Dysphonia Due to Vocal Cord Injury After Rigid Bronchoscopy: A Case Study With 1-Year Bronchoscopic Follow-up.
Dysphonia Due to Vocal Cord Injury After Rigid Bronchoscopy: A Case Study With 1-Year Bronchoscopic Follow-up.
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硬性支气管镜检查后因声带损伤导致的发声困难：一年支气管镜随访的案例研究。
DOI：
10.1097/lbr.0000000000000587
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发表时间：
2019
影响因子：
3.3
通讯作者：
D. Ekbom
中科院分区：
文献类型：
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作者：
Stephanie J. Youssef;D. Orbelo;K. Sakata;Terence M. Zimmermann;Rebecca L. Pittelko;D. Nelson;D. Midthun;E. Edell;D. Ekbom
建议在经支气管活检前5 - 7天停用氯吡格雷，并提示阿司匹林会加重氯吡格雷的出血风险。关于重新开始DAPT的最佳时间，专家意见建议在术后12至24小时重新开始;然而，没有发表的数据评价该问题。3，4第二种可能的解释是在纵隔淋巴结活检期间未识别出穿刺针的经血管或心房通道。已发表的病例系列表明，在经血管针吸的情况下EBUSTBNA出血的风险较低7 -9;然而，该技术并非没有风险-如Botana-Rial等人11所示，他们报告了EBUS-TBNA肺动脉穿刺后发生壁内血肿。作者指出，如果他们在穿刺后即刻超声检查中未发现血肿，则不会进行进一步检查。因此，由于缺乏常规的影像学随访，无症状性出血可能被低估。此外，该手术是在培训环境中进行的，由于操作者经验不足，增加了意外血管穿刺或撕裂的可能性。尽管该病例中的主要操作者是一名亚专业实习生，记录了249例EBUS-TBNA病例，但Stather等人13证明，即使在200例病例后，EBUSTBNA的技能仍在继续提高。
the recommendation for stopping clopidogrel 5 to 7 days before transbronchial biopsy and suggesting that aspirin exacerbates the bleeding risk of clopidogrel. Regarding the optimal time to reinitiate DAPT, expert opinion suggests reinitiation 12 to 24 hours postprocedure; however, there are no published data evaluating this question.3,4 A second possible explanation is unrecognized transvascular or atrial passage of the needle during mediastinal lymph node biopsy. Published case series suggest low risk of bleeding from EBUSTBNA in the setting of transvascular needle aspiration7–9; however, the technique is not without risk—as shown by Botana-Rial et al,11 who report the development of intramural hematoma after EBUS-TBNA pulmonary arterial puncture. The authors note that, had they not seen the hematoma on immediate postpuncture ultrasound, no further investigation would have been performed. Thus, asymptomatic bleeding may be underrecognized due to lack of routine radiographic follow-up. In addition, this procedure was performed in a training setting, raising the possibility of inadvertent vascular puncture or laceration due to operator inexperience. Although the primary operator in this case was a subspecialty trainee with 249 recorded EBUS-TBNA cases, Stather et al13 demonstrate that skill with EBUSTBNA continues to improve even after 200 cases.