Tracheobronchial balloon dilation and stent placement have been well used in the treatment of patients with benign and/or malignant diseases.Balloon dilation is the first option in the treatment of benign airway steno...Tracheobronchial balloon dilation and stent placement have been well used in the treatment of patients with benign and/or malignant diseases.Balloon dilation is the first option in the treatment of benign airway stenosis.Although balloon dilation is simple and fast,recurrence rate is high.Stent placement promptly relieves acute airway distress from malignant extraluminal and intraluminal airway obstruction.Temporary stent placement may be an alternative for benign airway strictures refractory to balloon dilation.This article reviews the indications,pre-procedure evaluation,technique,outcomes and complications of balloon dilation and stent placement with regard to benign and malignant tracheobronchial stenoses.展开更多
Tracheobronchial obstruction in children due to benign stenosis or tracheobronchomalacia still remains a challenging matter of concern.Currently,there is 10%–20%complication rate in clinical treatment.The nonbiodegra...Tracheobronchial obstruction in children due to benign stenosis or tracheobronchomalacia still remains a challenging matter of concern.Currently,there is 10%–20%complication rate in clinical treatment.The nonbiodegradable property of silicone stents and nickel-titanium memory alloy stents take the primary responsibility for drawbacks including stimulating local granulation tissue proliferation,displacement,and stent-related infections.Permanent tracheobronchial stent will be a persistent foreign object for a long time,causing excessive secretion of tracheal mucosa,ulceration and even perforation,which is particularly unsuitable for young children with persistent tracheal growth.In this study,the degradation and biocompatibility performance of three typical biodegradable metals were investigated as potential tracheobronchial stent materials.The results exhibited that these materials showed different degradation behaviors in the simulating respiratory fluid environment compared with SBF.Except for pure iron group,high purity magnesium and zinc showed favorable cell adhesion and proliferation in three culture methodologies(direct culture,indirect culture and extraction culture).The proper corrosion rate and good biocompatibility indicated that high purity magnesium and zinc may be good candidates as tracheobronchial stent materials.展开更多
A representative human upper respiratory tract （URT） with idealized oral region and asymmetric tracheo- bronchial （TB） airway has been modeled, and laminar-to-turbulent airflow for typical inhalation modes as well...A representative human upper respiratory tract （URT） with idealized oral region and asymmetric tracheo- bronchial （TB） airway has been modeled, and laminar-to-turbulent airflow for typical inhalation modes as well as micro-particle transport and deposition has been simulated using CFX10.0 software from Ansys Inc. on a personal computer. The asymmetric TB airway could not be replaced by an extended straight tube as outlet of the oral region while investigating the tracheal airflow field and particle deposition. Compared to an idealized oral airway with an extended straight tube, several differences could be noted： （i） The laryngeal jet extends further down the trachea and inclines towards the anterior wall; （ii） the turbulence level in trachea is less and decays more quickly; （iii） three recirculation zones are visible with intense adverse current after the glottis; （iv） deposition of small particles in trachea is reduced due to lower turbulence. Refined unstructured mesh with densified boundary layer mesh could be a proper substitute for the structured mesh in the human URT model with asymmetric TB airway. Based on the refined unstructured mesh, the physiological structure of uvula in the soft palate is properly simulated in the present human URT model.展开更多
Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergi...Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis （PNTA）. In this study we analyzed the clinical data from patients with PNTA, so as to guide the diagnosis and treatment of the disease. Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 clinical data, including the demographic information, clinical symptoms, imaging findings treatment strategies and efficacy, and prognosis, were retrospectively analyzed. to January 2009. Their bronchoscopy findings, Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways. Nine patients （9/16, 56.3%） had pulmonary and tracheobronchial tumors, 5/16 （31.3%） had tracheobronchial involvement secondary to non-pulmonary tumors, and 2/16 （12.5%） had lung transplantation. The most common causes of PNTA included local radiotherapy （10/16, 62.5%）, repeated chemotherapy （7/16, 43.8%） and recurrent intervention therapy by bronchoscope （4/16, 25.0%）. Aspergillus fumigatus was the most frequent pathogen （62.5%, 10/16）. The main clinical manifestations included progressive dyspnea （14/16, 87.5%） and irritable cough （12/16, 75.0%）. The trachea was involved in 9/16 patients （56.3%）, right main bronchus in 10/16 （62.5%）. All 16 patients were treated with systemic anti-aspergillosis agents, local anti-aspergillosis agents with amphotericin B inhalation and direct perfusion of amphotericin B by bronchoscope, and interventional treatment by bronchoscope to ensure an unobstructed airway. The total efficiency was 31.3%. Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea, primary bronchus and segmental bronchus. A. fumigatus is the most common pathogen. PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency展开更多
Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The...Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.展开更多
The left pulmonary artery sling （LPAS） is a rare vascular anomaly causing respiratory distress in which theleft pulmonary artery arises from the posterior aspect of the right pulmonary artery, courses posteriorly to...The left pulmonary artery sling （LPAS） is a rare vascular anomaly causing respiratory distress in which theleft pulmonary artery arises from the posterior aspect of the right pulmonary artery, courses posteriorly to the right of the bronchus and passes between the trachea and oesophagus to reach the hilum of the left lung. The LPAS is frequently associated with tracheobronchial tree anomalies and congenital cardiac defects. Proper assessment of the tracheobronchial and cardiovascular anomaly is essential in LPAS for planning management of the patient. Currently,展开更多
Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy...Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy, photodynamics treatment, radiofrequency ablation and stenting, etc. The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan. This study used radial probe endobronchial ultrasound （RP-EBUS） scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall, and the influence of RP-EBUS scanning in treatment plan making and guidance. Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy. We performed EBUS scanning after common bronchoscopy under local anesthesia. A radial ultrasonic probe （2.0 mm in diameter with 20-MHz frequency） with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope. The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control. The circular image of EBUS, which revealed the layered structure of the tracheobronchial wall, could be achieved. Results Total of 125 patients were enrolled in the study. Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% （27/30）, sensitivity and specificity were 88.89% （24/27） and 100% （3/3）, respectively. In response to EBUS images, 40 approaches were altered or guided： lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration （TBNA） （n=8）; Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility （n=13）, stents size were changed （n=14）, operation was canceled （n=3） and foreign body was 展开更多
BACKGROUND Tracheobronchial tuberculosis(TBTB)is a common subtype of pulmonary tuberculosis.Concomitant diseases often obscure the diagnosis of senile TBTB.AIM To characterize senile patients with TBTB and to identify...BACKGROUND Tracheobronchial tuberculosis(TBTB)is a common subtype of pulmonary tuberculosis.Concomitant diseases often obscure the diagnosis of senile TBTB.AIM To characterize senile patients with TBTB and to identify the potential causes of misdiagnosis.METHODS One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively analyzed.Patients were classified as diagnosed group(n=58)and misdiagnosed group(n=62).Clinical manifestations,laboratory results,radiographic data,and endoscopic findings were compared between the two groups.RESULTS Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis(non-TBTB,29/62,46.8%),general pneumonia(9/62,14.5%),chronic obstructive pulmonary disease(8/62,12.9%),and tracheobronchial carcinoma(7/62,11.3%).The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group[median(first quartile,third quartile):6.32(4.94,16.02)mo vs 3.73(2.37,8.52)mo].The misdiagnosed group had lower proportion of patients who underwent bronchoscopy[33.87%(21/62)vs 87.93%(51/58)],chest computed tomography(CT)scan[69.35%(43/62)vs 98.28%(57/58)],and those who showed CT signs of tuberculosis[27.91%(12/62)vs 50%(29/58)]as compared to that in the diagnosed group(P<0.05).There were no significant between-group differences with respect to age,gender,occupation,clinical manifestations,or prevalence of comorbid chronic diseases(P>0.05).CONCLUSION Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of TBTB.Increased implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.展开更多
文摘Tracheobronchial balloon dilation and stent placement have been well used in the treatment of patients with benign and/or malignant diseases.Balloon dilation is the first option in the treatment of benign airway stenosis.Although balloon dilation is simple and fast,recurrence rate is high.Stent placement promptly relieves acute airway distress from malignant extraluminal and intraluminal airway obstruction.Temporary stent placement may be an alternative for benign airway strictures refractory to balloon dilation.This article reviews the indications,pre-procedure evaluation,technique,outcomes and complications of balloon dilation and stent placement with regard to benign and malignant tracheobronchial stenoses.
基金supported by National Natural Science Foundation of China(No.31670974,No.31370954).
文摘Tracheobronchial obstruction in children due to benign stenosis or tracheobronchomalacia still remains a challenging matter of concern.Currently,there is 10%–20%complication rate in clinical treatment.The nonbiodegradable property of silicone stents and nickel-titanium memory alloy stents take the primary responsibility for drawbacks including stimulating local granulation tissue proliferation,displacement,and stent-related infections.Permanent tracheobronchial stent will be a persistent foreign object for a long time,causing excessive secretion of tracheal mucosa,ulceration and even perforation,which is particularly unsuitable for young children with persistent tracheal growth.In this study,the degradation and biocompatibility performance of three typical biodegradable metals were investigated as potential tracheobronchial stent materials.The results exhibited that these materials showed different degradation behaviors in the simulating respiratory fluid environment compared with SBF.Except for pure iron group,high purity magnesium and zinc showed favorable cell adhesion and proliferation in three culture methodologies(direct culture,indirect culture and extraction culture).The proper corrosion rate and good biocompatibility indicated that high purity magnesium and zinc may be good candidates as tracheobronchial stent materials.
基金supported by the National Natural Science Foundation of China, Project Number 10672081the Foundation of Chinese State Key Laboratory of Loess and Quaternary Geology
文摘A representative human upper respiratory tract （URT） with idealized oral region and asymmetric tracheo- bronchial （TB） airway has been modeled, and laminar-to-turbulent airflow for typical inhalation modes as well as micro-particle transport and deposition has been simulated using CFX10.0 software from Ansys Inc. on a personal computer. The asymmetric TB airway could not be replaced by an extended straight tube as outlet of the oral region while investigating the tracheal airflow field and particle deposition. Compared to an idealized oral airway with an extended straight tube, several differences could be noted： （i） The laryngeal jet extends further down the trachea and inclines towards the anterior wall; （ii） the turbulence level in trachea is less and decays more quickly; （iii） three recirculation zones are visible with intense adverse current after the glottis; （iv） deposition of small particles in trachea is reduced due to lower turbulence. Refined unstructured mesh with densified boundary layer mesh could be a proper substitute for the structured mesh in the human URT model with asymmetric TB airway. Based on the refined unstructured mesh, the physiological structure of uvula in the soft palate is properly simulated in the present human URT model.
文摘Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis （PNTA）. In this study we analyzed the clinical data from patients with PNTA, so as to guide the diagnosis and treatment of the disease. Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 clinical data, including the demographic information, clinical symptoms, imaging findings treatment strategies and efficacy, and prognosis, were retrospectively analyzed. to January 2009. Their bronchoscopy findings, Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways. Nine patients （9/16, 56.3%） had pulmonary and tracheobronchial tumors, 5/16 （31.3%） had tracheobronchial involvement secondary to non-pulmonary tumors, and 2/16 （12.5%） had lung transplantation. The most common causes of PNTA included local radiotherapy （10/16, 62.5%）, repeated chemotherapy （7/16, 43.8%） and recurrent intervention therapy by bronchoscope （4/16, 25.0%）. Aspergillus fumigatus was the most frequent pathogen （62.5%, 10/16）. The main clinical manifestations included progressive dyspnea （14/16, 87.5%） and irritable cough （12/16, 75.0%）. The trachea was involved in 9/16 patients （56.3%）, right main bronchus in 10/16 （62.5%）. All 16 patients were treated with systemic anti-aspergillosis agents, local anti-aspergillosis agents with amphotericin B inhalation and direct perfusion of amphotericin B by bronchoscope, and interventional treatment by bronchoscope to ensure an unobstructed airway. The total efficiency was 31.3%. Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea, primary bronchus and segmental bronchus. A. fumigatus is the most common pathogen. PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency
基金supported by the grants from Natural Science Foundation of Zhejiang Province (No.Y2080323)Zhejiang Provincial Science and Technology Administration (No.2009R100310 and No.2008C03002-2)Health Department of Zhejiang Province (No.2009QN010)
文摘Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.
文摘The left pulmonary artery sling （LPAS） is a rare vascular anomaly causing respiratory distress in which theleft pulmonary artery arises from the posterior aspect of the right pulmonary artery, courses posteriorly to the right of the bronchus and passes between the trachea and oesophagus to reach the hilum of the left lung. The LPAS is frequently associated with tracheobronchial tree anomalies and congenital cardiac defects. Proper assessment of the tracheobronchial and cardiovascular anomaly is essential in LPAS for planning management of the patient. Currently,
文摘Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy, photodynamics treatment, radiofrequency ablation and stenting, etc. The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan. This study used radial probe endobronchial ultrasound （RP-EBUS） scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall, and the influence of RP-EBUS scanning in treatment plan making and guidance. Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy. We performed EBUS scanning after common bronchoscopy under local anesthesia. A radial ultrasonic probe （2.0 mm in diameter with 20-MHz frequency） with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope. The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control. The circular image of EBUS, which revealed the layered structure of the tracheobronchial wall, could be achieved. Results Total of 125 patients were enrolled in the study. Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% （27/30）, sensitivity and specificity were 88.89% （24/27） and 100% （3/3）, respectively. In response to EBUS images, 40 approaches were altered or guided： lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration （TBNA） （n=8）; Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility （n=13）, stents size were changed （n=14）, operation was canceled （n=3） and foreign body was
基金China's 13th Five-Year Major Science and Technology Project,No.2018ZX10302-302.
文摘BACKGROUND Tracheobronchial tuberculosis(TBTB)is a common subtype of pulmonary tuberculosis.Concomitant diseases often obscure the diagnosis of senile TBTB.AIM To characterize senile patients with TBTB and to identify the potential causes of misdiagnosis.METHODS One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively analyzed.Patients were classified as diagnosed group(n=58)and misdiagnosed group(n=62).Clinical manifestations,laboratory results,radiographic data,and endoscopic findings were compared between the two groups.RESULTS Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis(non-TBTB,29/62,46.8%),general pneumonia(9/62,14.5%),chronic obstructive pulmonary disease(8/62,12.9%),and tracheobronchial carcinoma(7/62,11.3%).The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group[median(first quartile,third quartile):6.32(4.94,16.02)mo vs 3.73(2.37,8.52)mo].The misdiagnosed group had lower proportion of patients who underwent bronchoscopy[33.87%(21/62)vs 87.93%(51/58)],chest computed tomography(CT)scan[69.35%(43/62)vs 98.28%(57/58)],and those who showed CT signs of tuberculosis[27.91%(12/62)vs 50%(29/58)]as compared to that in the diagnosed group(P<0.05).There were no significant between-group differences with respect to age,gender,occupation,clinical manifestations,or prevalence of comorbid chronic diseases(P>0.05).CONCLUSION Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of TBTB.Increased implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.
