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Objective: To evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis. Methods: We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room, The First Affiliated Hospital of Bengbu Medical College. We analyzed the patients' general data, diagnosis results, clinical manifestations, imaging and interventional treatment. The severity, type and distribution of stenosis were evaluated. The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index (MRC DI) and Karnofsky Performance Score (KPS). Through regular follow-up, dynamic observation and evaluation of clinical efficacy, according to the occurrence of intraoperative and postoperative complications, safety assessment was carried out to evaluate the postoperative outcome. The clinical efficacy, safety evaluation and prognosis were observed. Results: The average age of 46 patients was (62.43±12.34) years old. 36 (78.26%) had tracheal stenosis, 6 (13.04%) had stenosis in the left main bronchus, 10 (21.74%) in the right main bronchus, and 2 (4.35%) in the right middle bronchus. Among them, 33 patients (71.74%) had malignant central airway stenosis and 13 (28.26%) had benign lesions. Forty-six patients underwent 58 interventional therapies, including stent placement, cryotherapy and balloon dilatation. Endoscopic estimation of the degree of tracheal stenosis was (85.42±7.81)% before the first intervention and (24.17±5.79)% after operation. The degree of stenosis in the right main bronchus was improved from (81.00±17.13)% to (20.50±6.43)%. The degree of left main bronchus stenosis (24.17±9.14)% was significantly improved compared with preoperative (77.50±16.66)%. The difference was statistically significant (t=42.73, t=22.43, t=19.02, P<0.001). The degree of dyspnea was relieved in all the patients. Postoperative MRC DI was 0.98±0.62, significantly lower than the preoperative one 3.42±0.57(t=19.65, P<0.001). KPS was 34.01±13.14 and 83.91±8.96 before and after interventional therapy, and KPS increased significantly after operation (t=21.28, P<0.001). The main complications were local hemorrhage, hypoxemia in 4 cases (8.70%, 4/46), transient ventricular premature rupture in 1 case (2.17%, 1/46), and tooth loss in 2 cases(4.35%, 2/46). Most patients had sore throat of varying degrees after operation. The 1-year survival rate of patients with malignant central airway stenosis was 13.79% (4/29), and 4 patients with malignant tumor were followed up; 13 patients with benign airway stenosis had good quality of life. Conclusion: For central airway stenosis, especially complex central airway stenosis, rigid bronchoscopy combined with electronic bronchoscopy shows immediate improvement of dyspnea and causes rare severe complications; thus it is safe and effective. It can improve the patients' quality of life.
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Objective To analyze the clinical characteristics and risk factors of patients with confirmed venous thromboembolism (VTE) in order to improve recognition of VTE, and reduce the rate of missed diagnosis and wrong diagnosis. Methods A retrospectively review was performed for 205 patients diagnosed with VTE confirmed by CT pulmonary angiography (CTPA), radionuclide pulmonary ventilation/perfusion (V/Q) imaging, lower extremity deep vein ultrasound or venography in the First Affiliated Hospital of Bengbu Medical College from January 2009 to December 2018. The clinical manifestations, laboratory examination results, imaging results, treatment and prognosis of patients diagnosed with VTE were analyzed. The clinical possibility was assessed by pulmonary thromboembolism (PTE) simplified Wells score and deep venous thrombosis (DVT) Wells score. 130 non-VTE patients admitted in the same period were enrolled as controls, and the risk factors of VTE were screened by multivariate Logistic regression analysis. Results Among 205 VTE patients, 14 cases had incomplete data, 2 cases were complicated with other diseases deteriorated, 2 cases were excluded because of economic reasons, 10 cases abandoned treatment because of serious illness, and finally 177 cases were included in the analysis. The main clinical symptoms of VTE patients were chest tightness (36.16%), followed by chest pain (29.94%), dyspnea (29.38%) and hemoptysis (24.29%). Swelling or tenderness of unilateral/bilateral lower extremities (38.98%) and lung moist rale (20.90%) were the most common signs. ST-T changes were the main changes in electrocardiogram (ECG, 49.15%), followed by SⅠQⅢTⅢ or QⅢTⅢ changes (35.03%). Only 5.65% of the patients had plasma D-dimer less than 0.5 mg/L. 31.07% (55/177) patients had normal arterial blood gas results. Of the 177 VTE patients, 175 were diagnosed as PTE by CTPA, with bilateral/multi-lobar pulmonary artery embolism and its branches being the main type [44.57% (78/175)]. Two cases were diagnosed as PTE by V/Q imaging. Among them, 112 cases were received lower extremity deep venous ultrasound or lower extremity deep venography, 51 cases were diagnosed as lower extremity DVT, with thrombosis of popliteal and above vein as common [68.63% (35/51)]. The clinical possibility assessment showed that 67.23% (119/177) patients might have PTE (PTE simplified Wells score greater than or equal to 2), 38.98% (69/177) patients might have lower extremity DVT (DVT Wells score greater than or equal to 2). Multivariate Logistic regression analysis showed that operation less than 4 weeks [odds ratio (OR) = 5.503, 95% confidence interval (95%CI) = 1.577-19.206, P = 0.007], trauma or fracture less than 3 months (OR = 6.771, 95%CI = 1.510-30.370, P = 0.012), VTE history (OR = 0.072, 95%CI =0.009-0.549, P = 0.011) were independent risk factors for VTE occurrence. Thrombolytic therapy was administered in 13 cases while anticoagulant therapy alone was prescribed in 164 cases. 176 patients recovered, while 1 case died. Conclusions VTE clinical manifestations are not specific. Patients with risk factors should be vigilant, be strengthen with diagnostic awareness, paid attention to the evaluation of clinical possibilities. Timely thrombolytic or anticoagulant treatment after diagnosis, can improve the survival rate.
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Objective To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs),assess its safety and diagnostic value,and explore the influencing factors.Methods Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study.Eighty-three cases were diagnosed as PPLs.The detection rate,ability to locate the peripheral lesions,and influencing factors of EBUS were analyzed.The incidence rate of complications was observed to assess its safety.Results Of the 83 PPLs patients,they were 55 males and 28 females,and at a mean age of 59.81 ± 11.85 years.The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04％ (49/83),and the diagnostic rate was 50.94％ (27/53) for malignant lesions,and 73.33％ (22/30) for benign diseases.The rate of EBUS-TBB (56.92％,37/65) was significantly higher than that of brush biopsy (30.12％,25/83,Chi square =10.76,P =0.001).EBUS-guided diagnostic methods had an accuracy of 60.00％ (45/75),while the EBUS-guided bronchoscopy had a rate of 50.0％ (4/8),but no significant difference was seen between the 2 methods (Chi square =0.03,P =0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm,and the diagnostic yield for PPLs ≤20 mm in diameter (36.84％,7/19) was lower than that for those ＞20 mm (65.62％,42/64,Chi square =5.02,P =0.003).There was no significant difference (Chi square =10.05,P =0.07)in the diagnostic yield for different sites,with that of right upper lobe of 46.15％ (12/26),right middle lobe 100.00％ (8/8),right lower lobe 53.85％ (7/13),left upper lobe 37.50％ (3/8),left lingula lobe 63.64％ (7/11),left lower lobe 70.59％ (12/17).But the detection rate was obviously lower in the upper lobe (22/45,48.89％) than the middle/lower lobe (27/38,71.05％,Chi square =5.02,P =0.003).Of all the 83 patients,74 ones (89.16％) were successfully identified using radial probe EBUS,but the lesions were not found in 9 patients.When the radial probe position was within the target lesion,the diagnostic yield was 81.58％ (31/38),notably higher than that when the probe was positioned adjacent to the lesion (50.00％,18/36,Chi square =8.24,P =0.004).Mild bleeding was observed when performing biopsy under bronchoscope,and no pneumothorax,or other serious complications were observed.Conclusion Radial EBUS is a safe and feasible nethod to accurately identify PPLs and improve its diagnostic rate.EBUS-guided bronchoscopy has higher positive detection rate for PPLs,and is cost saving.The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.