Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
The present study was to develop and design a new sonography rigid bronchoscopy and corollary vacuum-assisted biopsy device system with less injury and complication. The system combined ultrasonic-probe with ultrasound catheter, a new medical ultrasound technique, and rigid bronchoscopy (RB) which is improved with an auxiliary vacuum-assisted biopsy device. The principle of the device is vacuum suction and rotary knife. The reduced outer diameter of the RB led to less pain and lower complications for the patient. With the help of ultrasonic-probe (30 MHz), lesions and blood vessels can be identified clearly and unintentional puncture and damage to blood vessels can be avoided. Plenty of lesions can be obtained quickly through the vacuum-assisted biopsy device without getting puncture needle in and out repeatedly. The novel endobronchial sonography rigid bronchoscopy and matched vacuum-assisted biopsy device has many remarkable advantages. It can enlarge the applied range of the RB from endobronchial to mediastinal lesions, avoiding unintentional puncture of vessels. Obtaining multiple samples with a higher accuracy rate than that by other sampling techniques, minimizing operation time, alleviating pain and decreasing the complication rate, the system makes up the technical deficiency for the diagnosis and treatment of the mediastinal lesions, to a certain degree.
The robotic bronchoscopy system is a new technology for lung lesion location, biopsy and interventional therapy. Its safety and effectiveness have been clinically proven. Based on many advanced technologies carried by the robotic bronchoscopy system, it is more intelligent, convenient and stable when clinicians perform bronchoscopy operations. It has higher accuracy and diagnostic rates, and less complications than bronchoscopy with the assistance of magnetic navigation and ordinary bronchoscopy. This article gave a review of the progress of robotic bronchoscopy systems, and a prospect of the combination with artificial intelligence.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
Objective To compare the diagnostic value of sterile sputumsuction tube with protected specimen brush in mechanically ventilated patients with serious lung infection, and explore the safety and efficacy of bronchofibroscope combining mechanical ventilation in the treatment of severe lung infection.Methods Seventy-four severe lung infection patients with invasive mechanical ventilation support were recruited in the study. Based on the routine treatment, the subjects were randomly divided into a control group received only mechanical ventilation, and a treatment group received sputum aspiration and bronchial lavage by bronchofibroscope combiningmechanical ventilation. Lower respiratory tract secretion was collected to analyze the bacterial etiology with sterile sputum suction tube in the control group, and with protectedspecimen brush in the treatment group. Results The positive rate of sputum suction tube and protected specimen brush was 70. 27% and 75. 68% , respectively, with no statistical difference between the two groups ( P gt; 0. 05) . The PaO2 of the treatment group increased and PaCO2 decreased obviously after sputum aspiration and bronchial lavage by bronchofibroscope ( P lt; 0. 01) . The total effective rate was also highly increased, and the heart rate and respiration were stable in the treatment group. The time of mechanical ventilation and the length of ICU stay were all shortened in the treatment group compared with the control group. Conclusions Sterile sputum suction tube can not only acquire accurate pathogen, but also is a simple and economical method for patients with severe lung infection with mechanical ventilation. Sputum aspiration and bronchial lavage with bronchofibroscope combining mechanical ventilation are effective and safe treatment for patients with severe lung infection.
Abstract: Objective To compare the sensitivity and accuracy of autofluorescence bronchoscope (AFB) and white light bronchoscope (WLB) in airway examination for patients with central type lung cancer. Methods From September 2009 to May 2010, 46 patients including 36 males and 10 females with an average age of 62.1 years underwent both AFB and WLB procedures in People’s Hospital of Peking University. Among them, 35 were preliminary diagnostic cases and 11 were postoperative surveillance cases. Local anaesthesia of glottis and airway, and general anaesthesia with continuous intravenous drugs were given before electric bronchoscope was adopted. All patients underwent WLB examination followed by AFB procedure. All suspicious abnormal visual findings were recorded for biopsy and pathological examination. Results All procedures were carried out safely without death or severe complications. We performed bronchoscopy 48 times for all 46 patients and 159 tissues of various sites were taken out for biopsy and pathologic examination which showed 64 malignancies and 95 none malignancies. In 64 malignancies, AFB found all but WLB missed 15 with a missed diagnosis rate of 23.4%. Thirtysix times of examination were performed for the 35 preliminary diagnostic cases and 56 sites of malignancy were found. AFB found all, while WLB missed 12, and 6 sites of malignancy found by AFB were larger in size than those found by WLB. AFB detected 3 cases of multisite malignancy, but WLB missed these diagnoses. The results of AFB and WLB were the same for 26 patients. Twelve times of bronchoscopy were performed for the 11 postoperative surveillance cases and 8 sites of malignancy were found. AFB found them all while WLB missed 3 which were two recurrent cases during the early period after lung cancer surgery. The sensitivity of AFB and WLB was 100.0 % and 76.6%(Plt;0.05) respectively, and the negative predictive value of AFB and WLB was 100.0% and 84.5%(P=0.002) respectively. Conclusion AFB has a better sensitivity and negative predictive value than WLB in detecting mucous canceration lesions in central type lung cancer, and is more accurate in assessment of tumor margins, more sensitive in finding multiple lesions in airway and detecting early cancer recurrence in postoperative surveillance patients.
ObjectiveTo investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). MethodsPatients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. ResultsInitially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
Objective
To explore the efficacy and safety of bronchoscopy-guided radioactive 125I seeds implantation combination with chemotherapy for advanced central type lung cancer.
Methods
Sixty-six patients with central type lung cancer in stage Ⅲb or Ⅳ were enrolled in this study from May 2014 to July 2016. The patients were randomly divided into two groups, ie. bronchoscopy-guided seeds implantation combined with chemotherapy group (experimental group, n=30) and chemotherapy group (control group, n=36). All patients accepted GP regimen (gemcitabine plus cisplatin) chemotherapy and were followed up by CT and electric bronchoscopy (EB) examination 1, 3, 5 months later. According to WHO unified standard, the efficacy and adverse effects were evaluated
. Results
In the experimental group and the control group, the response rate (complete response plus partial response) was 80.00% and 50.00%, respectively. There was significant difference between two groups (P<0.05). The incidence rate of hemoptysis in the experimental group was significantly higher than that in the control group (P<0.05), but there was no significant difference between the two groups in the incidence rate of pneumothorax, fever or bone marrow suppression (allP>0.05). All adverse reactions were light and could be controlled.
Conclusions
The short-term clinical efficacy is better in the bronchoscopy-guided seeds implantation combined with chemotherapy group. The bronchoscopy-guided seeds implantation combined with chemotherapy is a safe and minimally invasive treatment for advanced central type lung cancer.
Objective To evaluate the diagnostic yield and safety of two biopsy methods, electromagnetic navigational bronchoscopy (ENB) and transthoracic needle biopsy (TTNB), in peripheral pulmonary lesions. To select a low-risk and high-benefit biopsy method based on the clinical characteristics of the lesions and patients. Methods A retrospective analysis was conducted on inpatients who underwent ENB and/or TTNB for peripheral pulmonary lesions in Huadong Hospital Affiliated to Fudan University. Propensity score matching was used to compare the diagnostic yield and safety of the two biopsy methods. Results A total of 126 patients were included in the ENB group, and 104 patients in the TTNB group. After propensity score matching, 83 matched pairs were obtained. The TTNB group exhibited a significantly higher diagnostic yield compared with the ENB group (90.4% vs. 48.2%, P<0.001), but it was also associated with a higher incidence of pneumothorax (1.2% vs. 21.7%, P<0.001). In the ENB group, the diagnostic efficacy was correlated with lesion diameter (P<0.001, OR=0.183, 95%CI 0.071 - 0.470), but there was no statistically significant difference in the diagnostic yield among different lung segments (P>0.05). In the TTNB group, lesion characteristics did not significantly affect the diagnostic yield, but a lesion diameter ≤30 mm (P=0.019, OR=5.359, 95%CI 1.320 - 21.753) and a distance from the pleura ≥20mm (P=0.030, OR=6.399, 95%CI 1.192 - 34.360) increased the risk of pneumothorax. When stratified based on lesion and patient blood characteristics, no significant difference was found in the diagnostic yield between the two groups for characteristics such as left upper lobe (P=0.195), right middle lobe (P=0.333), solid with cavity (P=0.567), or abnormal serum white blood cell count (P=0.077). However, the incidence of pneumothorax in the TTNB group was higher than that in the ENB group. Conclusions The diagnostic yield of ENB is affected by the size of the lesion, while the incidence of pneumothorax in TTNB is influenced by both lesion size and distance from the pleura. In cases with lesions located in the left upper lobe, right middle lobe, solid with cavity, or with abnormal serum white blood cell count, selecting ENB for biopsy is considered preferable to TTNB.
ObjectiveTo explore the clinical utility and safety of electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) in the patients with inoperable high-risk pulmonary nodules.MethodsClinical data of patients who were diagnosed with inoperable pulmonary nodules highly suspected as malignant tumors and treated with ENB-guided MWA in Zhongshan Hospital, Fudan University from December 2019 to September 2020 were retrospectively collected and analyzed to evaluate the efficacy and safety of the procedure. There were 6 males and 3 females aged 72.0 (59.5-77.0) years.ResultsTotally ENB-guided MWA was performed in 9 patients with 12 lesions. All patients suffered from at least one chronic comorbidity. The inoperable reasons included poor pulmonary function (55.6%), comorbidities of other organs which made the surgery intolerable (33.3%), multiple lesions in different lobes or segments (22.2%), personal wills (22.2%) and advanced in age (11.1%). The median diameter of nodules was 13.5 (9.5-22.0) mm and the median distance from the edge of nodules to pleura was 5.3 (1.8-16.3) mm. Bronchoscope maneuver to the targeted lesions was manipulated according to navigation pathway under visual and X-ray guidance and confirmed with radial ultrasound probe. Rapid on-site evaluation also helped with primary pathological confirmation of biopsy specimen. Among all the lesions, 4 adenocarcinoma, 1 non-small cell lung cancer-not otherwise specified and 2 inflammatory lesions were reported in postoperative pathological diagnosis, while no malignant cells were found in 5 specimens. The ablation success rate was 83.3% (10/12). For the two off-targeted lesions, percutaneous ablations were performed as salvage treatment subsequently. The median hospitalization time was 3.0 (2.0-3.0) days and no short-term complications were reported in these patients.ConclusionENB-guided MWA is a safe and effective procedure for patients with high-risk pulmonary nodules when thoracic surgery cannot be tolerated.
