难治性中心气道狭窄的综合介入治疗  

The application of combined interventional procedures for the management of intractable central airway stenosis

作　　者：金发光[1] 傅恩清[1] 谢永宏[1] 李王平[1] 南岩东[1] 刘伟[1] 孙瑞琳[1] 

机构地区：[1]第四军医大学唐都医院,西安710038

出　　处：《中华结核和呼吸杂志》2010年第1期21-24,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的评价5种介入技术联合应用在难治性中心气道狭窄治疗中的价值。方法2001年1月至2008年6月第四军医大学唐都医院呼吸科收住的138例难治性中心气道狭窄患者，经临床、肺功能评价后，根据狭窄的病因、类型、部位、程度、长度以及狭窄远端肺组织和气道功能的不同，选择高频电刀、氩等离子体凝固（APC）、冷冻、支架置入和高压球囊扩张等5种技术中的2种（包括2种）以上方法。138例中高频电刀＋APC治疗42例，高频电刀＋冷冻＋APC治疗54例，高频电刀＋冷冻＋APC＋支架置入治疗29例，冷冻＋APC＋高压球囊扩张治疗13例。达到理想效果1个月后评价气道开放、近期疗效和肺功能改善情况。结果138例患者近期总有效率为100％，气道直径术前为（2．6±1．5）mm，术后为（6．2±1．7）mm；气促评分由术前的（2．4±0．8）减少到术后的（0．7±0．6）。FEV，由术前的（1．8±0．6）％上升到术后的（3．1±0．7）％。23例良性病变（包括4例良性肿瘤，15例结核性狭窄和4例其他肉芽肿狭窄）的患者，3个月随访有5例发生再狭窄需要介入治疗，有效率为78．3％（18／23），6个月随访有3例再狭窄需要介入治疗，有效率为86．9％（20／23），12个月随访23例患者均未见明显狭窄。恶性肿瘤狭窄患者未进行远期随访。结论高频电刀、APC、冷冻、支架置入和高压球囊扩张等5种介入技术联合应用，对难治性中心气道狭窄有较好的效果，该方法并发症少，安全可行，值得临床推广应用。Objective To evaluate the application of combined five interventional procedures in the management of intractable central airway stenosis. Methods Clinical manifestations and pulmonary functions of 138 patients with intractable central airway stenosis were evaluated. Five interventional procedures, including high-frequency electrotome, argon plasma coagulation （APC）, cryotherapy, stent placement and high-pressure balloon dilatation, were used in this study. Among them, two or more procedures were combined to manage complicated airway stenosis according to stenosis causes, types,position, degree and duration,or functions of distal lung tissue and airway. Forty-two cases were treated with high-frequency electrotome and APC, 54 cases with high-frequency electrotome, eryotherapy and APC, 29 cases with high- frequency electrotome,cryotherapy,APC and stent placement, and 13 cases with cryotherapy, APC and high- pressure balloon dilatation. Airways opening, short-term therapeutic effects and improvement of pulmonary functions were evaluated when ideal curative effects were achieved in the first month after intervention. Results The total short-term effective rate in the 138 patients was 100%. The airway diameter was increased from （2. 6 ±1.5 ） mm before operation to （6, 2 ±1.7 ）mm after operation （ P 〈 0. 05 ）. Dyspnea score was decreased from （2. 4 ±0. 8） before operation to （0. 7 ±0. 6） after operation （P 〈 0. 05）. FEV1 was increased from （ 1.8 ±0. 6） L before operation to （ 3.1 ±0.7 ） L after operation （ P 〈 0. 05 ）. Among 23 cases benign disease, including 4 benign tumor, 15 tuberculosis and 4 other granulomatosis,5 cases with various degrees of restenosis needed further interventional therapy after 3 months of follow up and effective rate was 78.3% （18/23）. After 6 months of follow-up ,3 cases with restenosis needed re-intervention, and the effective rate was 86. 9% （20/23）. All of the 23 cases did not experience stenosis after 12 months of follow-up. Pati

关 键 词：高频电刀 氩等离子体凝固(APC) 冷冻 支架置入 高压球囊扩张 

分 类 号：R562[医药卫生—呼吸系统] R735.7[医药卫生—内科学]