气道内结核病的微创治疗  

The combination of argon plasma coagulation and cryoablation in the treatment of endobronchial tuberculosis

作　　者：王洪武[1] 周云芝[1] 李晶[1] 邹珩[1] 李冬妹[1] 张楠[1] 

机构地区：[1]北京煤炭总医院呼吸科,100028

出　　处：《临床肺科杂志》2008年第6期683-685,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨氩等离子体凝固术(APC)结合CO2冷冻治疗气道结核的疗效。方法15例气道结核患者中右侧支气管4例,主气管3例,左主支气管9例。在抗结核的基础上,给予气管镜下APC+冷冻+药物注射治疗。结果5例干酪坏死型及4例增殖型气道结核经治疗后4～10个月均痊愈。5例接受裸支架的患者,半年～1年后气道再狭窄,将支架取出后给予APC+冷冻治疗,病情好转。左主支气管闭塞2例,无法再通,另1例经APC+冷冻+球囊扩张等处理,半年后痊愈。结论APC结合冷冻治疗气道结核,能加速溃疡愈合,减少气道狭窄的发生。Objective The aim of this study was to assess the utility of therapeutic bronchoscopy in the combined bronchoscopic argon plasma coagulation （APC） and CO2 cryoablation in treating endobronchial tuberculosis. Method 15 cases with endobronchial tuberculosis underwent bronchoscopic APC followed by CO2 cryoablation in 4 right bronchus,3 trachea and 9 left bronchus. Procedures of APC ＋ cryoablation ＋ anti-TB drugs injection were given in patients with mucus ulcer and tissue hyperplasia. Results 5 cases with mucus ulcer and 4 cases with proliferation were cured after 4 - 10 months treatment using the combination systemic anti-TB approach and local treatment. 5 cases were given expandable nitinol stents placed sequentially due to trachea stenosis and with trachea TB. After one and an half year, the stents were drawn out due to trachea stenosis again. Then a Gianturco covered stent was placed if APC and cryoablation failed. Of 7 stenosis, 2 stents were successfully removed either 3 or 4 months after the placement. 1 obstructed 6 months after the placement. Obstruction was.not relived due to total left lung collapse in 2 patients. 1 patient with left lung etelectasis was cured 6 months after the combination of APC, cryoablation and balloon dilatation. Conclusion. Endobronchial TB could be cured by APC combined with cryoablation and anti-TB drug injection.

关 键 词：气道结核 APC 冷冻 支架 

分 类 号：R655[医药卫生—外科学]