoscopy for pulmonary complications after surgical repair for atrial septal defect， ventricular septal defect， tetralogy of Fallot， double outlet right ventricle or transposition of the great arteries in First Affiliated Hospital of Harbin Medical University From August 2009 to February 2012. There were 26 male patients and 32 female patients with their age ranging from 20 days to 2 years. Olympus xp-60 fiberoptic bronchoscopy was used for removal of airway secretions and bronchial alveolar lavage under anesthesia with propofol， fentanyl and lidocaine. Pulse oximetry， respiratory sound and chest X-ray changes were observed. Results The examination time of painless fiberoptic bronchoscopy was 10-25 minutes in the 58 patients. After removal of airway secretions by fiberoptic bronchoscopy， their respiratory status improved significantly， pulse oxygen saturation increased by 5%-12%， and their pulmonary crackles were significantly reduced. In 29 patients with atelectasis， their pulmonary lobes demonstrated significant reexpansion in chest X-ray reviews on the next day after fiberoptic bronchoscopy， and 8 patients received another fiberoptic bronchoscopy treatment on the next day to achieve complete pulmonary reexpansion. One patient with severe pulmonary hypertension （PH） stayed in intensive care unit （ICU） for 6 days， 3 patients with transposition of the great arteries stayed in ICU for 5 days， 3 patients with double outlet of right ventricle and moderately high PH stayed in ICU for 4 days， and all the other patients were discharged from ICU within 48 hours after admission. There was no severe complication related to fiberoptic bronchoscopy， except 2 patients with minor nasal mucosa bleeding who were cured with hemostatic drugs and local compression. Conclusion Painless flexible fiberoptic bronchoscopy can significantly enhance clinical outcomes and shorten ICU stay for postoperative pediatric patients with congenital heart diseases.
Objective To explore the pathological diagnostic value of optical coherence tomography (OCT) in lung cancer. Methods This study selected patients who underwent general anesthesia and electronic bronchoscope biopsy at the Respiratory Endoscopy Center of Sichuan Provincial People’s Hospital from January 1, 2023, to December 1, 2023. White-light bronchoscopy (WLB), auto-fluorescence bronchoscopy (AFB), and OCT examinations were performed in all patients. Lesions were assessed for benign or malignant characteristics based on AFB and OCT before biopsy. The final pathological results were determined according to pathology report. Results A total of 124 patients were included in the study. The accuracy of OCT in differentiating the nature of lesions was 93.55%, significantly higher than AFB (accuracy 83.06%). The accuracy, sensitivity, and specificity of OCT were all higher than AFB. For squamous carcinoma, adenocarcinoma, and small cell lung cancer, the accuracy rates of OCT imaging characteristics were 91.94%, 94.35%, and 94.35%, respectively. Conclusion OCT can improve the accuracy of pre-bronchoscopic tissue pathology biopsy in determining the nature of lesions and provide rapid pathological typing basis, potentially further promoting the development of non-invasive histological biopsy.
Objective To summarize our experience of using rigid bronchoscopy in the managent of patients with tracheobronchial disease. Methods From Sep.2002 to Nov.2007, 44 patients of tracheobronchial disease（31 men，13 women, median age 51.9 years) underwent rigid bronchoscopic operations. All procedures were carried out under general anesthesia with high frequency jet ventilation. After the rigid bronchoscope was placed in the main trachea through the mouth , the airway was checked out firstly, and then the lesion was removed by repeated freezing, argon plasma coagulation, cauterization or mechanical ablation, and a stent maybe implanted while needed. Results All 54 procedures were accomplished endoscopically without mortality or major morbidity (16 clearence,19 core out,8 scar clearance,3 foreign body removal, 8 stent insert or removal).The lesion located at trachea in 19 cases, at carina in 4 cases,at left main bronchus in 11 cases and at right main bronchus in 10 cases. There were 17 benign diseases and 27 malignant diseases. There were 3 slight complications. 16 patients compliating with benign disease were followed-up and 1 patient was missed,there was no tumor recurrence except 3 patients complicating with tracheal scar who received reoperations during 4-44 (mean 23.0) months follow-up period. Of the 27 malignant cases,23 patients were followed-up and 4 patients were missed, the follow-up period were 5-58(mean 27.1)months.3 patients died in one months after operation of other disease; the other patients all survived more than one month,especially 7 patients who received radical resection of the tumor survived more than one year. Conclusions These data show that rigid bronchoscope can be applied safely and effectively in the management of tracheobronchial disease.
摘要:目的：探討纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經口引導氣管插管組(纖支鏡組)125例和喉鏡經口引導氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導下按常規進行氣管插管術。結果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現咽喉部少量出血,并發癥發生率為40%;喉鏡組共有12例發生并發癥,并發癥發生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側肺通氣1例,插入食管2例,心跳呼吸驟停1例。結論：纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發癥少的有效方法,值得臨床推廣應用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
ObjectiveTo investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). MethodsPatients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. ResultsInitially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
ObjectiveTo investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.MethodsThe clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate.ResultsPulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups.ConclusionElectromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.