Giant Bullae In Lung Parenchyma — A Case Series

Introduction: Bullae are air filled spaces in lung parenchyma which develop in various diseases and cause respiratory compromise. Bulla which occupies one third of hemithorax is considered as a giant bulla. Case series: This case series consists of eleven cases of giant bullae with varied clinical and radiological features. Common presenta?ons include breathlessness, associated para-septal emphysema and complica?ons like pneumothorax. Conclusion: Pa?ents presen?ng with acute chest symptoms should also be evaluated for bullous disease and Computed tomography of chest can differen?ate pneumothorax from giant bullae.

Neumotórax y bulla como complicación tardía en un paciente con neumonía por COVID-19. Reporte de un caso y revisión de la literatura / Pneumothorax and bullae as a late complication in a patient with COVID-19 pneumonia. Case report and literature review / Pneumotórax e bulas como complicação tardia em paciente com pneumonia COVID-19. Relato de caso e revisão da literatura

Resumen: El neumotórax y la presencia de bullas se han reportado como complicaciones tardías asociadas a la neumonía por COVID-19 en pacientes con mala evolución. Se desconoce el mecanismo exacto que ocasiona estas complicaciones y su papel en el curso clínico de la enfermedad. A continuación se expone el caso de paciente masculino de 56 años de edad con neumotórax y bulla como complicación tardía de neumonía por COVID-19.

Abstract: Pneumothorax and the presence of bullae have been reported as late complications associated with COVID-19 pneumonia in patients with poor evolution. The exact mechanism that causes these complications and their role in the clinical course of the disease are unknown. The following is the case of a 56-year-old male patient with pneumothorax and bulla as a late complication of COVID-19 pneumonia.

Resumo: O pneumotórax e a presença de bulas foram relatados como complicações tardias associadas à pneumonia por COVID-19 em pacientes com má evolução. O mecanismo exato que causa essas complicações e seu papel no curso clínico da doença são desconhecidos. A seguir, o caso de um paciente do sexo masculino de 56 anos com pneumotórax e bula como complicação tardia de pneumonia por COVID-19.

Bulla con nivel hidroaéreo en su interior, interpretación y enfoque terapéutico / Air-Fluid Level Within Bulla: Interpretation and Therapeutic Approach

Bulla se define como un área de enfisema bien delimitada mayor o igual a 1cm de diámetro y pared fina epitelizada de grosor generalmente menor a 1mm. Se presentan preferentemente sobre los vértices pulmonares y se corresponden con un alargamiento de los espacios centrolobulillares1. Tienden a aumentar de volumen y complicarse con neumotórax, hemorragia e infección2. Durante la infección adquieren líquido, presencia de nivel hidroaéreo y sus paredes se engrosan2. Es importante la diferenciación con la neumonía perienfisematosa, la cual cursa con la infección del parénquima circundante generando una afectación por contigüidad a la bulla, produciendo volcado de líquido inflamatorio a la misma, y comprometiendo sistémicamente al paciente

Application of tubless therapy in the treatment of pulmonary bulla resection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery. Methods    We retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). Results    There was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups. Conclusion    Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.

Unrecognized hyperlucent lesion on lateral film of chest X-Ray

We report an interesting case of bulla right lung, incidently found during CABG surgery.

Otitis media en el perro: diagnóstico, tratamiento quirúrgico y posibles complicaciones. Revisión / Otitis media in dogs: diagnosis and surgical treatment, and possible complications. Review

RESUMEN El propósito de este artículo es discutir los aspectos relativos al tratamiento y diagnóstico de la otitis media en el perro, haciendo énfasis en las complicaciones más frecuentes observadas luego de una ablación total del canal auditivo con osteotomía de la bulla timpánica, procedimiento que en la actualidad se considera el tratamiento de elección. Además, se expone el ámbito clínico en el cual se indica esta intervención considerando otras condiciones diferentes de la otitis media. Se contrasta de manera crítica la experiencia de los autores con la literatura publicada referente a este tema en algunos aspectos que conciernen a la técnica quirúrgica y el diagnóstico.

SUMARY The purpose of this article is to discuss the aspects related to the treatment and diagnosis of otitis media in dogs, emphasizing the most frequent complications observed after a total ablation of the auditory canal with osteotomy of the tympanic bulla, a procedure that is currently considered the treatment of choice. Additionally, the clinical setting in which this intervention is indicated is exposed, considering other conditions other than otitis media. The experience of the authors with the published literature regarding this topic is critically contrasted in some aspects that concern the surgical technique and the diagnosis.

Complete resolution of the giant pulmonary bulla: a case of inflammatory autobullectomy / 고신대학교의과대학학술지

Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.

The expression of the cytokines TβR1 and part of SMAD family members in bullae of lung and its significance / 中华胸心血管外科杂志

Objective This study intended to investigate the expression of TGF-β receptor1 (TβR1),smad2,smad3 and smad4 in bullae of lungs of PSP patients and to examine the role of these cytokines in the pathogenesis of PSP.Methods Bullae of thirty-four PSP patients who received standard video-assisted thoracic surgery were included as study group.Normal lung tissues around the bullae of lung of part of the 34 PSP specimens were used as a self-control.Normal lung tissues from ten patients without pneumothorax associated disease were used as a control.Immunohistochemical (IHC) staining of TβR1,smad2,smad3 and smad4 were performed on the normal lung tissue of control specimens and the bullae of lung of PSP specimens.Immunoreactivity was evaluated based on immunoreactive score(IRS).Statistical analyses were performed using t-test or Fisher exact test.Results (1)Overexpression ofTβR1(P＜0.01),smad2(P=0.023) and smad4(P=0.015) was detected in the bullae of lung of PSP patients compared with normal lung tissue around the bullae of lung.(2) TβR1 (P =0.012),smad2 (P =0.031) and smad4 (P ＜ 0.01) was significantly high-expressed in bullae of lung of PSP patients compared with normal lung tissue of control group.The expression of smad3 in the study group and the control group was not statistically significant(P ＞0.05).However,the absolute value of expression of smad3 in PSP bullae tissue was higher than that in control group(IRS 4.253 ± 1.719 vs.3.260 ± 2.213).Conclusion TβR1,smad2 and smad4 was significantly overexpressed in PSP lesions.These results suggest that an abnormal expression of TβR1,smad2 and smad4 may be involved in the pathogenesis of PSP.

Thoracoscopic Treatment of Giant Pulmonary Bulla With Complex Conditions: Report of 32 Cases / 中国微创外科杂志

Objective To explore the efficacy of thoracoscopic treatment of giant pulmonary bulla with complex conditions. Methods Video-assisted thoracoscopic surgery (VATS) was performed in 32 cases of giant pulmonary bulla with complex conditions in our department from September 2011 to November 2015. According to the dyspnea index of the American medical research council, there were 22 cases with distress index Ⅳ and 10 cases with distress index Ⅴ. Results All the patients underwent thoracoscopic surgery smoothly. The drainage tube was retained for 4-7 d in 17 cases, 8-14 d in 14 cases and 48 d in 1 case. The follow-up after operation was 12-18 months (mean, 16. 0 ± 3. 2 months). The dyspnea index was maintained at gradeⅠin 10 cases and gradeⅡin 22. All the patients were able to take care of themselves in daily life. Conclusion Giant pulmonary bulla with complex conditions can be treated under thoracoscopy with good surgical outcomes.

Neumotórax espontáneo debido a bulas subpleurales: presentacion de un caso / Spontaneous pneumothorax and subpleural bulla: case report

Pneumothorax is defined as the presence of air within the pleural cavity. It may be traumatic, iatrogenic, spontaneous secondary or primary. In the latter cause, the most frequent are subpleural and apical bulla in longiline patients, with connective tissue diseases and smokers. Treatment should be conservative in patients who present a small pneumothorax. Instead, a probe should be installed if it is greater. In the presence of frequent recurrences or persistent air leakage, pleurodesis should be considered, or resection of the bullous should be practiced. In this article we review a patient with Elhers Danlos syndrome, who presents a primary spontaneous pneumothorax due to subpleural bulla

El neumotórax se define como la presencia de aire dentro de la cavidad pleural. Puede ser traumático, iatrogénico, espontáneo secundario o primario, dentro de esta última causa la más frecuente son las bulas subpleurales y apicales, en pacientes longilíneos, portadores de enfermedades del tejido conectivo y fumadores. En neumotórax pequeños el tratamiento debe ser conservador, en cambio en los de mayor cuantía se debe proceder a la instalación de una sonda pleural. Frente a recidivas frecuentes o persistencia del escape aéreo, se debe considerar la pleurodesis o bien practicar la resección de las bulas.En el presente artículo se reporta a un paciente con síndrome de Elhers Danlos que presenta un neumotórax espontáneo primario debido a bulas subpleurales.

Methods for estimating the volume of the tympanic bulla in the big hairy armadillo Chaetophractus villosus (Mammalia, Xenarthra, Dasypodidae) / Métodos para la estimación del volumen de bula timpánica en el quirquincho grande Chaetophractus villosus (Mammalia, Xenarthra, Dasypodidae)

Two methods of measurement of bullar dimensions (callipers and scaling from digital images) and subsequent application of four volume formulae (rectangular prism, cylinder, ellipse and elliptical cone) were tested to find the most appropriate non-destructive method for estimating the bullar volume in Chaetophractus villosus. Material for the study consisted in clean adult skull (n=22). Real volume was obtained from latex casts of the tympanic bulla. Each estimation was corrected by a factor based on the differences between the estimated and the real volumes. Highest accuracy (5-7 % of underestimation) and precision (coefficient of variation: 13.27 %) were obtained from callipers and application of rectangular prism, cylinder and ellipse formulae. The corresponding correction factors were 0.31, 0.39 and 0.58, respectively.

Se evaluaron dos métodos para la obtención de medidas de la bula (calibre y escalado a partir de imágenes digitales), con posterior aplicación de cuatro fórmulas de volumen (prisma rectangular, cilindro, elipse y cono elíptico), a fin de hallar el método no destructivo más adecuado para el cálculo de volumen de bula en Chaetophractus villosus. El material de estudio consistió en cráneos limpios de individuos adultos (n=22). El volumen real fue obtenido a partir de moldes de látex de la bula timpánica. Cada estimación fue corregida mediante un factor basado en las diferencias entre los volúmenes reales y estimados. La mayor precisión (coeficiente de variación: 13,27 %) y exactitud (subestimaciones del 5-7 %) fueron obtenidas a partir de mediciones con calibre y aplicación de fórmulas de prisma rectangular, cilindro y elipse (factores de corrección: 0,31, 0,39 y 0,58, respectivamente).

Expression and correlation of CTGF, TGF-β1, β-Gal in the primary pulmonary bulla / 中华胸心血管外科杂志

Objective To detect the express of the pulmonary fibrosis factor CTGF,TGF-β1 and the senescence correlated β-Gal in the primary pulmonary bulla,and investigate the correlation of the pulmonary fibrosis factor,cell senescence and the development of the primary pulmonary bulla.Methods The expression of CTGF,TGF-β1 and β-Gal protein in the tissue of normal lung tissues and lung bullae were tested.The cell image extracted with the digital camera system was entered into the Image-pro Plus 6.0 morphology Image analysis system and analyzed with Semi-quantitative way.Results The expression level of TGF-β1 and CTGF in primary pulmonary bulla organization was obviously higher than that of normal lung tissue.There was a statistically significant difference(P ＜ 0.05).CTGF and TGF-β1 expression level had a significant correlation (r =0.965,P ＜ 0.01).β-Gal expression level of primary pulmonary bullae had no obvious difference with normal lung tissue.Conclusion CTGF and TGF-β1 may play an important role in the formation of primary pulmonary bulla.Both play a synergistic role in the formation of primary pulmonary bulla.Cell senescence is not relevanted with the formation of primary pulmonary bulla.

The application of fast track surgery theory in thoracoscopes pulmonary bulla resection / 中国医师进修杂志

Objective To explore the feasibility, safety and advantage of thoracoscopes pulmonary bulla resection without thoracic closed drainage tube according to the fast track surgery (FTS) theory. Methods The clinical data of 53 patients with pulmonary bulla were retrospectively analyzed. Among them, 29 patients underwent the thoracoscopes pulmonary bulla resection without thoracic closed drainage tube (FTS group), and 24 patients underwent the thoracoscopes pulmonary bulla resection with thoracic closed drainage tube (tradition group). The oxygenation index at 24 h after operation, visual analogue score (VAS) at 24, 48 and 72 h after operation, postoperative complications, postoperative hospital stay and hospital costs were compared between 2 groups. Results There was no statistical difference in oxygenation index at 24 h after operation between FTS group and tradition group:(312.4 ± 16.4) mmHg (1 mmHg=0.133 kPa) vs. (330.6 ± 13.2) mmHg, P>0.05. The VAS at 24, 48 and 72 h after operation in FTS group was significantly lower than that in tradition group:(2.6 ± 1.1) scores vs. (4.3 ± 1.6) scores, (1.6 ± 0.9) scores vs. (3.8 ± 1.4) scores and (0.8 ± 1.0) scores vs. (2.9 ± 1.4) scores, and there was statistical difference (P<0.05). The incidence of postoperative complications, postoperative hospital stay and hospital costs in FTS group were significantly lower than those in tradition group:13.8%(4/29) vs. 37.5% (9/24), (3.2 ± 0.9) d vs. (6.2 ± 1.2) d and (1.3 ± 0.3) × 104 yuan vs. (1.5 ± 0.4) × 104 yuan, and there were statistical differences (P<0.05). Conclusions FTS used in thoracoscopes pulmonary bulla resection is feasible and safe, and has certain advantages.

Clinical observation of lung abscesses secondary to pulmonary bulla treated through chest wall and airway intervention (29 cases) / 中国内镜杂志

Objective To evaluate the efficacy and safety of locating the target bronchus and treating through the chest wall and airway intervention in 29 cases with lung abscess secondary to pulmonary bulla. Methods In 29 cases the lung abscess secondary to pulmonary bulla had a mean diameter of 14 cm, of which 25 with COPD. Implement-ing 4 different ways to locate the target bronchus of lung abscess: Preoperative pulmonary CT, conventional fiber bronchoscopy, and locating the target bronchus by infecting colored saline separately forward and backward. Under guiding of CT, the central venous catheter was inserted via chest wall into lung abscess, which had pus suction, lavage, medicine injection and continuous negative pressure suction and then under direct vision of bronchoscopy, all of the target bronchi of pulmonary absess were occluded with fibrin glue. Results All of the 29 cases, the target bronchi of lung abscess were localized by lung CT in 17, by conventional bronchoscopy in 23, and by infecting col-ored saline forward in 26 and backward in 24 respectively. Cured in 25 and improved in 3, the total effective rate was 96.6%. The adverse effects:chest pain in 3, pneumothorax in 2, pyothorax, pyopneumothorax, subcutaneous em-physema, the drainage catheter falling off and dislocating separately in 1. Conclusion It was simple, safe and effec-tive to treat lung abscess secondary to lung bulla through the chest wall and airway intervention.

Neumostomía con sonda de balón en colecciones purulentas del pulmón / Neumostomy with a balloon catheter in supurative lung collections

Introducción: el desarrollo de los antimicrobianos provocó que el drenaje externo dejara de realizarse en pacientes con absceso de pulmón, en quienes la resección pulmonar es la opción ante el fracaso médico. En los últimos años, la neumostomía ha resurgido por la necesidad de asistir a enfermos con un marcado deterioro físico que impide una intervención quirúrgica resectiva. Objetivo: caracterizar a los pacientes con supuración pulmonar tratados quirúrgicamente mediante drenaje percutáneo externo y neumostomía con sonda de balón (método de Monaldi) practicados con anestesia local. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo en el período de 1995 a 2012 en el Hospital Universitario Comandante Manuel Fajardo. El universo estuvo conformado por 8 pacientes a los que se les practicó el método de Monaldi. En todos los casos se utilizaron sondas de goma de balón de 24 unidades F, de tres ramas. Resultados: cuatro pacientes padecían de absceso del pulmón y el resto de bullas enfisematosas voluminosas infectadas. Todos los casos tuvieron resolución de la colección infectada en un período inferior a las 2 semanas, y no hubo complicaciones ni mortalidad quirúrgica. Conclusiones: el drenaje percutáneo con anestesia local utilizando sondas de balón es un instrumento adecuado para el tratamiento de colecciones pulmonares en enfermos con deterioro físico por el cuadro infeccioso. Con él se logra la resolución de la lesión pulmonar, y es efectivo tanto en los abscesos pulmonares como en las bullas enfisematosas infectadas(AU)

Introduction: with the advent of the antibiotic therapy, external drainage ceased to be performed in lung abscess patients for whom the pulmonary resection is the choice. In the last few years, pneumostomy has reemerged due to the need of giving assistance to patients with remarkable physically deterioration that hinders resective surgery. Objectives: to characterize patients with pulmonary suppuration and surgically treated by means of external percutaneous drainage with balloon catheter pneumostomy (Monaldi method) using local anesthesia. Methods: retrospective, descriptive and longitudinal study of eight patients, who underwent Monaldi method-based surgery, conducted from 1995 through 2012 at Manuel Fajardo university hospital. Three branch twenty-four F unit balloon rubber catheters were used in all these cases. Results: out of the eight, four had been diagnosed with lung abscess and the other four had large septic emphysematous sacs. The infected collection was eliminated in all these patients in less than 2 weeks with no complication and no surgical death. Conclusion: The percutaneous drainage with local anesthesia using balloon catheter as an instrument was adequate and useful in the treatment of septic lung collections in patients with very poor physical condition. This method manages to eliminate the pulmonary lesion and is good for both pulmonary abscesses and infected emphysematous sacs(AU)

The express of the cytokines KL-6 、FGF-10 、MMP-9 in the spontaneous pneumothorax patients with bulla and its significance / 中华胸心血管外科杂志

Objective Spontaneous pneumothorax occurred mainly because of bulla rupture and its formation process and pathogenesis were unknown,the study was to detect the express level of the cytokines KL-6,FGF-10 and MMP-9 in the spontaneous pneumothorax patients with bulla and researched its significance.Methods Selected 24 cases of bulla resection for spontaneous pneumothorax patients,the immunohistochemical staining techniques and enzyme-linked immunosorbent assay (ELISA) was taken to detect the expression level of KL-6,FGF-10 and MMP-9 of the bulla site and the bulla adjacent site.Results Immunohistochemical results showed that the staining intensity of the KL-6 and FGF-10 in groups of bulla site was higher than those in groups of bulla adjacent site while there was no significant difference of MMP-9 in the two groups.ELISA results showed that the expression levels of the KL-6 and FGF-10 in groups of bulla site are higher than those in groups of bulla adjacent site and the results had statistically significant (P ＜ 0.05),while there was no statistically significant of MMP-9 in the two groups(P ＞0.05).Conclusion The expression of the KL-6 and FGF-10 in the bulla site in primary spontaneous pneumothorax patients was higher than that in the normal site ; the pulmonary fibrosis mediated by KL-6 and the lung-bronchial congenital abnormalities mediated by abnormal expression of FGF-10 might have correlation with bulla formation.There was no statistically significant of the MMP-9 expression between the two groups and the correlation between inflammation mediated by MMP-9 and bulla formation was not clear.

Comparison of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection / 中国基层医药

Objective To compare the effects of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection.Methods 38 cases of congenital pulmonary bulla patients,both in the VATS downlink congenital pulmonary bulla resection.According to the number of holes,thoracoscopic operation were divided into the two groups. To observe the use of group 19 cases of 2 holes,19 cases 3 holes were adopted in the control group.Pull the chest tube operation time,operation time of the two groups were compared after.and the average hospitalization time after opera-tion,postoperative analgesia drug application.Results The observation group operation time,operation time,pulling the chest tube after operation the average hospitalization time, analgesic drug application rate respectively were (46.89 ±9.11)min,(3.95 ±0.85) d,(7.37 ±1.34) d,21.1%,The control group were (66.05 ±12.09) min, (4.37 ±0.98)d,(7.32 ±1.57)d,52.6%.There were statistically significant differences in rate of the two groups in operation time,analgesic drug application.(t=-5.516,χ2 =4.071,P<0.05);38 cases were cured,followed up for 3-24 months,no recurrence occurred in 1 cases.Conclusion Video assisted thoracic descending congenital pulmona-ry bulla resection,the 2 hole 3 hole more than minimally invasive,short operation time,postoperative analgesic use rate is low.

Idiopathic thrombocytopenic purpura with oral mucosal blood bulla / 实用口腔医学杂志

Idiopathic thrombocytopenic purpura (ITP)is the syndrome with platelet destruction increase through immunologic mechanism. In this case,the patient's main performance was oral mucosal bloody bulla with the ecchymosis on whole body.

Clinical analysis on 38 cases of pulmonary bulla treatment with uniport video-assisted thoracoscope / 中国基层医药

Objective To assess the clinical efficacy and safety of uniport video-assisted thoracoscopic surgery in treatment of pulmonary bulla.Methods Clinical data of 38 patients with pulmonary bulla treated with uniport video-assisted thoracoscopic surgery were analyzed.Results 30 patients under general anesthesia and double-chamber tracheal intubation anesthesia and 8 patients under general anesthesia and single-chamber tracheal intubation and tracheal plugger anesthesia underwent the resection of their pulmonary bulla through the surgery with uniport video-assisted thoracoscope, and 2 patients therein were simultaneously treated with bilateral resection of pulmonary bulla.36 patients were treated successfully;1 patient was given another exploratory thoracotomy after his unilateral surgery because of progressive hemothorax and substantial pneumothorax;and 1 patient underwent respiratory failure after his unilateral surgery and was improved in respiration 2 days after the help of a respirator.The average time of operations were 52 minutes.It averagely took 3.2 days to remove closed thoracic drainage pipes.The post-operation hospital stays took 6 days.The post-operation follow-up took 7-39 months,without relapse and other compli-cations.No death occurred in this group.Conclusion It is safe and reliable to treat pulmonary bulla by the surgery with uniport video-assisted thoracoscope,which is in line with the concept of minimally invasive surgery and therefore deserves promotion.

Comparative analysis of effect of two kinds of biological agents in volume-reduced bullae / 中国基层医药

Objective To retrospectively analyze the effect of two kinds of biological agents in volume -re-duced bullae .Methods 11 patients who suffered from bullae were operated under large C-arm locating ,and infused two kinds of biological agents through micro catheter of fibreoptic bronchoscopy .All of them were randomly divided into the two groups .The biological agents in group A were fibrinogen and diluent thrombin , and that of group B was Porcine Fibrin Sealant Kit .In group A,the micro catheter with diameter of micro thread less than 1.2mm was placed in bullae through fibreoptic bronchoscope ,and then the 2mL lidocaine,5 ml fibrinogen,and double of 500u diluent thrombin were inproperorder injected through micro catheter .In group B,the Porcine Fibrin Sealant Kit was injected at the same method,and then the suspension fluid was exacted .The operation time was recorded ,and then the clinical efficacy and incidence rate of complications were compared .Results The operation time of group A was 5-15 minutes, and that of group B was 6-20 minutes.For all the patients ,4 cases were totally effective ,2 cases were significantly effective,and 2 cases were totally non-effective.The total effective rate was 81.82%(9/11).The incidence rates of common complications in group A and B were 52.38%(22/42),58.33%(14/24),respectively,the difference was not significant (χ2 =0.22,P>0.05).Moreover,there were no serious complications in all cases .Conclusion The security and effect of two kinds of biological agents might be well enough ,but in view of less cases ,they were worth to further popularized and applied in clinical practice .