纤维支气管镜引导下气道内置入双腔球囊漂浮导管治疗气胸的临床研究
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摘要
目的:探讨经纤维支气管镜引导下双腔球囊漂浮导管气道内介入、定位和粘堵气胸肺破裂口所属支气管的方法,并以纤维支气管镜专用球囊导管方法为对照,评价其疗效及安全性。
方法:2001年11月至2006年11月河北医科大学附属第四医院呼吸内科收治的气胸患者60例。男性53例,女性7例,年龄范围19～70岁,平均年龄40±14岁。入选条件:(1)符合自发性气胸诊断标准;(2)经胸腔闭式引流术治疗1 w后无效,患者同意进入本研究;(3)无严重心、肺功能障碍;(4)无纤维支气管镜检查的禁忌症。60例自发性气胸患者中,原发性气胸33例,继发性气胸27例;继发性气胸中慢性阻塞性肺病(COPD)14例、支气管扩张3例、肺癌5例、陈旧性肺结核4例、其他1例。根据气胸类型分类:闭合性气胸41例,开放性气胸14例和张力性气胸5例。
实验器材:(1)双腔球囊漂浮导管(Swan-Ganz catheter)外径5～9 F,长60～110 cm,其远端包绕乳胶球囊,充气后直径0.6～2.2cm。近端有两个开口,一是带阀门并通向球囊;一是不带阀门通向球囊前端的管道,用于气道内注气、测压和注药。(2)纤维支气管镜专用球囊导管(型号:Bronchus blocker 170,德国Ruesch公司),导管长170 cm,外径2 mm;其远端包绕乳胶球囊(最大直径可膨胀2.0 cm)。近端阀门系统可与导管分离,阀门系统有两个开口,一个通向导管远端,用于注药和注入气体定位,另一个带阀门通向远端球囊。(3) Olympus BF-1T60型纤维支气管镜,其工作通道2.8 mm。(4)供纤维支气管镜应用的生物蛋白胶注射专用导管,医用生物蛋白胶。(5)心电监护仪、引导钢丝、压力表(脑脊液压力表)和手术丝线。
60例患者随机分为A组对照组(应用纤维支气管镜专用球囊导管):30例,沿纤维支气管镜工作道插入纤维支气管镜专用球囊导管,将球囊置于可疑气胸肺破裂所属叶、段或亚段支气管,球囊充气、阻断气道气流,然后胸腔持续负压吸引,观察胸腔闭式引流瓶内气体引流情况,定位气胸肺破裂所属支气管;B组(应用双腔球囊漂浮导管):30例,采用丝线将双腔球囊漂浮导管固定于纤维支气管镜,并行气道内插入,将球囊置于可疑气胸肺破裂所属叶、段或亚段支气管,球囊充气,封堵支气管管腔,向充气球囊远端气道注气、测压,定位气胸肺破裂所属支气管。两组患者确定气胸肺破裂所属支气管后,均采用经纤维支气管镜活检孔插入专用的双腔医用生物蛋白胶注射导管,由支气管远端缓慢注入液态生物蛋白胶A胶和B胶,蛋白胶用量以完全封堵段或亚段支气管为宜,一般1～3支之间,观察引流管气体排出情况和评价两组疗效。
两组患者于治疗前和治疗后(术后2小时)监测并记录静息状态下的生命体征和血氧饱和度(T、P、R、BP和SaO2)。记录两组定位及粘堵结果、操作时间、住院时间和不良反应。
结果
1两组间患者年龄、性别和气胸类型比较差异无统计学意义。
2两组球囊导管定位结果
2.1所有气胸患者定位结果
A组:30例应用纤维支气管镜专用球囊导管患者中成功定位20例,成功率为66.7%;B组:30例应用双腔球囊漂浮导管患者中成功定位26例,成功率为86.7%,两组定位成功率之间差异无统计学意义(P >0.05)。
2.2不同类型气胸的定位结果
两组闭合性气胸患者中,A组:20例患者成功定位10例,成功率为50%;B组:21例患者成功定位17例,成功率为81%,两者之间差异有统计学意义(P< 0.05)。
3对成功定位患者粘堵的结果
A组:20例成功定位患者中,16例1次粘堵成功,2例2次粘堵成功;成功率为90%;B组:26例成功定位患者中,21例1次粘堵成功,3例2次粘堵成功,成功率为92.3%。两组粘堵成功率比较差异无统计学意义(P > 0.05)。
4两组安全性比较结果
4.1生命体征变化
治疗前,A组与B组T、P、R、BP和SaO2比较,差异无统计学意义(P>0.05);治疗后,A组与B组T、P、R、BP和SaO_2比较,差异亦无统计学意义(P>0.05);A组,治疗前与治疗后P、R和BP比较,差异有统计学意义(P<0.05);B组,治疗前与治疗后P、R和BP比较,差异有统计学意义(P<0.05)。
4.2不良反应
A组30例患者中,出现胸痛1例、肺炎1例及肺不张1例、发热2例。B组30例患者中,出现肺不张1例、发热1例。
5两组患者的操作时间及平均住院时间
5.1操作时间A组:14.3±1.2 min;B组:14.8±1.3 min,两组间球囊导管操作时间比较差异无统计学意义(P>0.05)。
5.2平均住院时间A组:14.3±2.4 d;B组:13.8±2.1 d,两者比较差异无统计学意义(P>0.05)。
6医疗费用比较
双腔球囊漂浮导管(Swan-Ganz catheter)每支价格800元,而纤维支气管镜专用球囊导管(德国Ruesch公司,型号Bronchus blocker 170)每支价格2400元,双腔球囊漂浮导管价格明显低于纤维支气管镜专用球囊导管价格。
结论
1采用丝线固定双腔球囊漂浮导管和纤维支气管镜并行气道内介入,气道内充气、测压、定位肺破裂所属支气管的方法与应用纤维支气管镜专用球囊导管的方法相比是一种操作简单、安全、价格低廉并具有确切疗效的新方法。
2对于闭合性气胸来说,采用双腔球囊漂浮导管充气测压定位的方法较纤维支气管镜专用球囊导管充气单纯胸腔负压吸引定位的方法具有更高的敏感性。
Objective: To evaluate the efficacy and safety of localization technique with double-lumen balloon floating catheter (Swan-Ganz catheter) under the lead of bronchofibroscope in the treatment of pneumothorax, comparing with the catheter special for bronchofibroscope (Fogarty catheter).
Methods: 60 patients with pneumatothorax were studied from November 2001 to November 2006. male 53 and female 7, ages ranging from 19 to 70 years old and the average age was 40±14. The selecting standards: (1) all the patients were suffered with spontaneous pneumothorax; (2) after the treatment of closed drainage of thoracic cavity for 1 week but had no effect, and willingly accepted the treatment of Swan-Ganz catheter;(3) without serious functional disorder of heart and lung system; (4) without the contraindications of bronchofiberscopy. These 60 patients include 33 idiopathic pneumothorax, 27 secondary pneumothorax. Among the patients with secondary pneumothorax, chronic obstructive pulmonary disease was 14, bronchiectasia was 3, lung cancer was 5, obsolete pneumonophthisis was 4 and others was 1. Pneumatothorax type: closed pneumothorax 41, open pneumothorax 14 and tension pneumothorax 5.
Experiment equipment: (1)Swan-Ganz catheter, outer diameter is 5～9F, length is 60～110cm and it's anterior extremity was encasemented with a balloon. The diameter after aerating is 0.6～2.2cm. There were two gabs in the proximal end, the one lead to the balloon with spigot; the other one lead to the conduit without spigot in front of the balloon which was used to pour gas, measure pressure and inject drug. (2) Catheter special for bronchofibroscope (pattern number: Bronch blocker 170, German Ruesch company), tube length 170cm, external diameter 2 mm; anterior extremity was encasemented with a balloon (maximum diameter 2.0 cm). The spigot system could be separated from conduit and had two debouches, the one lead to the anterior extremity of conduit in order to pour drug and localization, the other one with spigot lead to the balloon. (3) Olympus BF-1T60 bronchofibroscope, the working passageway was 2.8 mm. (4) The special conduit for injecting fibrin glue, medical fibrin glue. (5) Electrocardiogram monitor, aiming steel-wire, pressure gage (spinal fluid pressure gauge) and surgical thread .
All the patients were divided into two groups randomly: control group (group A) and the study group (group B). Group A (fogarty catheter): 30 patients, fogarty catheter were inserted into the lung along the bronchofibroscope working way and placed the balloon on lobes of lung, segment or deutosegmental bronchus in that rupture exist, filling gas, blocked air current and made the cavitas thoracis negative pressure aspiration continuously. At last, the ruptured bronchus was aligned by observing the gas draining in drainage bottle. Group B (Swan-Ganz catheter): 30 patients, using the surgical thread to fix Swan-Ganz catheter and bronchofibroscope, then inserted into the airway together, placed the balloon on lobes of lung and segmental bronchus that rupture exist. At last, filling gas, blocking airway, pouring gas to the distal end, measuring pressure and align the ruptured bronchus. After ascertaining the ruptured bronchus, the special double-lumen injection catheter for fibrin glue was inserted into the working channel of bronchofibroscope. Fibrin glue A and B were infused into the bronchus distal end slowly. The dosage was proper to block the segmental bronchus completely.
Then compare the result of localization, running time, adverse reactions between the two groups, and evaluate the effectiveness of the two methods in blocking the bronchus Results
1 There was no statistically significance between the two groups in age, sex and type of the pneumothorax.
2 The achievement ratio of localization and sealing Group A: 20 of 30 patients were succeeded in localization. 16 of 20 patients were succeeded in sealing at the first time and 2 were succeeded in sealing at the second time. Group B: 26 of 30 patients were succeeded in localization. 21 of 26 patients were succeeded in sealing at the first time and 3 were succeeded in sealing at the second time. No statistically significance between the two groups (P>0.05).
3 The localization result of closed pneumothorax patients, group A: 10 of 20 patients were succeed in localization. Group B: 17 of 21 patients were succeed in localization, the difference of localizing ruptured bronchus between the two groups was statistically significant (P<0.05).
4 The average running time and average stay of the two groups
4.1The average running time A: 14.3±1.2 min, B: 14.8±1.3 min, and no statistically significance between the two groups (P>0.05).
4.2The average stay A: 14.3±2.4 d, group B: 13.8±2.1 d, there was no statistically significance (P>0.05).
5 Comparison of the security between the two groups
5.1 The variation of vital sign
The vital sign and saturation of blood oxygen were monitored respectively in the pre-treatment and post-treatment (two hours after the operation). There was no statistically significance between the two groups in post-treatment (P>0.05); and there is no statistically significance between the two group in pre-treatment (P>0.05); group A: there was statistically significant between the pre-treatment and post-treatment (P<0.05); group B: there was statistically significant between the pre-treatment and post-treatment (P<0.05).
5.2 The adverse effect
Group A: chest complaint 1, pneumonia 1 and fever 2 and pulmonary atelectasis 1. Group B: fever 1, pulmonary atelectasis 1.
Conclusion
1 Through this research, the method that using surgical thread to fix the double-lumen balloon floating catheter and bronchoscope, and further inserted into the airway together, pouring the gas to the airway and measuring pressure to locate the ruptured bronchus was used. And it comes to a new kind of convenient, safe and inexpensive method.
2 As to the closed pneumothorax, the method which was using the double-lumen balloon floating catheter and bronchoscope inserted into the airway together is sensitive than the usage of the Fogarty catheter.
方法:2001年11月至2006年11月河北医科大学附属第四医院呼吸内科收治的气胸患者60例。男性53例,女性7例,年龄范围19～70岁,平均年龄40±14岁。入选条件:(1)符合自发性气胸诊断标准;(2)经胸腔闭式引流术治疗1 w后无效,患者同意进入本研究;(3)无严重心、肺功能障碍;(4)无纤维支气管镜检查的禁忌症。60例自发性气胸患者中,原发性气胸33例,继发性气胸27例;继发性气胸中慢性阻塞性肺病(COPD)14例、支气管扩张3例、肺癌5例、陈旧性肺结核4例、其他1例。根据气胸类型分类:闭合性气胸41例,开放性气胸14例和张力性气胸5例。
实验器材:(1)双腔球囊漂浮导管(Swan-Ganz catheter)外径5～9 F,长60～110 cm,其远端包绕乳胶球囊,充气后直径0.6～2.2cm。近端有两个开口,一是带阀门并通向球囊;一是不带阀门通向球囊前端的管道,用于气道内注气、测压和注药。(2)纤维支气管镜专用球囊导管(型号:Bronchus blocker 170,德国Ruesch公司),导管长170 cm,外径2 mm;其远端包绕乳胶球囊(最大直径可膨胀2.0 cm)。近端阀门系统可与导管分离,阀门系统有两个开口,一个通向导管远端,用于注药和注入气体定位,另一个带阀门通向远端球囊。(3) Olympus BF-1T60型纤维支气管镜,其工作通道2.8 mm。(4)供纤维支气管镜应用的生物蛋白胶注射专用导管,医用生物蛋白胶。(5)心电监护仪、引导钢丝、压力表(脑脊液压力表)和手术丝线。
60例患者随机分为A组对照组(应用纤维支气管镜专用球囊导管):30例,沿纤维支气管镜工作道插入纤维支气管镜专用球囊导管,将球囊置于可疑气胸肺破裂所属叶、段或亚段支气管,球囊充气、阻断气道气流,然后胸腔持续负压吸引,观察胸腔闭式引流瓶内气体引流情况,定位气胸肺破裂所属支气管;B组(应用双腔球囊漂浮导管):30例,采用丝线将双腔球囊漂浮导管固定于纤维支气管镜,并行气道内插入,将球囊置于可疑气胸肺破裂所属叶、段或亚段支气管,球囊充气,封堵支气管管腔,向充气球囊远端气道注气、测压,定位气胸肺破裂所属支气管。两组患者确定气胸肺破裂所属支气管后,均采用经纤维支气管镜活检孔插入专用的双腔医用生物蛋白胶注射导管,由支气管远端缓慢注入液态生物蛋白胶A胶和B胶,蛋白胶用量以完全封堵段或亚段支气管为宜,一般1～3支之间,观察引流管气体排出情况和评价两组疗效。
两组患者于治疗前和治疗后(术后2小时)监测并记录静息状态下的生命体征和血氧饱和度(T、P、R、BP和SaO2)。记录两组定位及粘堵结果、操作时间、住院时间和不良反应。
结果
1两组间患者年龄、性别和气胸类型比较差异无统计学意义。
2两组球囊导管定位结果
2.1所有气胸患者定位结果
A组:30例应用纤维支气管镜专用球囊导管患者中成功定位20例,成功率为66.7%;B组:30例应用双腔球囊漂浮导管患者中成功定位26例,成功率为86.7%,两组定位成功率之间差异无统计学意义(P >0.05)。
2.2不同类型气胸的定位结果
两组闭合性气胸患者中,A组:20例患者成功定位10例,成功率为50%;B组:21例患者成功定位17例,成功率为81%,两者之间差异有统计学意义(P< 0.05)。
3对成功定位患者粘堵的结果
A组:20例成功定位患者中,16例1次粘堵成功,2例2次粘堵成功;成功率为90%;B组:26例成功定位患者中,21例1次粘堵成功,3例2次粘堵成功,成功率为92.3%。两组粘堵成功率比较差异无统计学意义(P > 0.05)。
4两组安全性比较结果
4.1生命体征变化
治疗前,A组与B组T、P、R、BP和SaO2比较,差异无统计学意义(P>0.05);治疗后,A组与B组T、P、R、BP和SaO_2比较,差异亦无统计学意义(P>0.05);A组,治疗前与治疗后P、R和BP比较,差异有统计学意义(P<0.05);B组,治疗前与治疗后P、R和BP比较,差异有统计学意义(P<0.05)。
4.2不良反应
A组30例患者中,出现胸痛1例、肺炎1例及肺不张1例、发热2例。B组30例患者中,出现肺不张1例、发热1例。
5两组患者的操作时间及平均住院时间
5.1操作时间A组:14.3±1.2 min;B组:14.8±1.3 min,两组间球囊导管操作时间比较差异无统计学意义(P>0.05)。
5.2平均住院时间A组:14.3±2.4 d;B组:13.8±2.1 d,两者比较差异无统计学意义(P>0.05)。
6医疗费用比较
双腔球囊漂浮导管(Swan-Ganz catheter)每支价格800元,而纤维支气管镜专用球囊导管(德国Ruesch公司,型号Bronchus blocker 170)每支价格2400元,双腔球囊漂浮导管价格明显低于纤维支气管镜专用球囊导管价格。
结论
1采用丝线固定双腔球囊漂浮导管和纤维支气管镜并行气道内介入,气道内充气、测压、定位肺破裂所属支气管的方法与应用纤维支气管镜专用球囊导管的方法相比是一种操作简单、安全、价格低廉并具有确切疗效的新方法。
2对于闭合性气胸来说,采用双腔球囊漂浮导管充气测压定位的方法较纤维支气管镜专用球囊导管充气单纯胸腔负压吸引定位的方法具有更高的敏感性。
Objective: To evaluate the efficacy and safety of localization technique with double-lumen balloon floating catheter (Swan-Ganz catheter) under the lead of bronchofibroscope in the treatment of pneumothorax, comparing with the catheter special for bronchofibroscope (Fogarty catheter).
Methods: 60 patients with pneumatothorax were studied from November 2001 to November 2006. male 53 and female 7, ages ranging from 19 to 70 years old and the average age was 40±14. The selecting standards: (1) all the patients were suffered with spontaneous pneumothorax; (2) after the treatment of closed drainage of thoracic cavity for 1 week but had no effect, and willingly accepted the treatment of Swan-Ganz catheter;(3) without serious functional disorder of heart and lung system; (4) without the contraindications of bronchofiberscopy. These 60 patients include 33 idiopathic pneumothorax, 27 secondary pneumothorax. Among the patients with secondary pneumothorax, chronic obstructive pulmonary disease was 14, bronchiectasia was 3, lung cancer was 5, obsolete pneumonophthisis was 4 and others was 1. Pneumatothorax type: closed pneumothorax 41, open pneumothorax 14 and tension pneumothorax 5.
Experiment equipment: (1)Swan-Ganz catheter, outer diameter is 5～9F, length is 60～110cm and it's anterior extremity was encasemented with a balloon. The diameter after aerating is 0.6～2.2cm. There were two gabs in the proximal end, the one lead to the balloon with spigot; the other one lead to the conduit without spigot in front of the balloon which was used to pour gas, measure pressure and inject drug. (2) Catheter special for bronchofibroscope (pattern number: Bronch blocker 170, German Ruesch company), tube length 170cm, external diameter 2 mm; anterior extremity was encasemented with a balloon (maximum diameter 2.0 cm). The spigot system could be separated from conduit and had two debouches, the one lead to the anterior extremity of conduit in order to pour drug and localization, the other one with spigot lead to the balloon. (3) Olympus BF-1T60 bronchofibroscope, the working passageway was 2.8 mm. (4) The special conduit for injecting fibrin glue, medical fibrin glue. (5) Electrocardiogram monitor, aiming steel-wire, pressure gage (spinal fluid pressure gauge) and surgical thread .
All the patients were divided into two groups randomly: control group (group A) and the study group (group B). Group A (fogarty catheter): 30 patients, fogarty catheter were inserted into the lung along the bronchofibroscope working way and placed the balloon on lobes of lung, segment or deutosegmental bronchus in that rupture exist, filling gas, blocked air current and made the cavitas thoracis negative pressure aspiration continuously. At last, the ruptured bronchus was aligned by observing the gas draining in drainage bottle. Group B (Swan-Ganz catheter): 30 patients, using the surgical thread to fix Swan-Ganz catheter and bronchofibroscope, then inserted into the airway together, placed the balloon on lobes of lung and segmental bronchus that rupture exist. At last, filling gas, blocking airway, pouring gas to the distal end, measuring pressure and align the ruptured bronchus. After ascertaining the ruptured bronchus, the special double-lumen injection catheter for fibrin glue was inserted into the working channel of bronchofibroscope. Fibrin glue A and B were infused into the bronchus distal end slowly. The dosage was proper to block the segmental bronchus completely.
Then compare the result of localization, running time, adverse reactions between the two groups, and evaluate the effectiveness of the two methods in blocking the bronchus Results
1 There was no statistically significance between the two groups in age, sex and type of the pneumothorax.
2 The achievement ratio of localization and sealing Group A: 20 of 30 patients were succeeded in localization. 16 of 20 patients were succeeded in sealing at the first time and 2 were succeeded in sealing at the second time. Group B: 26 of 30 patients were succeeded in localization. 21 of 26 patients were succeeded in sealing at the first time and 3 were succeeded in sealing at the second time. No statistically significance between the two groups (P>0.05).
3 The localization result of closed pneumothorax patients, group A: 10 of 20 patients were succeed in localization. Group B: 17 of 21 patients were succeed in localization, the difference of localizing ruptured bronchus between the two groups was statistically significant (P<0.05).
4 The average running time and average stay of the two groups
4.1The average running time A: 14.3±1.2 min, B: 14.8±1.3 min, and no statistically significance between the two groups (P>0.05).
4.2The average stay A: 14.3±2.4 d, group B: 13.8±2.1 d, there was no statistically significance (P>0.05).
5 Comparison of the security between the two groups
5.1 The variation of vital sign
The vital sign and saturation of blood oxygen were monitored respectively in the pre-treatment and post-treatment (two hours after the operation). There was no statistically significance between the two groups in post-treatment (P>0.05); and there is no statistically significance between the two group in pre-treatment (P>0.05); group A: there was statistically significant between the pre-treatment and post-treatment (P<0.05); group B: there was statistically significant between the pre-treatment and post-treatment (P<0.05).
5.2 The adverse effect
Group A: chest complaint 1, pneumonia 1 and fever 2 and pulmonary atelectasis 1. Group B: fever 1, pulmonary atelectasis 1.
Conclusion
1 Through this research, the method that using surgical thread to fix the double-lumen balloon floating catheter and bronchoscope, and further inserted into the airway together, pouring the gas to the airway and measuring pressure to locate the ruptured bronchus was used. And it comes to a new kind of convenient, safe and inexpensive method.
2 As to the closed pneumothorax, the method which was using the double-lumen balloon floating catheter and bronchoscope inserted into the airway together is sensitive than the usage of the Fogarty catheter.
引文
1 任少华 . 自发性气胸诊断治疗的研究进展 . 新医学1999,30(4):214~215
2 Vricella LA,Gregory D.Trachiotis Heimlich Valve in the Management of Pneumothorax in Patients With Advanced AIDS.Chest,2001,120(1):15~18
3 Milanez JR,Vargas FS.Thoracoscopy Talc Poundage:A15-Year experience. Chest,2001,119 (3):801~806
4 邓在春,张敦华等.自发性气胸的治疗.新医学,2006, 37(5):27~29
5 Henry M, Arnold T, Harvey J. et al BTS guidelines for the management of spontaneous pneumothorax.Thorax, 2003, 58(Suppl):39~52
6 Baumann MH, Strange C, Heffner JE. Management of Spontaneous Pneumothorax :An American College of Chest Physicians Delphi Consensus Statement.Chest,2001, 119(2):590~602
7 Sahn SA , Heffner JE .Primary Care :Spontaneous Pneumothorax .N Eng l J Med,2000,342(12):868~874
8 Wallach SL, Taylor G, Sahn SA, et al. Spontaneous Pneumothorax .N Engl J Med, 2000, 343 (4):300~301
9 孔晖,赵珊,扬瑞安. 滑石粉胸膜固定术治疗复法性顽固性气胸的临床应用.中国医师杂志,2003,5(2): 213
10 Yi-Cheng Wu, Ming-Shian Lu, Chi-Hsiao Yeh, et al. Justifying Video-Assisted Thoracic Surgery for Spontaneous Hemopneumothorax. Chest, 2002, 122(5): 1844~1847
11 Loubani M, Lynch V. Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous Pneumothorax. Respir Med, 2000, 94(9):888~890
12 纪树国,李燕玉,何云京等.自发性气胸的胸膜腔造影及“点焊”治疗.心肺血管病杂志,2002,21(1):32~33
13 Lillington GA, Stevens RP, DeNardo GL. Bronchoscopic location of bronchopleural fistula with xenon-133. Nucl Med,1982,23(4):322~323
14 Kabanov AN, Astafurov VN .Temporary occlusion of the bronchi in the treatment of nonspecific spontaneous pneumothorax. SovMed,1979(10):60~62
15 曾奕明,张华平,吕良超等.球囊探查加选择性支气管封堵术 治 疗 难 治 性 气 胸 10 例 . 中 华 内 科 杂 志 ,2003, 42(3):193~195
16 Leo F, Della Monica J, Venissac N, et al. Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax. Eur J Cardiaothorac Surg, 2005, 28(1):47~49
17 贾育红,袁大柱,刘新等.内镜下应用 OB 胶治疗顽固性自发性气胸.中国实用内科杂志,2001,21 (11):665
18 陶 仲 为 . 自 发 性 气 胸 . 中 国 实 用 内 科 杂 志 , 2005, 25(8):74-751
19 张耀亭,吴妙芬.纤维支气管镜介入对自发性气胸的疗效评价,江西医学院学报.2006,46(3): 142~143
20 林大欢,许潮,黄仁丽.经胸腔闭式引流管纤维支气管镜注入凝血酶及纤维蛋白酶原治疗难治性气胸.广东医学院学报,2003, 21(5):466~470
21 高兴林,张伟,陈正贤等.经纤维支气镜球囊定位及生物材料 填 塞 治 疗 顽 固 性 气 胸 . 中 华 结 核 和 呼 吸 杂 志 , 2003,26(7):402
22 程宏宁,陈永悻,罗美娟等.经纤维支气管镜局部注入医用生物蛋白胶治疗支气管残端瘘 4 例分析.海南医学, 2003,14(6):7~8
23 刘又宁 . 呼吸系统疾病治疗学 . 北京:科学出版社, 2005:723
24 张敦熔.结核病新概念.北京:中国农业科技出版社, 2003:859
25 朱元钰,陈文彬主编.呼吸病学.人民卫生出版社,2004,1294~1295
26 卢晔.胸腔内注入凝血酶治疗自发性气胸 65 例.右江医学,2003, 31(2):116
27 殷香保.纤维蛋白胶的临床应用进展.岭南现代临床外科,2003,3(1):67~69.
28 Davidson B R.Bumett S, Javed MS,etal.Study of anovel fibrin sealant for achieving haemostasis following partical hepatectomy.Br J Surg,2000,87(6):790.
29 苏怡,侯延文,高珉之.医用生物蛋白胶生物性能的研究.预防医学情报杂志,2001,17(6):433~435.
30 Duichavsky SA,Geller RE,Maurer J, et al.Autologous fibringel bactericidal roperites in contammated hepatic injury[J].Jtrauma,1991,31:991~992.
31 Walshe P,Harkin C,Murphy S, et al.The use of fibrin glue in refractory coagulopathic epistaxis.Clin Otolaryngol,2001,26:284~285
32 Kubo T, Hosokawa K,Haramoto U, et al.A simple technique for fibrin glue application in skin grafting.Plast Reconstr Surg,2000,105:1906~1907
33 Kanaoka Y,Hirai K,Ishiko O, et al. Vesicovaginal fistula treated with fibrin glue. Int J Gynaecol Obstet,2001,73:147~149
34 Siedler S,Schuller=Petrovic S.Allogenic keratinocytes suspended healing support in chronic leg ulcers.Arch Dermatol,2000,136:676~678
35 Kitajiri S, Tabuchi K, Hiraumi H, et al. Relief of post-tonsillectomy pain by release of lidocaine from fibrin glue.Laryngoscope,2001,111:642~644
36 Takagi T,Ito T,Shimomura K, et al.Intraoperative coating of tumor surface using fibrin glueas a prophylaxis for cancer cell detachment.Gan To Kagaku Ryoho,2001,28:1674~1676
37 Rocco G, Allen M Bronchial repair with pulmonary preservation for severe blunt traumal[J].Thorac Cardiovasc Surg,2001,49(4):231~233.
38 Topcuoglu M S, Kayhan C,Ulus T.Transsternal transpericardial approach for the repair of bronchopleural fistula[J].Ann Thorac Surg,2000,69(2):394~397.
39 宗建平,季蕴辛,史建国,赵敏.生物胶对动物支气管的粘合作用.宁波大学学报(理工版),2002,3:95~96.
1 Henry M,Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax.Thorax,2003, 58(Suppl Ⅱ ):39
2 Baumann MH,Strange C, Heffner JE. Management of Spontaneous Pneumothorax: An American College of Chest Physicians Delphi Consensus Statement.Chest,2001, 119(2):590~602
3 滕维亚,毛宝龄.自发性气胸的发病机理和诊治.中华结核和呼吸杂志,1995,18(6):330
4 张晓膺,范晋明,高克柔等.肺大疱致自发性气胸的外科治疗及分型探讨.中华结核和呼吸杂志,1996,19(5):47
5 朱元钰,陈文彬主编.呼吸病学.人民卫生出版社,2004,1294~1295
6 任 少 华 . 自 发 性 气 胸 的 诊 治 进 展 . 新 医 学 ,1999 ,30(4):241~243
7 Baumann MN, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach. Chest, 1997, 102(3);789~804
8 Engdahl O, Toft T, Boe J. Chest radiograph a poor method of determing size of a pneumothorax. Chest, 1993, 103(1); 26~29
9 张阳德.内镜学.北京:人民卫生出版社,2001:1482
10 Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest, 1997, 102(3): 822~ 828
11 李万平,续春艳等.自发性气胸 40 例临床分析,中国社区医师,2005,13(7):20~21
12 Fishman RM, Elias JA, Fishman JA, et al. Fishman’s Pulmonary Diseases and Disorder, 3rd ed. New tak Mc Graw-Hill, 1999, 2627~2641
13 Vricella LA, Gregory D. Heimlich Valve in the Management of Pneumothorax in Patients with Advanced AIDS. Chest, 2001, 120(1):15~18
14 Milanez JR, Vargas FS. Thoracoscopy Talc Poudrage: A
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15 Sahn SA, Heffner JE. Primary Care: Spontaneous Pneumothorax, N Engl J Med, 2000, 342(12):868~874
16 王培兰.自发性气胸的治疗.中国医刊,1999,34(1):16~18
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33 Loubani M, Lynch V. Video assisted thoracoscopic bullectomy and acromycin pleurodesis:an effective treatment for spontaneous pneumothorax. RespirMed, 2000, 94(9):888~890
34 曲加骐,侯淮平,史宁江等.胸腔镜外科临床应用体会. 中华胸心血管外科杂志,1998,14(4):193~195
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38 Kabanov AN, Astafurov VN .Temporary occlusion of the bronchi in the treatment of nonspecific spontaneous pneumothorax. SovMed, 1979(10):60~62
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41 宋永生,钟思陶主编.病理学.广东省高等教育出版社,2000,1:29
42 曾奕明,张华平,吕良超等.气囊探查加选择性支气管封堵术 治 疗 难 治 性 气 胸 10 例 . 中 华 内 科 杂 志 ,2003,03(1) :193~195
43 Lillington GA,Stevens RP, DeNardo GL. Bronchoscopic location of bronchopleural fistula with xenon-133. Nucl Med, 1982, 23(4):322~323
44 刘又宁.呼吸系统治疗学.北京:科学出版社,2005,72
45 胡建林,杨和平,熊 玮等.支气管球囊定位及凝血块填塞治疗气胸 4 例.第三军医大学学报,2005,07(1):1390
2 Vricella LA,Gregory D.Trachiotis Heimlich Valve in the Management of Pneumothorax in Patients With Advanced AIDS.Chest,2001,120(1):15~18
3 Milanez JR,Vargas FS.Thoracoscopy Talc Poundage:A15-Year experience. Chest,2001,119 (3):801~806
4 邓在春,张敦华等.自发性气胸的治疗.新医学,2006, 37(5):27~29
5 Henry M, Arnold T, Harvey J. et al BTS guidelines for the management of spontaneous pneumothorax.Thorax, 2003, 58(Suppl):39~52
6 Baumann MH, Strange C, Heffner JE. Management of Spontaneous Pneumothorax :An American College of Chest Physicians Delphi Consensus Statement.Chest,2001, 119(2):590~602
7 Sahn SA , Heffner JE .Primary Care :Spontaneous Pneumothorax .N Eng l J Med,2000,342(12):868~874
8 Wallach SL, Taylor G, Sahn SA, et al. Spontaneous Pneumothorax .N Engl J Med, 2000, 343 (4):300~301
9 孔晖,赵珊,扬瑞安. 滑石粉胸膜固定术治疗复法性顽固性气胸的临床应用.中国医师杂志,2003,5(2): 213
10 Yi-Cheng Wu, Ming-Shian Lu, Chi-Hsiao Yeh, et al. Justifying Video-Assisted Thoracic Surgery for Spontaneous Hemopneumothorax. Chest, 2002, 122(5): 1844~1847
11 Loubani M, Lynch V. Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous Pneumothorax. Respir Med, 2000, 94(9):888~890
12 纪树国,李燕玉,何云京等.自发性气胸的胸膜腔造影及“点焊”治疗.心肺血管病杂志,2002,21(1):32~33
13 Lillington GA, Stevens RP, DeNardo GL. Bronchoscopic location of bronchopleural fistula with xenon-133. Nucl Med,1982,23(4):322~323
14 Kabanov AN, Astafurov VN .Temporary occlusion of the bronchi in the treatment of nonspecific spontaneous pneumothorax. SovMed,1979(10):60~62
15 曾奕明,张华平,吕良超等.球囊探查加选择性支气管封堵术 治 疗 难 治 性 气 胸 10 例 . 中 华 内 科 杂 志 ,2003, 42(3):193~195
16 Leo F, Della Monica J, Venissac N, et al. Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax. Eur J Cardiaothorac Surg, 2005, 28(1):47~49
17 贾育红,袁大柱,刘新等.内镜下应用 OB 胶治疗顽固性自发性气胸.中国实用内科杂志,2001,21 (11):665
18 陶 仲 为 . 自 发 性 气 胸 . 中 国 实 用 内 科 杂 志 , 2005, 25(8):74-751
19 张耀亭,吴妙芬.纤维支气管镜介入对自发性气胸的疗效评价,江西医学院学报.2006,46(3): 142~143
20 林大欢,许潮,黄仁丽.经胸腔闭式引流管纤维支气管镜注入凝血酶及纤维蛋白酶原治疗难治性气胸.广东医学院学报,2003, 21(5):466~470
21 高兴林,张伟,陈正贤等.经纤维支气镜球囊定位及生物材料 填 塞 治 疗 顽 固 性 气 胸 . 中 华 结 核 和 呼 吸 杂 志 , 2003,26(7):402
22 程宏宁,陈永悻,罗美娟等.经纤维支气管镜局部注入医用生物蛋白胶治疗支气管残端瘘 4 例分析.海南医学, 2003,14(6):7~8
23 刘又宁 . 呼吸系统疾病治疗学 . 北京:科学出版社, 2005:723
24 张敦熔.结核病新概念.北京:中国农业科技出版社, 2003:859
25 朱元钰,陈文彬主编.呼吸病学.人民卫生出版社,2004,1294~1295
26 卢晔.胸腔内注入凝血酶治疗自发性气胸 65 例.右江医学,2003, 31(2):116
27 殷香保.纤维蛋白胶的临床应用进展.岭南现代临床外科,2003,3(1):67~69.
28 Davidson B R.Bumett S, Javed MS,etal.Study of anovel fibrin sealant for achieving haemostasis following partical hepatectomy.Br J Surg,2000,87(6):790.
29 苏怡,侯延文,高珉之.医用生物蛋白胶生物性能的研究.预防医学情报杂志,2001,17(6):433~435.
30 Duichavsky SA,Geller RE,Maurer J, et al.Autologous fibringel bactericidal roperites in contammated hepatic injury[J].Jtrauma,1991,31:991~992.
31 Walshe P,Harkin C,Murphy S, et al.The use of fibrin glue in refractory coagulopathic epistaxis.Clin Otolaryngol,2001,26:284~285
32 Kubo T, Hosokawa K,Haramoto U, et al.A simple technique for fibrin glue application in skin grafting.Plast Reconstr Surg,2000,105:1906~1907
33 Kanaoka Y,Hirai K,Ishiko O, et al. Vesicovaginal fistula treated with fibrin glue. Int J Gynaecol Obstet,2001,73:147~149
34 Siedler S,Schuller=Petrovic S.Allogenic keratinocytes suspended healing support in chronic leg ulcers.Arch Dermatol,2000,136:676~678
35 Kitajiri S, Tabuchi K, Hiraumi H, et al. Relief of post-tonsillectomy pain by release of lidocaine from fibrin glue.Laryngoscope,2001,111:642~644
36 Takagi T,Ito T,Shimomura K, et al.Intraoperative coating of tumor surface using fibrin glueas a prophylaxis for cancer cell detachment.Gan To Kagaku Ryoho,2001,28:1674~1676
37 Rocco G, Allen M Bronchial repair with pulmonary preservation for severe blunt traumal[J].Thorac Cardiovasc Surg,2001,49(4):231~233.
38 Topcuoglu M S, Kayhan C,Ulus T.Transsternal transpericardial approach for the repair of bronchopleural fistula[J].Ann Thorac Surg,2000,69(2):394~397.
39 宗建平,季蕴辛,史建国,赵敏.生物胶对动物支气管的粘合作用.宁波大学学报(理工版),2002,3:95~96.
1 Henry M,Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax.Thorax,2003, 58(Suppl Ⅱ ):39
2 Baumann MH,Strange C, Heffner JE. Management of Spontaneous Pneumothorax: An American College of Chest Physicians Delphi Consensus Statement.Chest,2001, 119(2):590~602
3 滕维亚,毛宝龄.自发性气胸的发病机理和诊治.中华结核和呼吸杂志,1995,18(6):330
4 张晓膺,范晋明,高克柔等.肺大疱致自发性气胸的外科治疗及分型探讨.中华结核和呼吸杂志,1996,19(5):47
5 朱元钰,陈文彬主编.呼吸病学.人民卫生出版社,2004,1294~1295
6 任 少 华 . 自 发 性 气 胸 的 诊 治 进 展 . 新 医 学 ,1999 ,30(4):241~243
7 Baumann MN, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach. Chest, 1997, 102(3);789~804
8 Engdahl O, Toft T, Boe J. Chest radiograph a poor method of determing size of a pneumothorax. Chest, 1993, 103(1); 26~29
9 张阳德.内镜学.北京:人民卫生出版社,2001:1482
10 Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest, 1997, 102(3): 822~ 828
11 李万平,续春艳等.自发性气胸 40 例临床分析,中国社区医师,2005,13(7):20~21
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