At present, low-grade malignant tumor in the bronchial tract is a rare disease in clinical practice, so whether patients should take extra-thoracic surgery or minimally invasive bronchoscopic surgery for the treatment of such diseases is a difficult problem in clinical practice. In this paper, we observed the clinical results of 6 patients who did not want to undergo extra-thoracic surgery and underwent bronchoscopic treatment for 3 years after surgery. Mao F, Department of Internal Medicine, Wuxi Ninth People’s Hospital
1 Object and method
1.1 Subjects Collected 6 cases of bronchial low-grade malignant tumors, including 5 male cases and 1 female case, aged 31-57 years old, average (38±5.32) years old, who were pathologically confirmed in the Department of Internal Medicine, Binhu People’s Hospital, Wuxi City, from January 2007 to November 2009. Inclusion criteria: (1) 4 cases were central type carcinoid tumors and 2 cases were mucinous epidermoid tumors. ; (2) All 6 patients were informed of the option of extra-thoracic surgical resection treatment, which was rejected, signed and approved consent and cooperated with regular review.
1.2 Methods All 6 patients should be seen with cough and no intrapulmonary occupying lesions were seen on chest plain film and chest CT examination, and patients who were biopsied under bronchoscopy and pathologically confirmed; all 6 patients were informed that extra-thoracic surgical treatment could be preferred under current medical technology, and all 6 patients refused surgical treatment because the cost of surgery was more than 5 times higher than that of bronchoscopic treatment, and signed and agreed to undergo bronchoscopic treatment.
All patients fasted after 8 pm before surgery, and were routinely anesthetized with lidocaine airway nebulization before surgery, nasal tract tube oxygenation, and cardiac and pulse oxygen testing with Olympus CV-260sL and YH300A from Shandong Yuhua Electric Co.
The tumor in the airway was first trapped with a trap, ENDO CUT mode, power 20,All six patients did not bleed significantly after tumor trapping, and further removal of residual tumor was performed by extended cautery with argon gas (1.5 flow rate) at the base of the tumor; see the following atlas. after October 2008, after the introduction of autofluorescence bronchoscopy in our hospital, three patients were withdrawn after high frequency electrical treatment with the trap 1T260 therapeutic scope and used the F260 bronchoscope to observe the base, and in one case, a purplish-red abnormal spectrum was observed in the peripheral part of the tumor tip, which made the scope of argon knife treatment more clear.
2 Results
After treatment, none of the 6 patients had complications such as coughing up blood and pneumothorax, all of them moved freely on the day of surgery, and the cough basically disappeared after 3 days, all of them reviewed bronchoscopy every 3 months and chest CT every 6 months after surgery, and no abnormality was found under bronchoscopy and chest CT in 5 patients so far, one patient who did treatment in March 2007 was found under white light bronchoscopy in June 2009 In one patient treated in March 2007, no abnormality was found under white light bronchoscopy in June 2009, but under autofluorescence bronchoscopy (AFI), an abnormal purplish spectrum was seen at the original tumor site, and the pathology was diagnosed as recurrence after biopsy, and there was still no abnormality on chest CT.
Discussion
Bronchial low grade malignant tumors account for only 2% – 5% of bronchopulmonary malignant tumors, and in principle, most of the treatments are lobectomy and bronchial sleeve anastomosis [1], [2], but such surgeries are after all traumatic, and for tracheal and bronchial low grade malignant tumors near the bulge the surgical range is broader, and the high cost of surgery is also something that patients need to consider. Before the surgery, the patient must be given a thin layer CT scan of the chest to carefully observe whether the tumor invades the whole bronchus, whether there are metastases in the lung, whether there are enlarged lymph nodes in the mediastinum, and to consider whether it is suitable for minimally invasive bronchoscopic surgery; secondly, after the tumor ligation, the patient should be cauterized with an argon knife at the base. It is more clinically meaningful; third, regular AFI examination and related examination of the whole body must be performed after treatment [3], which can provide effective treatment at the first time of tumor recurrence or distant metastasis. From the three-year treatment effect, bronchoscopic treatment of low-grade malignant tumor in bronchus is less invasive, cheaper, and the efficacy is still satisfactory, but because of the small sample, we need to accumulate more cases to further explore the significance of such procedures.