大气道癌性梗阻的集束治疗  

The bundle therapy of malignant central airway obstruction

作　　者：韩开宝[1] 汪栋[1] 张传生[1] 周源[1] 孙宏志[1] 路东明[1] 许罡[1] 张剑锋[1] 

机构地区：[1]解放军八一医院全军肿瘤中心胸心外科,南京210002

出　　处：《临床肿瘤学杂志》2009年第9期808-811,共4页Chinese Clinical Oncology

摘　　要：目的：回顾性总结中晚期癌灶侵犯气管、主支气管导致大气道梗阻、呼吸困难的救治方法及疗效。方法：33例气管、支气管癌性梗阻伴呼吸困难患者，7例伴声音嘶哑，12例伴左或右全肺不张，26例伴肺部感染。治疗组27例经纤支镜插入CO2冷冻软探针冷冻摘除肿瘤或植入带膜金属内支架紧急疏通大气道；痰及支气管分泌物培养并应用敏感抗生素；胸腺肽抗肿瘤、抗感染免疫治疗；后续辅助光动力、放疗或伽玛刀、化疗或分子靶向药物治疗。对照组6例未疏通气道，仅放疗、化疗、分子靶向药物及对症治疗。结果：治疗组：22例气道梗阻、呼吸困难及肺部感染完全缓解，4例气道梗阻部分缓解，呼吸困难及肺部感染减轻。1例隆突癌支架置人后继发咯血哮喘，呼吸机支持36小时后死亡，1例28天后死于肺部感染并呼吸衰竭。15例存活6～14个月，中位生存期9个月，另10例仍在随访中。对照组：2例于等待定做内支架的过程中死亡，1例气管重度梗阻，在行表面麻醉后纤支镜检查后出现窒息，于呼吸机支持24小时后死亡，另3例均于1～3个月内死亡。结论：癌肿转移、侵入气管支气管后于腔内生长迅速，短期即可导致气道阻塞、呼吸困难死亡。冷冻摘除肿瘤或植入带膜金属内支架疏通大气道缓解呼吸困难为集束治疗之首，为后续抗肿瘤治疗创造了条件。Objective：To explore the palliative treatment for patients with central airway obstruction due to advanced malig- nancies and its efficacy. Methods ： There were a total of thirty-three patients with carcinous airway obstruction and respiratory distress including 6 cases with hoarse voice, 12 cases with ateleetaisis and 26 with pulmonary infection, which were divided into two groups： remedy group and control group. The remedy group had 27 cases and the control group had 6 cases. In the remedy group, the soft cryo- ablated probe of carbon dioxide and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope, and the continuous therapy was given to these patients, including photodynamic therapy, gamma-knife, radiother- apy or chemotherapy, and/or target therapy. The control group only was cured with gamma-knife, radiotherapy, chemotherapy, and/or target therapy. Results ：In remedy group, there were 22 patients achieved completely remission, including airway obstruction, respira- tory distress and pulmonary infection remission, and 4 cases achieved partial remission. Meanwhile, there were 2 eases death, in which one was with knob invaded death because of hemoptysis and asthema secondarily 36 hours after stent placed. And another death of re- spiratory distress and pulmonary infection remission after 28 days of operation. Fifteen cases has lived for 8-19 months,and 10 eases were following up. In the control group, 2 cases died during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 hours after the operation of bronchofibroscope examination, and the rest of 3 cases died during fol- lowed 1-3 months. Conclusion ：The emergency remedy using soft cryoablated probe of carbon dioxide and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroseope to patients with malignant central airway obstruction is a effective salvage treatment, which cou

关 键 词：气管肿瘤 冷冻外科 内支架 集束治疗 

分 类 号：R730.5[医药卫生—肿瘤]