Tracheal pressure
Introduction
Introduction The trachea and bronchus are the respiratory channels of the human body. Because it is shaped like a tree, it is also called a bronchial tree. The compression of the bronchial tree is due to the compression of bronchial lung cancer. Magnetic resonance imaging can show the compression and displacement of the trachea, bronchial tree and bronchus next to the mass.
Cause
Cause
The trachea can be divided into the neck segment and the thoracic cavity segment; general neck unilateral lesions: such as thyroid lesions (thyroid tumor, nodular goiter, simple goiter, etc.), cervical lymphadenopathy, neurogenic tumors, etc. Both can compress the tracheal displacement. Chest tracheal compression is mainly caused by mediastinal tumor, macrovascular disease (aortic aneurysm), and massive pleural effusion on one side.
The etiology of lung cancer is complex, and it has not been possible to determine a consistent cancer factor, which is generally considered to be related to the following factors:
1. Smoking: The relationship between lung cancer and smoking is relatively close. About 3/4 of lung cancers are caused by smoking. The lung cancer mortality rate of smokers is 10 to 13 times higher than that of non-smokers.
2. Physical and chemical carcinogenic factors: Currently considered to be carcinogenic factors are inorganic arsenic, asbestos, chromium, nickel, coal tar, soot and other combustion products of coal and
Chloromethyl ether and chloromethyl methyl ether.
3. Air pollution.
4. The occurrence, evolution and malignancy of lung cancer are closely related to the activation of certain oncogenes and the loss of anti-cancer genes.
5. Chronic lung disease: tuberculosis, chronic bronchitis.
Examine
an examination
Related inspection
Chest CT chest CT examination
(1) X-ray examination X-ray examination is the most important means of diagnosing lung cancer. X-ray examination can be used to understand the location and size of lung cancer. X-ray examination of early lung cancer cases has not yet shown a mass, but local emphysema, atelectasis or invasive lesions in the vicinity of the lesion or inflammation of the lungs may be seen due to bronchial obstruction.
Chest X-ray observation of diaphragmatic muscles helps to determine whether the phrenic nerve is invaded by cancer. Standard tomography can show bronchial obstruction in central lung cancer, distinguishing between tumor and inflammatory images, clearly showing lung and lobulated morphology, hilar and mediastinal lymphadenopathy, and showing calcification in the shadow Lesion.
(B) cytology examination Most patients with primary lung cancer can find shed cancer cells in sputum, and can determine the histological type of cancer cells. Therefore, sputum cytology is a simple and effective method for screening and diagnosing lung cancer. After waking up, rinse with water, fresh sputum coughed from the deep lungs or bronchial secretions bronched by bronchoscopy can be used as an examination specimen. Multiple sputum cytology can increase the positive rate. The positive rate of sputum cytology in central lung cancer can reach 70-90%, and the positive rate of peripheral lung cancer sputum test is only about 50%. Therefore, the negative sputum cytology test can not rule out the possibility of lung cancer. Most of the squamous cell carcinomas are located in the larger bronchus, the tumor grows into the lumen, the surface cancer cells are easy to fall off, and the positive rate of sputum detection is high, and the histological type is also determined to be accurate. The positive rate of sputum detection in undifferentiated small cell carcinoma is also high, but it is difficult to determine the histological type.
Lung cancer is transferred to the pleural cavity or pericardial cavity, and cases of pleural or pericardial effusion are generated. Part of the effusion is taken. After centrifugation, the precipitate is taken for smear examination, and the cancer cells are found to confirm the diagnosis.
(C) bronchoscopy bronchoscopy is an important measure for the diagnosis of lung cancer. The bronchoscopy can directly observe the pathological changes of the endobronchial and luminal lumens. For glimpses of cancer or cancerous infiltrates, tissue can be taken for pathological biopsy, or bronchial secretions can be taken for cytological examination to confirm the diagnosis and determine the histological type. However, due to the abundant blood vessels, bronchial adenomas should not be used for bronchoscopy biopsy to avoid massive bleeding. Bronchoscopy can also observe the position, shape, width and mobility of the carina and bronchus. If necessary, taking tissue for pathological examination is helpful to understand the extent of the lesion, the possibility of resection and the extent of lung resection. The rigid bronchoscope used in the past can only see larger bronchoscopes, and has a greater diagnostic value for central lung cancer. Fiber optic bronchoscopy has been widely used in the past 20 years. This bronchoscope has a thin diameter, soft and bendable, and can extend into the lungs, lung segments and most of the sub-bronchial bronchus, and can be applied by cell brush or X-ray TV. Positioning the biopsy in the lung tissue, taking specimens for pathological examination, can improve the positive rate of bronchoscopy, and is also helpful for the early diagnosis of peripheral lung cancer.
(4) Mediastinoscopy is mainly used to determine the extent of central type lung cancer invading the mediastinum. Through the transverse incision with short upper edge of the sternal notch, the cervical banded muscle and the anterior tracheal fascia were cut longitudinally along the midline, and the anterior fascia of the trachea was separated by the finger in the posterior sac of the innominate artery and the aortic arch, and the tracheal bulge was reached. Then put a mediastin to see the swollen lymph nodes. The lymph nodes are attracted or excised by pathology for pathological biopsy. Patients with mediastinal lymph nodes, especially metastatic or undifferentiated lung cancer in the contralateral mediastinal lymph nodes, are contraindications for pneumonectomy.
(5) Percutaneous puncture lung biopsy near the chest wall or invasive lesions suspected peripheral lung cancer or diffuse thin branch alveolar cancer using other diagnostic methods, failed to determine the nature of the lesion, the patient's physical condition is not suitable for thoracotomy For cases of exploration, percutaneous lung biopsy can be used. Determine the location of the lesion under X-ray TV fluoroscopy. Under the local infiltration anesthesia, insert the puncture needle into the central part of the lesion when the patient is holding the breath, pull out the needle, connect the 30~50ml syringe, and rotate the puncture needle while using the force for negative pressure suction. Then quickly pull out the puncture needle and send the collected specimen for pathological examination. After percutaneous lung puncture, close attention should be paid to the presence of pneumothorax, hemothorax and hemoptysis. The positive rate of peripheral lung cancer case examination can reach 80%, and the incidence of complications is not high. Lesions that have metastasized to the pleura can also be taken for pathological examination by pleural tissue through skin puncture.
(6) Radionuclide examination 67Ga-phthalate and other radioactive drugs have affinity for lung cancer and its metastatic lesions, can be concentrated in cancer after intravenous injection, can be used for lung cancer localization, showing the range of cancer, positive rate Up to 90%. However, other non-cancerous lesions such as lung inflammation and tuberculosis may also show a phenomenon of concentration. Therefore, comprehensive analysis must be combined with clinical manifestations and other examination data.
Pulmonary perfusion and ventilation scans with 133Xe can measure the effects of lung cancer lesions on bilateral lung function, which can help to determine the indications for surgical treatment.
(7) Metastatic examination of metastatic lesions In patients with advanced lung cancer, superficial lymph node metastasis or subcutaneous metastatic nodules at the supraclavicular, neck, or armpit, etc., can be taken for pathological biopsy or puncture of tissue for coating. Tablet check to confirm the diagnosis.
(8) Mediastinal incision Mediastinoscopy is difficult to see the lesions located in the left anterior mediastinum below the level of the aortic arch. In order to avoid the adverse consequences of unnecessary thoracotomy, a small number of central lung cancer cases may be considered for the treatment of mediastinal incision with less physical trauma. Through the second intercostal incision of the left anterior thoracic sternum, or the second or third and third costal cartilage under the subcapsular, the thoracic internal vessels are ligated, and the pleura is pushed outward to reveal the mediastinum and hilar lymph nodes for tissue organization. For pathological examination. Although this method of examination has not been widely adopted, it has certain reference value in some cases when formulating treatment plans.
Diagnosis
Differential diagnosis
Differential diagnosis
Tracheal displacement: When one side of the pleural effusion, gas accumulation or space-occupying neoplasm, the trachea is pushed to the healthy side due to increased intrathoracic pressure; when one side of the atelectasis, pleural thickening and adhesion The trachea is pulled to the affected side. Let the patient head in the middle position, use the right middle finger to touch the trachea along the sternal notch. The index finger and the ring finger are on the left and right sides of the sterno-lock joint respectively. See if the middle finger is equidistant from the other two fingers, or touch the trachea with the middle finger. The size of the gap between the middle finger and the thoracic mammary muscles on both sides to determine whether the trachea is displaced or not, the tracheal shift is important for the diagnosis of chest diseases.
Tracheal damage: the trachea and bronchus are the respiratory channels of the human body. The tree is the plant in nature. People associate the bronchus with the tree because the shape of the trachea, bronchi and its branches is like a tree with a lot of technology. . However, the shape of the tree is inverted, the trunk is on the trachea, the branches are bronchi and the branches are below. In addition, the venturi tree is hollow, and its lumen is a passage for airflow. If the bronchial tree is damaged, it cannot pass through the fresh air inside the human body, and the carbon dioxide and the like are discharged from the body.
Tracheal obstruction: Patients have varying degrees of dyspnea and hypoxemia, and even respiratory failure. Blow test, chest radiograph, etc. can be diagnosed.
Lung cancer, like other malignant tumors, can produce some biological substances such as hormonal enzymes, antigens, and fetal proteins. However, these cancer markers have no application value for detecting lung cancer. Clinicians have long-term cough or blood stasis in middle-aged and above. X-ray examination of the lungs revealed that unexplained lumps or inflammatory cases should be vigilant, highly suspected of the possibility of lung cancer, and timely and thorough examination.
