| At present,domestic and foreign recommended pneunmthotax treatmentincludes conservative therapy and operation therapy,exhausttreatment,somelonger duration of disease,lung persistent air leak intractablepneumothoraxoften require the VATS or open chest operation tocure.However,some elderly,frail,presenc of heart and lung underlying diseasesintractabe pneumothoraxpatients can not tolerate operation,require long-termclosed thorcic drainage,thoracic indwelling frainage tube,inconvenience topatients.In recent years,fiber bronchoscope,double lumen balloon catheterpositioning bronchopleural fistula associated with bronchial and pluggingtechnology,the new research direction for Department of intemal medicinetreatmet of intractable pneumothorax,at home and abroad,many researchreports,and achieved a better therapeutic effect.However,we division in theclinical application of this method are:compicated operation,high cost ofhealth care,positioning time,safety and efficacy still needimprovement,clinical application and promotion limited.Therefore,ourhospital developed by airway bronchoscopy albumin foampnermothoraxpulmonary air leak location relatde bronchial new method,the clinicalapplication effect is satisfactory,the method and the results are reportidasfollows:Objective:To study the fiber bronchoscope positoning pleural bronchusfistula mediated by fiber bronchoscope,and the observation time,pluggingeffect,adverse reactions and recurrence rate.Methods:Frome2005May to2013December during th vistits to therespiatorydepartment of internal medicine,Fourth Affiliated Hospital of HebeiMedical University in24cases of intractable pneumothorax.All patients werescholasticoutside the closed thoracic drainage in the treatent of3weeks to39 weeks,the average(6±3.4)weeks.Incusion criteria:①in our hospital withchestcontinuous negaive pressure suction≥5days.②The non thoracoscopicand open chest operation history.③No breathing,circulation and the functionof liver and kidney failure,can tolerate bronchoscopy.④The KPS score≥50.⑤Hhe family or the patient agreed and signed the informed conset.Preoperative routine examination,routine sedation,glandularsecretion,inhibitairway localanesthesia,connecting the ECG monitoringcontinuously monitor thevital aigns,chest drainage tube is connected to asuction device,negative pressure to-10~-20cm water column,observation ofthe patient during quiet breathing with continuous gas from escaping thedrainage bottle box.To preparealbumin foam50~100ml backup.Fiberopticbronchoscopy nasal insertionairway,reaches the predetermined detection ofpneumothorax suspicious targetbronchus opening,along the bronchoscopeworking path into the foam injection catheter to the target bronchus inabout2~3cm,slow infusion of albumin foam,localization of targetbronchus,such as mobile foam with the resperatory cycle up and down,toreduce or disappear,as pneumothorax non leakage relatedbronchus,orderlypositioning a ches suspected bronchial.Positioning the order.After the first (thefirst leaf,after the leaf),after nearly(lobebronchun,bonchus,sub segmentalbronchi,sub segmental bronchus).Such as pneumothoraxsuspicious relatedendobronchial foam added,raidly disappeared or reducedcontinuously,can beregarded as pneumothorax pulmonary air ldakage relatedbronchus,exit thebubble injection catheter,then the bronchoscope and injection catheter in thenext level of pneumothorax pulmonary air leakage suspicioustargetbronchus,repeat the above operation,the target bronchus pulmonary airleakage suspicioustarget bronchus,reprat the above opration,the targt bronchuspulmonary air leakge.Positoning pneumothorax pulmonary airleak aftersuspected bronchialocclusion,stop or reduce pleural suctionlevel,bronchoscopic working path into the Obglue injdction catheter,slow tothe pulmonary air leakage endobronchialinjection of OB glue,genera1~3/times (1ml/),observe drainage gas,gasdrainage is reduced or disappeared as plugging effctively.If invalid,then5days later repositoning andsealing,disappear until frainage box gas escape.Andthe chest X-ray filmshowed patients with pneumothorax side,atelectasis,continuned to observe1weeks,no recurrence of pneumothorax positioning forplugging success.Results:1Target bronchial localization results24cases of intractable pneumothorax lung rupture associated bronchialweresuccessful positioning. Positioning segmental bronchus in17cases(70.8%), sub section in3cases (12.5%),1cases of sub paragraph (4.2%),relates to theadjacent multi segmental bronchus in3cases (12.5%);16cases(66%), locatingthe right lung11cases, of which4cases, sub section in1cases,right upper lunglobe in5cases,8cases in lower lobe,3cases in the middle.Positioning of the left lung in8cases (33%),6cases, sub section of the upperlobe of the left lungin2cases,5cases,3cases in lower lobe.24cases ofpositioning patients,1positioning was successful in17cases (70.8%),2of5cases (20.8%),3of2cases (8.4%),4and above in0cases.2Positioning time (determined pneumothorax pulmonary air leakage relatedtobronchial from foam injection)Segmental or subsegmental bronchus positioning time is97s~354s, theaverage (211±74) s, the tension pneumothorax97s~327s, the average (197±66) s, traffic pneumothorax124~354s, average (255±87) s, tensionpneumothorax, pulmonary air leakage bronchial positioning time and trafficpneumothorax, pulmonary air leakage a gas pipe positioning time no statisticaldifference (P=0.15, table1).3the traget bronchus24patients with intractable pneumothorax were treated by OB gelpluggingsuccess, the closure of1successful in14cases,2succeeded in7cases,3succeeded in2cases,4succeeded in1cases. Further stratification:1pluggingsuccess rate:5cases of traffic (83.3%),9(50%) cases of tensionpneumothorax,2types showed no statistical significance (P=0.34, table2).This study is divided into38OB glue sealing, wherein OB glue injection immediately after drainagegas bottle disappear (≤5min) in18cases; OB glueinjection flow decreases after the cessation of6cases; OB glue injection flowdecreases continuously in8cases; OB glue injection after the drainage bottleflow did not change in6cases.4Adverse reactionsRough cough in7cases (29.1%),4cases of fever (16.6%),2cases ofpleuralhemorrhage (8.3%), bleeding was≤20ml, originalPyopneumothoraxexacerbation,1cases of acute liver injury induced by(4.1%), postoperative chest pain were not found in24patients. Patients werefollowed up for1~19months in24cases of intractablepneumothorax patientswere discharged from hospital after, in which1patients with ipsilateralrecurrent spontaneous pneumothorax, thoracic closed drainageafter cure, stillno recurrence of pneumothorax,23cases still showed no recurrence ofpneumothorax, the recurrence rate was4.1%;24patients had noadversereaction of chronic pain etcConclusion: Compared with1, and double lumen balloon Catheter,bronchoscopyairway albumin foam injection location pneumothoraxpulmonary air leakageassociated bronchial simpler methods, cheap, safe andeffective.2, with bronchoscope, OB glue closure pneumothorax associatedbronchial ruptureeffect really. However, OB glue airway mucosa irritation, asmall number of patients with severe coughing. Therefore, active coughshould preoperative,intraoperative anesthesia airway full, accurate calculationof OB gum, OB guminto the target bronchus distal, avoid reflux plugging nontarget air bronchus.3,the liquid foam is pneumothorax associated bronchialpositioning a new method.But the albumin is not ideal liquid pneumothoraxassociated bronchial positioningfoam, foam less albumin, short retention time;pollution lens, affecting the line of sight; easy to adhesion to airway wall, remove trouble, pneumothorax associatedbronchial positioning foam agent R&D new be imperative. |
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