摘要
目的探讨硬质气管镜联合可弯曲支气管镜在恶性重度中央型气道狭窄治疗中的效果及可行性。方法回顾性分析2014年5月至2016年12月在第四军医大学唐都医院呼吸与危重症医学科经支气管肺活检病理确诊恶性重度中央型气道狭窄患者128例,其中A组(62例):采用硬质支气管镜联合可弯曲支气管镜介入治疗,依据镜下表现采用冷冻、电圈套扎、氩等离子体凝固(APC)电刀等方法清除肿瘤组织。B组(66例):全麻下单纯使用可弯曲支气管镜进行介入治疗,观察两组患者的治疗效果:狭窄改善程度,氧合指数、气促指数;所需支气管镜操作次数、总操作时长、并发症。结果 (1)A组治疗总有效率为95.1%,B组为93.9%,差异无统计学意义,但显效患者A组(20例)明显多于B组(10例),差异有统计学意义(P<0.05);(2)对于瘤体基底较宽致主气管狭窄的28例患者,A组13例患者治疗前狭窄程度为(84.1±3.8)%,治疗后狭窄程度为(34.1±3.6)%,B组15例治疗前后分别(85.2±4.8)%和(43.2±3.9)%,A组气道狭窄改善更为明显,差异具有统计学意义(P<0.05);(3)A组患者所需支气管镜进入操作次数为(6.5±0.8)次,显著低于B组(9.4±1.0)次,A组所需操作总时长(1.2±0.3)h,明显低于B组(2.1±0.4)h患者,两组患者并发症比较无明显差异,均未出现心跳骤停、持续恶性心律失常、大出血等严重并发症。结论应用硬质气管镜联合可弯曲支气管镜可快速清除恶性重度气道狭窄患者的瘤体组织,缓解气道狭窄,尤其针对基底宽广的重度气道狭窄,是一种有效且安全的方法,值得临床推荐。
Objective To investigate the efficacy and feasibility of rigid bronchoscopy combined with flexible bronchoscopy in the treatment of severe central tracheal stenosis caused by malignant neoplasms.Methods A retrospective analysis was conducted on 128 patients of malignant severe central tracheal stenosis diagnosed through pathology from May,2014 to December,2016 at Department of Pulmonary and Critical Care Medicine,Tangdu Hospital,The Fourth Military Medical University.Group A(62 cases):rigid bronchoscopy combined with flexible bronchoscope interventional therapy,remove the tumor tissue by freezing,electric snare,argon plasma coagulation and other methods according to endoscopic features.Group B(66 cases):under general anesthesia simply using flexible bronchoscopy for interventional therapy.the therapeutic effect of two groups were observed:Narrow improvement degree,oxygenation index,dyspnea index;Indicators frequency of bronchoscope,total operation time,complications,etc.Results (1)There was no significant difference in the total efficiency between group A(95.1%)and group B(93.9%),But 20 patients evaluated as significantly effective in group A were significantly more than in group B(10 cases)(P<0.05);(2)For the 28 patients with broad base neoplasms tissue,13 patients were treated in group A,the degree of airway stenosis were(84.1±3.8)%before treatment and(34.1±3.6)%after treatment.15 patients in group B,the degree of airway stenosis before and after treatment respectively were(85.2±4.8)%and(43.2±3.9)%.The improvement degree of stenosis in group A was higher than that in group B(P<0.05);(3)The operation frequency of bronchoscope in group A(6.5±0.8)times was significantly less than that in group B(9.4±1.0)times,and the total operation time in group A(1.2±0.3 h)was significantly lower than that in group B(2.1±0.4)h,no significant difference was found between the two groups of patients with complications,there was no serious complications of cardiac arrest,sustained arrhythmia,bleeding etc in both group.Conclu
作者
姜华
薄丽艳
王琰
李春梅
颜西刚
穆德广
金发光
Jiang Hua;Bo Liyan;Wang Yan;Li Chunmei;Yan Xigang;Mu Deguang;Jin Faguang(Department of Pulmonary and Critical Care Medicine,Tangdu Hospital,The Fourth Military Medical University,Xi′an 710038,China)
出处
《中华肺部疾病杂志（电子版）》
CAS
2018年第1期14-19,共6页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
国家公益性行业科研专项(201402024)
关键词
支气管镜
介入治疗
恶性肿瘤
气道狭窄
Bronchoscopy
Interventional treatment
Malignant neoplasms
Airway stenosis
