目的:肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)是一种少见的肺部疾病,由于临床医生认识不足,容易误诊,而PAP通过灌洗治疗常常可获得较好的预后。本文通过分析PAP病例,总结PAP患者的临床特点、影像学表现和治疗方法,以提高该病的诊疗水平。方法:回顾性分析2003年2月～2008年5月四川大学华西医院呼吸科经病理确诊的15例PAP患者临床资料,并观察了全肺灌洗治疗PAP的效果。结果:PAP患者常见临床症状为咳嗽和进行性呼吸困难,体征正常或无特异性。胸部CT可表现为“地图样”、“铺路石样”或间质纤维化改变。全肺灌洗治疗的14例患者临床症状明显缓解。结论:肺泡蛋白沉积症虽然少见,但只要提高认识,诊断并不困难。支气管肺泡灌洗和(或)肺活检是确诊PAP的重要方法,全肺灌洗是治疗PAP的主要方法。
目的 探讨小儿结肠系膜淋巴管瘤的诊断与治疗方法。方法 回顾性分析我院2006年1月至2011年12月期间手术治疗的5例小儿结肠系膜淋巴管瘤的临床资料。结果 3例诊断为腹腔包块性质待查的患儿，术中发现腹腔肿块来源于乙状结肠系膜，其中1例肿块侵犯到降结肠系膜达结肠脾曲而行左半结肠切除＋肠吻合术，另外2例行乙状结肠系膜淋巴管瘤切除＋部分乙状结肠切除＋肠吻合术；1例患儿诊断为急性化脓性阑尾炎合并乙状结肠系膜淋巴管瘤，行阑尾切除＋乙状结肠系膜淋巴管瘤切除＋肠吻合术，1例患儿诊断为乙状结肠系膜淋巴管瘤破裂并弥漫性腹膜炎，行乙状结肠系膜淋巴管瘤切除＋乙状结肠造瘘术，术后6个月后再行二期手术。5例患儿手术后恢复良好，未发生吻合口漏等并发症。术后随访5个月～5年， （2.3±1.1）年，1例失访，余均存活，仍在随访中，所有病例均未复发。结论 日常行阑尾手术中，应常规探查小肠、结肠；未进行肠道准备的结肠一期吻合手术中结肠灌洗可减少吻合口漏等并发症的发生率；腹腔感染严重的患儿结肠一期吻合不可取，结肠造瘘安全；小儿结肠系膜淋巴管瘤术前确诊困难，反复出现腹痛、腹部包块的患儿应想到结肠系膜淋巴管瘤的可能性，行充分的肠道准备后择期手术，手术是肠系膜淋巴管瘤唯一的治疗方法。
目的 研究直肠癌切除后肠吻合前进行肠腔灌洗的临床作用。方法 对我院2006年6月至2007年2月期间连续56例行直肠癌低位前切除吻合的病例在切除原发灶、行远端封闭吻合前行生理盐水远端肠腔灌洗，收集灌洗前、后2份标本分别涂片行细胞学检查。结果 灌洗前收集液中观察到肿瘤细胞或核异形细胞者7例，中性粒细胞者24例，上皮细胞者4例； 灌洗后所有患者的收集液中均未观察到肿瘤细胞（P＜0.05），19例仍有少许中性粒细胞或上皮细胞。结论 低位直肠癌远端肠腔有可能存在脱落的肿瘤细胞。对直肠癌患者手术切除病灶后吻合前行远端肠腔灌洗的方法简单易行，可以显著减少或清除肠腔内可能残留的肿瘤细胞，从而可避免此类原因所致的局部肿瘤复发，值得提倡。
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
ObjectiveTo investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.MethodsA retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.ResultsThe patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.ConclusionsScedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.
目的 改善左半结肠癌性梗阻一期切除吻合术中结肠灌洗的方法。方法 利用市售塑料自来水三通管及大口径(直径3 cm)螺纹管制成结肠灌洗器，于梗阻近端结肠置入形成术中封密式结肠灌洗。结果 24例患者采用自制结肠灌洗器行术中结肠灌洗，无腹腔污染，术后无一例发生吻合口漏，均一期愈合，顺利出院。结论 掌握好一期手术适应证，自制结肠灌洗器可运用于左半结肠癌性梗阻一期切除吻合，术中肠腔灌洗彻底，方便，无污染，无溢漏，且制作简单，成本低。
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.