目的:观察电子支气管镜下氩气刀治疗气道腔内肿瘤的临床效果。方法:使用德国ERBE公司的300型氩气刀经支气管镜治疗气道肿瘤患者16例,以气道狭窄再通、气促评分及咯血缓解情况为评价疗效的依据。结果:16例患者共行氩气刀治疗28次,完全有效8例,部分有效3例,轻度有效4例,无效1例。结论:电子支气管镜下氩气刀治疗气道腔内肿瘤安全、有效,值得临床推广应用。

病历摘要 女,37岁,农民,因体位性呼吸困难2年,突发呼吸骤停20 d于2006年6月7日入院.患者近2年来不能平卧及左侧卧位睡眠,否则会出现憋喘,面色青紫,右侧卧位及俯卧位仍有张口呼吸现象.

目的通过分析肺栓塞的临床特征,以减少其漏诊和误诊.方法回顾性分析20例肺栓塞患者的临床资料,总结其临床特征.结果20例肺栓塞患者中11例有深静脉血栓性静脉炎病史,7例放射性核素显像有肺叶灌注缺损,11例X线或CT影像见肺内渗出性阴影,6例超声心动图均示右心室扩张.存活的19例患者经溶栓或抗凝治疗后,症状明显好转.结论深静脉血栓性静脉炎易诱发肺栓塞.放射性核素显像及X线或CT检查可协助诊断,早期积极溶栓及抗凝治疗可望改善预后.

目的检测p16基因在肺癌患者癌组织及相应痰液脱落细胞中甲基化状态,以探讨其在肺癌早期诊断中的价值.方法采用甲基化敏感的核酸内切酶SmaⅠ、SacⅡ酶切基因组DNA,对56份肺癌组织及相应痰液、60份非恶性病变肺组织及28份痰液进行PCR分析.结果 p16基因在肺癌组织中甲基化率为30.4%(17/56),相应的痰液中为28.6%(16/56),两组差异无显著性(χ2=0.0430,P=0.836).60份非恶性病变肺组织甲基化率为3.3%(2/60),28份痰液无1份发现p16基因甲基化.结论肺癌组织及相应的痰液脱落细胞p16基因5′-CpG岛甲基化率相似,即痰液脱落细胞p16基因甲基化状态可以反映肺癌组织p16基因甲基化状态.因此,检测痰液脱落细胞p16基因甲基化状态有助于肺癌的早期诊断.

Objective To investigate the diagnostic value of telomerase activity and p16 gene methylation from exfoliated cells of sputum in lung cancer patients.Methods The sputum specimens from 49 cases of lung cancer patients and 28 cases of other lung patients were detected for telomerase activity and p16 gene methylation by methylation analysis.Results 28 out of 77 sputum specimens were positive for cytology:sensitivity was 55.1%,specificity was 100%;telomersae activity was positive in 38 cases:sensitivity was 71.4%,specificity was 89.3%;p16 gene methylation was 14 cases:sensitivity was 28.6%,specificity was 100%.The sensitivity was increased to 90.9% by combination of conventional cytology,telomerase activity and p16 gene methylatiion.Conclusion The results suggest that detection telomerase activity and p16 gene methylation in sputum of lung cancer enhanced the diagnostic value of conventional cytology.It is a promising approach to lung cancer detection and massive screening in terms of its rapidity,economy and simplicity.

BACKGROUND:To explore the possibility of telomerase as tumor marker of lung cancer and to evaluate its value on early diagnosis of lung cancer.METHODS:Telomerase activity was measured in 40 resected specimens of lung cancer and 40 preoperative fibro-optic bronchoscope biopsied specimens of suspected lung cancer by PCR based silver staining telomeric repeat amplification protocal (TRAP) respectively.RESULTS:The positive rate of telomerase was 100% in SCLC, but 84.8% in resected samples and 95.7% in biopsied samples in NSCLC. The positive rate of telomerase was 87.5%(35/40) in resected lung cancer tissues, 7.5%(3/40) in paracancerous tissues and 0%(0/40) in normal lung tissues (P<0.01). 82.5% (34/40) biopsied specimens of suspected lung cancer were detected with telomerase activity. Its sensitivity, specificity, and accurate rate was 96.4%, 71.4%, and 91.4% respectively for detection of lung cancer, Youden's Index (J)=0.678,and SE(J)=0.174.CONCLUSIONS:Telomerase may be a sensitive tumor marker of lung cancer. Detecting telomerase activity in preoperative fibro-optic bronchoscope biopsied specimens may contribute to early diagnosis of lung cancer.