摘要
目的探讨经支气管镜球囊扩张术治疗支气管结核气道狭窄的临床应用价值。方法北京市结核病胸部肿瘤研究所2005年1月至2009年9月经支气管镜球囊扩张术治疗149例支气管结核气道狭窄患者，其中男18例，女131例；年龄16-59岁，平均（32±9）岁。回顾性分析患者治疗前后的临床表现、气道直径及肺复张情况。结果支气管结核的临床表现不典型，且合并气道狭窄等重症患者较为多见。经球囊扩张后气道直径即刻均有不同程度的增加，狭窄段气道直径由扩张前的（2．7±1．4）mm增至扩张结束时的（6．8±2．0）mm，扩张后3个月和12个月随访时气道直径仍为（6．4±1．7）mm和（6．3±2．3）mm。患者的阻塞性肺炎等症状随气道通畅而缓解或消失。扩张结束后12个月随访结果表明，37例肺不张患者中34例肺复张，再狭窄发生率为3．4％（5／146）。治疗前与治疗后3个时段比较，患者气道内径变化和肺复张的差异均有统计学意义（t值为13．09～20．50，均P〈0．01），治疗后12个月各项随访结果与治疗结束时和治疗后3个月比较均无明显差别。本组球囊扩张术的成功率为93．3％（139／149），失败率为6．7％（10／149），严重并发症发生率仅为4．0％（6／149）。结论经支气管镜球囊扩张术治疗支气管结核气道狭窄是一种安全、有效的治疗手段。
Objective To explore the clinical value of balloon dilatation through flexible bronchoscope in the management of tracheobronchial stenosis of endobronchial tuberculosis. Methods From January 2005 to September 2009, 149 cases of tracheobmnchial stenosis caused by endobronchial tuberculosis were examined by flexible bronchoscope and treated with balloon dilatation. Changes of the clinical features, atelectasis and airway diameters were observed and evaluated before and after the last treatment and in 12 months. Results The airway diameters were immediately enlarged （100%, 149/149） after the procedure, and the clinical symptoms were relieved. The average airway diameter changed from （2.7± 1.4） mm before the procedure, to （6.8±2.0） mm, （6.4± 1.7） mm and （6.3±2.3） mm immediately, 3 and 12 months after the treatments. Expansion of atelectasis was seen in 92% （34/37） of the cases, and the rate of restenosis was 3.4% （5/146） 12 months after treatment. There were significant differences before and after the treatments in the airway diameters, expansion rate of atelectasis and the general outcome （t = 13.09 - 20. 50, P〈0.01）, but there were no differences among measurements immediately, 3 and 12 months after the treatments. The final effective rate was 93.3% （139/149）. Severe complications （4.0%,6/149） were rare in these patients. Coneluslon Balloon dilatation through flexible bronchoscope is a simple, effective and safe method for the management of tracheobronchial stenosis after endobronchial tuberculosis.
出处
《结核病与胸部肿瘤》
2010年第4期250-256,共7页
Tuberculosis and Thoracic Tumor
关键词
结核
支气管
气管狭窄
支气管镜检查
气囊扩张术
Tuberculosis, bronchi Tracheal stenosis Bronchoscopy Balloon dilatation
