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1、1359例肺不张支气管镜下特点分析与治疗方法探讨李园园,胡成平,聂华萍,杨红忠,杨华平,瞿素洁,周燕芝(410008长沙,中南大学湘雅医院呼吸科)[摘要]目的总结肺不张的病因和支气管镜下特点,分析镜下特点与病因、肺不张发生部位的相互联系,探讨镜下治疗方法。方法对中南大学湘雅医院呼吸科支气管镜室2001年10月至2007年5月共诊治的1359例肺不张患者相关资料(病史特点、影像学资料、支气管镜下表现、组织病检、部分病例支气管镜下治疗经过和疗效)进行回顾性研究。结果①1359例患者经可弯曲支气管镜联合组织病检等检查明确病因129
2、4例,支气管镜总诊断率为95.2%,其中肿瘤占37.2%、炎症占35.5%、结核占19.9%。②肺不张镜下主要表现为:气道腔内菜花样新生物,病因多为肿瘤(74.6%);黏膜肥厚、充血肿胀、凹凸不平,病因无明显特异性;管腔瘢痕狭窄或闭塞,病因多为结核(80.6%);脓性分泌物,基本为炎症表现(92.9%)。③肺不张在各肺叶具有各种不同的镜下表现。④镜下治疗方法主要为支气管肺泡灌洗、球囊扩张、冷冻等。结论可弯曲支气管镜联合病检是确诊肺不张病因的最直接手段。肺不张的镜下表现和病因、发生部位存在一定联系。镜下治疗可一定程度上通畅气道
3、、缓解肺不张情况,从而改善呼吸功能。[关键词]肺不张;支气管镜检查;支气管肺泡灌洗;球囊扩张;冷冻[中图法分类号][文献标志码]A[通信作者]胡成平,电话:(0731)84327261,E-mail:huchengp28@yahoo.com.cnAnalysisofbBronchoscopicfeaturescharactersandtherapyofpulmonaryatelectasisin1359patientsLiYuanyuan,HuChengping,NieHuaping,YangHongzhong,YangHu
4、aping,QuSujie,ZhouYanzhi(DepartmentofRespiratoryDiseases,Medicine,XiangyaHospital,CentralSouthUniversity,Changsha,HunanProvince,410008,China)[Abstract]ObjectiveTosummitinvestigatethecausesandflexiblebronchoscopiccharactersfeaturesofpulmonaryatelectasis,andmeanwhile
5、,exploretherelationshipsbetweenofthefeatureswiththecausesandlesionsitesofitforabetterbronchoscopictreatmentywerealsodiscussed.MethodsTheclinicaldata(,includinghistorycharacters,,imagingdata,bronchoscopicfindings,pathologicalresults,andtheapproachesmethodsandoutcome
6、seffectofbronchoscopictreatment),inof1359patientswithpulmonaryatelectasisadmittedtoXiangyaourHhospitalbetweenfromOctober2001andMay2007wasretrospectivelyanalyzed.ResultsTherewere①1294of1359patients(95.2%)couldbediagnosedbyflexiblebronchoscopycombinedwithpathological
7、examinationwhichbroughta95.2%diagnosticrates.Inallthesecases,tumoraccoutedfortookup37.2%,whileinflammationwas35.5%andtuberculosistooktheotherleft19.9%.②Bronchoscopicmanifestationsincludingcauliflower-likeneoplasmduetowhichwerecausedbytumor(74.6%).Notspecificfinding
8、s,suchasAachymucosa,congestion,unsmoothwereobservednotspecificfindingsinbronchoscopyexamination.Trachealcavityscarstricturesorclosureswereoftense