1359例肺不张支气管镜下特点分析与治疗方法探讨  

Bronchoscopic features and therapy of pulmonary atelectasis in 1359 patients

作　　者：李园园[1] 胡成平[1] 聂华萍[1] 杨红忠[1] 杨华平[1] 瞿素洁[1] 周燕芝[1] 

机构地区：[1]中南大学湘雅医院呼吸内科,长沙410008

出　　处：《第三军医大学学报》2010年第14期1549-1552,共4页Journal of Third Military Medical University

摘　　要：目的分析肺不张支气管镜下特点与病因、肺不张发生部位的相互联系,探讨镜下治疗方法。方法对本科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1294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,病因多为炎症表现(92.9%)。③肺不张在各肺叶具有不同的镜下表现:左、右全肺不张,左上叶不张,右上叶不张以及右下叶不张均表现为不同程度的气道腔内菜花样新生物,左下叶不张中23.5%表现为黏膜充血肥厚肿胀;右中叶不张主要表现为气道黏膜肥厚肿胀和脓性分泌物。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。镜下治疗可在一定程度上通畅气道、缓解肺不张情况,从而改善呼吸功能。Objective To investigate the causes and bronchoscopic features of pulmonary atelectasis,and explore the relationships of the features with the causes and lesion sites for better bronchoscopic treatment. Methods The clinical data,including history,imaging data,bronchoscopic findings,pathological results,and the approaches and outcomes of bronchoscopic treatment,of 1359 patients with pulmonary atelectasis admitted to our hospital from October 2001 and May 2007 was retrospectively analyzed. Results There were 1294 of 1359 patients （95.2%） diagnosed by flexible bronchoscopy combined with pathological examination. In all these cases,tumor accounted for 37.2%,while inflammation was 35.5% and tuberculosis took the left 19.9%. Bronchoscopic manifestations including cauliflower-like neoplasm due to tumor （74.6%）. Not specific findings,such as mucosal hypertrophy,congestive and unsmooth were observed in bronchoscopy examination. Tracheal cavity scar strictures or closures were often seen in tuberculosis （80.6%）,and purulent secretions were almost caused by inflammation （92.9%）. Bronchoscopic manifestations were also related to lesion sites of different lobes. Bronchoscopic treatment included bronchoalveolar lavage,freezing and balloon dilatation. Conclusion Flexible bronchoscopy combined with pathological examination is a direct method to diagnose pulmonary atelectasis. Manifestations of pulmonary atelectasis are related to the causes and lesion sites. Bronchoscopic therapy can ease airway obstruction to some degree and thus relief pulmonary atelectasis,in order to improve respiratory function.

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 

分 类 号：R563.4[医药卫生—呼吸系统] R768.1[医药卫生—内科学]