Chartis系统联合经支气管镜呼气末CO_2监测定位难治性气胸漏气支气管3例及文献复习
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摘要
目的探讨Chartis系统联合经支气管镜呼末气CO_2监测定位难治性气胸漏气支气管的价值。方法筛选2015年1月-2016年4月期间我院就诊的难治性气胸患者,且经Chartis系统检测考虑存在可疑漏气支气管3例,联合经支气管镜呼出气CO_2监测定位漏气支气管,然后进行选择性支气管封堵。结果 Chartis系统和呼气末CO_2监测的漏气支气管结果一致;对两例患者采取自体血加凝血酶封堵,1例置入EBV封堵。两例采用自体血封堵者分别于术后第6天及第4天停止漏气,EBV置入1例术后第3天停止漏气。3例患者术后随访6个月,未见气胸复发及其他不良反应。结论 Chartis系统联合Et CO_2监测定位难治性气胸漏气支气管,能提高定位成功率和准确性,特别是对于存在侧支旁路或多瘘口的病例有很高的临床应用价值。
Objective To evaluate the effect of Chartis system combined with transbronchoscopic end-tidal carbon dioxide detection for the location of leaking bronchus of refractory pneumothorax. Methods 3 cases of refractory pneumothorax in our hospital from January 2015 to April 2016 were suspected of having leakage bronchus detected by Chartis system,and they were detected by transbronchoscopic end-tidal carbon dioxide. 3 patients were treated with select bronchial occlusion. Results Chartis system and transbronchoscopic end-tidal carbon dioxide detection obtained the same results. Two cases treated with autologous blood stop leaking 6 days and 4 days later after operation respectively,the other one treated with EBV stop leaking 3 days later after operation. 3 cases were followed up for 6 months,and no recurrence of pneumothorax or other adverse reactions were found. Conclusion Chartis system combined with EtCO_2 detection can improve the success and accuracy of localization of leaking bronchus of refractory pneumothorax. In particular,there is a high clinical value in the case of the presence of collateral bypass or multiple fistula.
Objective To evaluate the effect of Chartis system combined with transbronchoscopic end-tidal carbon dioxide detection for the location of leaking bronchus of refractory pneumothorax. Methods 3 cases of refractory pneumothorax in our hospital from January 2015 to April 2016 were suspected of having leakage bronchus detected by Chartis system,and they were detected by transbronchoscopic end-tidal carbon dioxide. 3 patients were treated with select bronchial occlusion. Results Chartis system and transbronchoscopic end-tidal carbon dioxide detection obtained the same results. Two cases treated with autologous blood stop leaking 6 days and 4 days later after operation respectively,the other one treated with EBV stop leaking 3 days later after operation. 3 cases were followed up for 6 months,and no recurrence of pneumothorax or other adverse reactions were found. Conclusion Chartis system combined with EtCO_2 detection can improve the success and accuracy of localization of leaking bronchus of refractory pneumothorax. In particular,there is a high clinical value in the case of the presence of collateral bypass or multiple fistula.
引文
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[12]Tian Q,Qi F,An Y,et al.Using the Chartis system to selectively target a lung segment with a persistent air leak[J].Eur Respir J,2013,41(6):1461-1463.
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[14]Dooms CA,De Leyn PR,Yserbyt J,et al.Endobronchial Valves for Persistent Postoperative Pulmonary Air Leak:Accurate Monitoring and Functional Implications[J].Respiration,2012,84(4):329-333.
[15]Cerfolio RJ,Bryant AS.The benefits of continuous and digital air leak assessment after elective pulmonary resection:a prospective study[J].Ann Thorac Surg,2008,86(2):396-401.
[16]Pompili C,Detterbeck F,Papagiannopoulos K,et al.Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems[J].Ann Thorac Surg,2014,98(2):490-497.
[17]Bhattacharyya P,Dutta A,Sarkar D,et al.Endobronchial Sealing of Bronchopleural Fistula following Capnographic Detection:A New Mode of Therapy[J].Indian J Chest Dis Allied Sci,2008,50(2):203-208.
[18]Moody GN,Zeno BR.Localization and Treatment of Bronchopleural Fistula Through Capnography[J].J Bronchology Interv Pulmonol,2010,17(3):261-263.
[19]曾奕明,林辉煌.经支气管镜呼气末二氧化碳探查对难治性气胸胸膜瘘口引流支气管的定位价值[J].中华结核和呼吸杂志,2015,38(4):286-289.
[20]杨震,姜丹丹,田庆,等.支气管镜介入治疗顽固性气胸的进展[J/CD].中华腔镜外科杂志(电子版),2014,7(4):321-325.
[2]Stolz AJ,Schützner J,Lischke R,et al.Predictors of prolonged air leak following pulmonary lobectomy[J].Eur J Cardiothorac Surg,2005,27(2):334-336.
[3]Videm V,Pillgram-Larsen J,Ellingsen O,et al.Spontaneous pneumothorax in chronic obstructive pulmonary disease:complications,treatment and recurrences[J].Eur J Respir Dis,1987,71(5):365-371.
[4]Macduff A,Arnold A,Harvey J.Management of spontaneous pneumothorax:British Thoracic Society Pleural Disease Guideline 2010[J].Thorax,2010,65 Suppl 2:ii18-31.
[5]Baumann MH,Strange C,Heffner JE,et al.Management of spontaneous pneumothorax:an American College of Chest Physicians Delphi consensus statement[J].Chest,2001,119(2):590-602.
[6]Rivas de Andrés JJ,Jiménez López MF,Molins López-RodóL,et al.Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax[J].Arch Bronconeumol,2008,44(8):437-448.
[7]Travaline JM,Mc Kenna RJ Jr,De Giacomo T,et al.Treatment of persistent pulmonary air leaks using endobronchial valves[J].Chest,2009,136(2):355-360.
[8]Cetinkaya E,Ozgül MA,Gül S,et al.Treatment of a prolonged air leak with radiotherapy:a case report[J].Case Rep Pulmonol,2012,2012:158371.
[9]Venuta F,Rendina EA,De Giacomo T,et al.Postoperative strategies to treat permanent air leaks[J].Thorac Surg Clin,2010,20(3):391-397.
[10]曾奕明.选择性支气管封堵术治疗难治性气胸[J].中华结核和呼吸杂志,2010,33(8):570-571.
[11]贺欣,高杨,宋珊,等.有色盐水定位气胸肺破裂口靶支气管(附23例临床分析)[J].中国内镜杂志,2015,21(3):287-290.
[12]Tian Q,Qi F,An Y,et al.Using the Chartis system to selectively target a lung segment with a persistent air leak[J].Eur Respir J,2013,41(6):1461-1463.
[13]Firlinger I,Stubenberger E,Müller MR,et al.Endoscopic one-way valve implantation in patients with prolonged air leak and the use of digital air leak monitoring[J].Ann Thorac Surg,2013,95(4):1243-1249.
[14]Dooms CA,De Leyn PR,Yserbyt J,et al.Endobronchial Valves for Persistent Postoperative Pulmonary Air Leak:Accurate Monitoring and Functional Implications[J].Respiration,2012,84(4):329-333.
[15]Cerfolio RJ,Bryant AS.The benefits of continuous and digital air leak assessment after elective pulmonary resection:a prospective study[J].Ann Thorac Surg,2008,86(2):396-401.
[16]Pompili C,Detterbeck F,Papagiannopoulos K,et al.Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems[J].Ann Thorac Surg,2014,98(2):490-497.
[17]Bhattacharyya P,Dutta A,Sarkar D,et al.Endobronchial Sealing of Bronchopleural Fistula following Capnographic Detection:A New Mode of Therapy[J].Indian J Chest Dis Allied Sci,2008,50(2):203-208.
[18]Moody GN,Zeno BR.Localization and Treatment of Bronchopleural Fistula Through Capnography[J].J Bronchology Interv Pulmonol,2010,17(3):261-263.
[19]曾奕明,林辉煌.经支气管镜呼气末二氧化碳探查对难治性气胸胸膜瘘口引流支气管的定位价值[J].中华结核和呼吸杂志,2015,38(4):286-289.
[20]杨震,姜丹丹,田庆,等.支气管镜介入治疗顽固性气胸的进展[J/CD].中华腔镜外科杂志(电子版),2014,7(4):321-325.