Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.
Bronchoscopy ; Emphysema ; Pulmonary Medicine ; Pulmonary Surgical Procedures

Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the "lobular bronchi" with main bronchi. Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung. The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.
Anastomosis, Surgical ; Bronchi/*surgery ; Carcinoma, Non-Small-Cell Lung/*surgery ; Lung Neoplasms/*surgery ; Pneumonectomy/*methods ; Pulmonary Surgical Procedures/*methods ; Recovery of Function ; Treatment Outcome

OBJECTIVETo investigate the method of early surgical treatment of bronchopleural fistula after pneumonectomy.

METHODSTwelve patients (9 males and 3 females with a mean age of 58.6-/+5.7 years) with bronchopleural fistula after pneumonectomy received a reoperation within 72 h after a definite diagnosis. Empyema was found in none of the 12 cases. Fistula occurred within 4 to 17 days (8 days in average) after the operation. The fistula of the residual main bronchus was resected, and the thoracic cavity was asepticized by flushing.

RESULTSTen patients were discharged with complete healing. One patient was discharged following open drainage with daily change of the wound dress. One patient died due to multiple organ failure. The hospital stay of the patients ranged from 18 to 49 days (31 days in average) after the reoperation.

CONCLUSIONBronchopleural fistula after pneumonectomy, in case that empyema and multiple organ failure do not occur, can be healed by closing the fistula with the stapling device in early stage. Flushing the thoracic cavity is also necessary after the reoperation.

Bronchial Fistula ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pleura ; surgery ; Pleural Diseases ; etiology ; surgery ; Pneumonectomy ; adverse effects ; Pulmonary Surgical Procedures ; methods ; Time Factors

BACKGROUND: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. MATERIAL AND METHOD: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6+/-11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. RESULT: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). CONCLUSION: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.
Chungcheongnam-do ; Granulocyte Precursor Cells ; Hemoptysis ; Humans ; Incidence ; Lung ; Male ; Mastectomy, Segmental ; Mortality ; Pneumonectomy ; Postoperative Complications ; Respiratory Function Tests ; Risk Factors* ; Surgical Procedures, Operative ; Tuberculosis, Pulmonary

The pain relief effect of thoracic cavity anesthesia in 105 patients of partial removal of lung was evaluated as good and stable. Concerning the respiratory, ventilation volume was improved, the reduce of breathing frequency was improved but on obviously, there was no improvement in oxygene saturation level. Concerning the circulation, the effect was not considerable. The technique was easy with low cost and high safety. It can be use largely for patients with a surgery of partial removal of lung.
Pain ; Analgesia ; Surgery ; Pulmonary Surgical Procedures ; Lung

OBJECTIVETo evaluate the efficacy and practicability between bronchial sleeve resection or reconstruction of the pulmonary artery by video-assisted thoracic small incision and routine posterolateral incision for lung cancer.

METHODSThe clinic data was analyzed retrospectively, including 139 cases in our hospital underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung cancer from January 1995 to July 2007 and 99 cases in the HUAXI Hospital of SICHUAN University underwent routine posterolateral incision from April 2000 to December 2005. All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve resection or reconstruction of the pulmonary artery.

RESULTSAll patients were done operation successfully with no perioperative mortality and no occurrence of anastomosis stenosis as well as fistula. The median survival period of video-assisted thoracic small incision patients and the posterolateral incision patients were 63.17 months and 42.00 months, respectively (P > 0.05). There was no sign of reperfusion injury in the reconstruction of the pulmonary artery patients. The small incisions' length was from 8 to 13 cm and the mean length was 10 cm. The routine posterolateral incisions' mean length was 30 cm. Compared to the patients underwent the routine posterolateral incision, patients underwent the operation of video assisted thoracic small incision had less operation time, less chest tube time, less hospitalization time and less postoperative shoulder joint dysfunction.

CONCLUSIONSThe bronchial sleeve resection and reconstruction of the pulmonary artery by video-assisted thoracic small incision surgery for lung cancer can finish the same work as the traditional thoracic lateral incision with less trauma and recovery time.

Adult ; Aged ; Bronchi ; surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Pneumonectomy ; Pulmonary Artery ; surgery ; Pulmonary Veins ; surgery ; Retrospective Studies ; Thoracoscopy ; Treatment Outcome

The frequency or primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with mean 57.13+/-7.15 and 80.5%(70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9:1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left side in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in 16.1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage IIIa 54.1% and stage IIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal lymph node involvement was observed in 17 cases, and multi-level mediastinal lymph node involvement in 23 cases. Lower paratracheal lymph node and subcarinal lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic lymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95+/-17.21 months. Overall one-year survival rate was 75.1% and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage I, 92.2% and 30.5% for stage II, and 61.2% and 17.4% for stage IIIa, respectively. These findings correlate survival rate with tumor size, mediastinal lymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal lymph node metastasis and complete surgical resection.
Carcinoma, Squamous Cell* ; Cause of Death ; Chest Pain ; Chylothorax ; Cough ; Female ; Follow-Up Studies ; Hemoptysis ; Hoarseness ; Humans ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Male ; Mortality ; Neoplasm Metastasis ; Pneumonectomy ; Pulmonary Edema ; Sputum ; Surgical Procedures, Operative ; Survival Rate ; Weight Loss ; Wound Infection

The frequency or primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with mean 57.13+/-7.15 and 80.5%(70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9:1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left side in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in 16.1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage IIIa 54.1% and stage IIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal lymph node involvement was observed in 17 cases, and multi-level mediastinal lymph node involvement in 23 cases. Lower paratracheal lymph node and subcarinal lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic lymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95+/-17.21 months. Overall one-year survival rate was 75.1% and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage I, 92.2% and 30.5% for stage II, and 61.2% and 17.4% for stage IIIa, respectively. These findings correlate survival rate with tumor size, mediastinal lymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal lymph node metastasis and complete surgical resection.
Carcinoma, Squamous Cell* ; Cause of Death ; Chest Pain ; Chylothorax ; Cough ; Female ; Follow-Up Studies ; Hemoptysis ; Hoarseness ; Humans ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Male ; Mortality ; Neoplasm Metastasis ; Pneumonectomy ; Pulmonary Edema ; Sputum ; Surgical Procedures, Operative ; Survival Rate ; Weight Loss ; Wound Infection

Management of severely dilated pulmonary artery (PA) associated with severe pulmonary hypertension from congenital heart disease remains controversial, primarily due to its rare nature and concern for perioperative unpredictable complications. Herein, we report a 25 year-old female with a severely dilated PA (up to 73 mm), who was successfully treated by a PA graft replacement by creating a Y-shaped conduit using a 28 mm hemashield tube in the main PA and a 20 mm hemashield tube in both proximal parts of the branch PA.
Female* ; Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary* ; Pulmonary Artery* ; Pulmonary Surgical Procedures ; Transplants

BACKGROUND AND OBJECTIVEFast track surgery (FTS) is a systematical method to accelerate the recovery of surgical patients by reducing the physical and mental trauma stress of them. The research is to investigate the feasibility of FTS application in lung cancer surgery.

METHODSA total of 80 cases of lung cancer patients with single leaf lobotomy resection were randomized into two groups. While the experimental group was treated with the conception of FTS, and the control group was treated with the traditional methods. The incident rate of post-operation pain degrees, telecasts, pleural effusion, the post-operation time stay in hospital time and the total cost during hospitalization in two groups were compared respectively.

RESULTSIn FTS group: the VAS score of post-operation pain at 1 h, 6 h, 12 h, 24 h and 48 h all significantly decreased compared to the traditional therapy group. The incidence rate of telecast was 10.53%. The incidence rate of pleural effusion was 26.31%. The length of stay after operation was (4 +/- 1) d and the total cost was RMB 15 600 +/- 7 600. In the control group, the above values were 77.78%, 33.33%, 22.22%, (9 +/- 1) d, RMB 23 600 +/- 5 400, respectively. The post operation pain (VAS method) of FTS group was remarkablely below the control group. There has significant difference of the incident rate of telecasts, stay time in hospital and the total cast in two groups (P < 0.05). No significant difference was observed in the incident rate ofpleural effusion.

CONCLUSIONThe new methods of FTS can apparently accelerates recovery after lung cancer resection, reduces complications, shorten timestay in hospital and cut down the total cost.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pulmonary Surgical Procedures ; Treatment Outcome