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支氣管Dieulafoy 病致大咯血一例

病歷摘要 患者男性, 62 歲。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急診入院。患者于入院3 d 前無誘因出現咯血, 初咯血量較少, 入院前1 h 突然出現大咯血, 鮮紅色, 約150 mL; 伴頭暈、心悸, 無畏寒、發熱, 無胸痛和呼吸困難。既往有兩次大咯血病史, 未明確診斷; 否認肺結核和支氣管擴張病史。

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。

兩例大咯血患者手術中麻醉處理的體會

Embosphere 微粒球栓塞大咯血出血靶血管的療效和安全性研究

目的 觀察 Embosphere 微粒球作為栓塞材料治療大咯血的近遠期療效和安全性。 方法 納入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球為主要的栓塞材料，栓塞支氣管動脈以及其他出血靶血管，觀察 24 h 內咯血有無停止，7 d 內有無咯血反復，以及圍手術期的不良反應。術后隨訪 1 年觀察咯血有無反復。 結果 患者術后 24 h 內咯血停止 78 例，明顯減少 3 例，無效 1 例；7 d 內有 1 例出現反復。近期有效率 97.6%（80/82）。隨訪 1 年，咯血復發 4 例，遠期有效率 92.7%（76/82）。圍手術期的不良反應主要為胸痛、胸悶和發熱，未發生嚴重并發癥。 結論 Embosphere 微粒球經出血靶血管栓塞治療大咯血的近期和中遠期療效確切，無嚴重的不良反應，值得臨床推廣應用。

Clinical and pathological analysis of pulmonary endometriosis: Three cases report

Pulmonary endometriosis (PEM) is a rare disease with diverse clinical manifestations, most commonly presenting as hemoptysis, while patients presenting solely with pulmonary nodules are less common. Here, we report three female patients (aged 32, 19, and 46 years, respectively). One patient sought medical attention due to hemoptysis during menstruation, while the other two had no obvious symptoms and were found to have pulmonary nodules during routine physical examinations. Two patients had a history of cesarean section, and one had a history of miscarriage. Pathologically, one patient of PEM showed extensive hemorrhage in the alveolar spaces, with fragmented endometrial glandular epithelium observed within the hemorrhagic foci. The other two patients exhibited proliferative endometrial glands and stroma, surrounded by old hemorrhage. Immunohistochemistry revealed that the endometrial glands and stroma in all three patients were positive for estrogen receptor, progesterone receptor, and vimentin, with CD10 positivity in the endometrial stroma. All three patients were definitively diagnosed as PEM by pathology and underwent thoracoscopic pulmonary wedge resection. Follow-up periods were 18, 31, and 49 months, respectively, with no recurrence observed in any of the patients.

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。

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.

咯血患者無痛纖維支氣管鏡檢查的麻醉一例

巨大甲狀腺血管肉瘤合并咯血患者的氣道管理

Multidetector-Row CT Angiography and Digital Subtraction Angiography of Bronchial Artery in Diagnosis of Hemoptysis: A Comparative Study

Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.