2017年 · 第40卷第06期

From the invention of rigid tracheobronchoscope by German doctor Gustav Killian, which was successfully used to remove foreign bodies in the airway, to the invention of fiberoptic bronchoscope by Shigeru Ikeda, to the subsequent development of many respiratory endoscopic diagnosis and treatment technologies^[1]； From Hans Christian Jacobaeus' first use of thoracoscope for the release of pleural adhesions, to the widespread application of video-assisted thoracic surgery (VATS) in thoracic surgery, to the invention of flexible thoracoscope, which led to the return of thoracoscopic technology to internal medicine^[2]Respiratory endoscopy technology has gradually developed and improved, becoming an important pillar of clinical respiratory disease, forming an independent subspecialty of modern respiratory disease-interventional respiratory disease. As far as nouns are concerned, "Interventional Pulmonology" is commonly used in English, which translates literally to "Interventional Pulmonology". These interventional techniques are not only used in the diagnosis and treatment of lung lesions, but also in the diagnosis and treatment of airway lesions. Therefore, the term "interventional respiratory disease" is more appropriate in Chinese.

rigid bronchoscopy (RB) is a highly skilled surgical technique that combines intra-airway visibility and therapeutic procedures with patient ventilation. Rigid bronchoscopy technology has a history of more than 100 years. During its development, four doctors from Germany, the United States, Japan and France have made significant contributions. They are the inventors and tweakers of bronchoscopy technology. Thanks to the innovative work of these four doctors, today's modern rigid bronchoscopy technology and interventional pulmonology (interventional pulmonology)^[1,2]。

As one of the representatives of minimally invasive techniques applied in clinical practice, interventional respiratory techniques have developed rapidly. The renaissance of rigid bronchoscopy, the improvement of various optical endoscopic techniques, the emergence of guidance and positioning techniques such as bronchoscopic ultrasound (EBUS), the application of multiple ablation techniques, and the popularization of medical thoracoscopy have benefited many patients. However, the popularization of new technologies requires standardized training. There is a huge difference between the training of interventional respiratory techniques and the training in internal medicine that we have faced in the past, requiring operators to have a solid theoretical foundation, a clear mind and excellent surgical skills. How to establish a more standardized training mechanism and environment, how to ensure the quality of training, and how to evaluate the training effect are important topics to be studied in the field of interventional respiratory diseases in China.

Benign central airway stenosis refers to airway stenosis caused by various benign lesions in the trachea, left and right main bronchus and right middle bronchus, which can lead to different degrees of dyspnea and even asphyxia death in clinical practice. The lobar bronchus does not belong to the central airway, but may also need treatment for patients who have undergone significant decrease in basic lung function such as pneumonectomy. Compared with malignant airway stenosis, benign airway stenosis is more difficult to manage and more prone to long-term complications. At the same time, the management of benign central airway stenosis is a difficult point in the field of interventional respiratory disease because of the long survival period of patients, higher expectations of patients and their families, and difficulty in accepting short-term and long-term serious complications caused by surgery. In the past, the treatment of benign airway stenosis was mainly surgical treatment, but surgical operation was traumatic, high risk and easy to relapse. A considerable number of patients were not suitable for surgical treatment and postoperative complications were not uncommon. At present, trans-bronchoscopic interventional therapy has gradually become one of the main methods for treating benign airway stenosis. However, at present, the technical level of respiratory interventional diagnosis and treatment in various units in China is uneven, the treatment methods are not uniform, and the treatment effects are very different, and some even have serious complications^[1,2,3,4]Respiratory interventional diagnosis and treatment technology of benign airway stenosis in China urgently needs to be standardized. Therefore, the interventional group of Respiratory Disease Branch of Chinese Medical Association organized relevant domestic experts to formulate this consensus after several rounds of full discussion.

Tuberculosis is one of the important infectious diseases that seriously threaten human health. According to the latest statistics of the World Health Organization, there were more than 10 million new tuberculosis patients and 1.8 million deaths in the world in 2015^[1]。 Pathological diagnosis is the most important way to confirm tuberculosis outside microbiology, and plays a very important role in the diagnosis of sputum-negative pulmonary tuberculosis and extrapulmonary tuberculosis. In recent years, with the rapid development of molecular pathology technology, the pathological examination of tuberculosis can provide more definite clinical diagnosis, such as the differential diagnosis of tuberculosis and non-tuberculosis mycobacterial disease and the diagnosis of drug-resistant tuberculosis. In order to improve the level of pathological diagnosis of tuberculosis in China and enhance clinicians' understanding of pathological diagnosis of tuberculosis, the Tuberculosis Branch of Chinese Medical Association organized pathology and clinical experts to jointly discuss the related problems of pathological diagnosis of tuberculosis, and finally formed the "Expert Consensus on Pathological Diagnosis of Tuberculosis".

peak expiratory flow (PEF) refers to the highest flow during forced expiration, also known as the highest (large) expiratory flow, peak expiratory flow (velocity), etc. PEF is one of the commonly used items to check pulmonary ventilation function^[1,2,3], and the first second forced expiratory volume (FEV) measured by a pneumometry₁) has good correlation, can better reflect the patency of airway, and can also be used to measure the function of large airway and understand the strength of respiratory muscles. peak expiratory flow variability refers to the degree of change of PEF at various time points or time periods within a certain period of time, which can better reflect the diastolic and contractile function of airway, and is one of the important lung function tests to detect airway reactivity and/or reversibility^[4,5]It is mainly used for the diagnosis and condition monitoring of bronchial asthma (asthma). Under normal circumstances, human PEF also fluctuates to some extent, generally the lowest in the morning and the highest in the afternoon, but the degree of change is small; The variation rate of PEF in patients with unstable asthma is large, and it varies with the changes of patients' condition, so it is widely used in clinical practice.

Local airway stenosis after tracheal intubation and incision not only makes the tracheotomy cannula impossible to remove, but also directly affects the vocal function of patients, resulting in a serious decline in the quality of life of patients. There are few reports on the management of subglottic stenosis (airway atresia) with Cotton-Myer grade IV after tracheotomy in the past. This article introduces an interventional treatment for airway atresia after tracheotomy with Montgomery T-tube (T-tube) insertion after bidirectional airway recanalization.

Transbronchial ultrasound-guided needle aspiration biopsy (EBUS-TBNA) is a new endoscopic technique^[1]When EBUS-TBNA is routinely performed, there is a core guide wire in the lumen of the puncture needle, which increases the time of operation examination and may add some rare complications^[2]However, whether the non-use of needle core guide wire in the puncture needle lumen during EBUS-TBNA operation affects the diagnosis and pathological specimen quality has not been reported.

tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) refer to a rare type of airway stenosis in which the structural integrity of the airway wall is impaired, resulting in chronic cough, recurrent lower respiratory tract infection, and dyspnea, mostly occurring in the central airway. Specifically, TBM refers to airway flattening and softening caused by the destruction of the integrity of the tracheobronchial cartilage ring; EDAC is a pathological condition in which the airway membrane is damaged and convex toward the lumen, resulting in stenosis and more than 50%^[1,2]。 At present, it is believed that the obvious difference between the two lies in the different anatomical sites of the airway involved in the lesions. In some cases of severe airway stenosis, destruction of the airway cartilage ring and damage to the normal structure of the membrane can occur simultaneously^[1,2]。 In view of the diversity and lack of specificity of clinical manifestations of this type of airway stenosis, it is easy to be misdiagnosed or missed, which delays the correct diagnosis and treatment of this type of disease. Therefore, the etiology, pathophysiology, diagnostic classification and treatment progress of this kind of disease are reviewed as follows.

Chronic obstructive pulmonary disease (COPD) is one of the major health problems worldwide due to increasing morbidity and mortality, often characterized by persistent airflow restriction, which usually develops progressively and is associated with abnormal inflammatory responses of airways and lung tissues to harmful gases or particles such as tobacco smoke^[1]。 Smoking is the most important environmental pathogenic factor of COPD. Tobacco smoke can expose the respiratory tract to a series of toxic substances repeatedly and for a long time through inflammation and oxidative stress mechanisms, and then cause great damage to the respiratory tract^[2]。

Chemokines are involved in the key processes of controlling MTB infection, including recruiting immune cells, activating adaptive immune response, helping to form protective granuloma and enhancing the protective effect of vaccine^[1]。 If the expression of chemokines is unbalanced, it can aggravate the inflammatory response, promote the formation of tuberculous cavities, and even lead to disseminated severe tuberculosis^[2]。 The role of chemokines in the pathogenesis of tuberculosis and their potential clinical application value are summarized as follows.

In recent years, China's interventional respiratory medicine has made great progress. Especially after the establishment of the Interventional Respiratory Medicine Group of the Respiratory Medicine Branch of the Chinese Medical Association in 2011, interventional diagnosis and treatment centers and interventional training bases have been established one after another all over the country, and the field of respiratory intervention has begun to develop rapidly. The international influence is increasing day by day. Professor Wang Guangfa, the editorial board member of this journal and the head of the interventional respiratory group of the respiratory branch of Chinese Medical Association, briefly introduced the development process and achievements of interventional respiratory disease in China in the "Review", especially the successful bid for the 2020 WCBIP, which marked the recognition of the development and progress of interventional respiratory disease in China by the international academic community. At the same time, it is also necessary to see that there are still shortcomings in the field of interventional respiratory diseases in China, such as insufficient standardization, physician training system to be improved, and lack of clinical research. It is hoped that through a higher level of "standardization, popularization and improvement", the construction of technical specifications and evaluation system will be strengthened, and the cause of interventional respiratory diseases in China will be further developed.