摘要
背景与目的大气道内肿瘤常伴有严重呼吸困难,患者难以平卧,局麻下气管镜检查受限。硬质气管镜具有通气功能,全麻下行硬质气管镜检查、治疗比较安全。本研究旨在探讨硬质气管镜结合可弯曲性支气管镜,应用冷冻联合氩等离子体凝固(APC)治疗大气道内恶性肿瘤的效果及可行性。方法回顾性分析两组经病理明确的气道内恶性肿瘤,分别采取两种不同的气管镜治疗模式。①A组:采取硬质气管镜结合可弯曲性电子支气管镜,应用冻取结合APC治疗大气道内肿瘤19例。全麻下经口插入硬质镜,然后结合电子支气管镜,采用冻取联合APC的方法,尽量一次性消除气道内肿瘤;②B组:单独采用电子支气管镜下单用APC治疗20例类似气道内病变患者,仅用APC烧灼肿瘤,然后用活检钳取出或冻取坏死物质,根据病人的最大耐受程度,尽量清除气道内肿瘤。结果A组气管及支气管术前阻塞程度均明显重于B组。但A组气管和支气管首次消融范围均大于B组,两组气管和支气管消融范围均无明显差别。A组所需气管镜操作次数明显少于B组,对患者的改善程度也优于B组。两组治疗过程中均无严重并发症发生。结论硬质气管镜结合可弯曲性支气管镜能快速冻取肿瘤,联合APC也能快速凝切肿瘤和止血,两种镜子结合应用,是严重气道阻塞快速、有效的治疗方法。单独应用电子支气管镜仅适合硬质气管镜有效治疗后的维持治疗或气道肿瘤较小、阻塞程度不重的患者。
Background and objective Main airway severe obstruction is a problem facing difficulty flexible bronchoscope because the patient is not able to breath smoothly under prostration, and death from suffocation is a frequent outcome. Managing the airway of patients with critical tracheal stenosis remains a formidable challenge to bronchoseopists. This study is to evaluate the application and efficacy of argon plasma coagulation （APC） and cryoextraction for the treatment of endobronchial neoplasma under rigid bronehoscope combined with flexible bronchoscope. Methods Two groups of airway pathologically proved neoplasma were retrospectively reviewed for the different endobronchial intervation modalities. Group A： Argon plasma coagulation （APC） and cryoextraetion were used for the treatment of endobronehial neoplasma under rigid bronchoscope combined with electronie bronchoseope in 19 cases with tracheobronchial carcinoma. Rigid bronchoseope was inserted into trachea with general anesthesia. Then the endobronchial tumor was removed by the combination APC and cryoextraction. Group B： APC and grasp or cryoextraction were used for the debulking of endobronehial tumor under flexible bronchoscope in 20 cases with airway tumor. Results Both tracheal and bronchial obstruction were more severe in Group A than those in Group B, but the tumor debulking was higher for the first time in Group A than in Group B. There were no difference on debulking volume between trachea and bronchus in the same group. The procedures were less complex in Group A than in Group B. The clinical improvement was better in Group A than in Group B. There were no severe complications directly related to the procedures. Conclusion The combination of APC and cryoextraetion is a rapid and effective method for the treatment of endoluminal airway tumor under rigid bronchoscope combined with electronic bronchoscope. Cryoextraction could rapidly debulk airway tumor and APC could effectively ablate tumor and stop bleeding. Electronic bronehoseope is used
出处
《中国肺癌杂志》
CAS
2009年第2期139-142,共4页
Chinese Journal of Lung Cancer
关键词
气管镜
肿瘤
冷冻
Bronchoscopes
Neoplasma
Cryosurgery
