纤维支气管镜下气管插管扩张术治疗良性气管狭窄  

Management of benign tracheal stenosis by intubation dilatation under flexible bronchoscopic guidance

作　　者：李文涛[1] 肖阳宝[1] 柳广南[1] 黄斯明[1] 凌芸[1] 张建全[1] 钟小宁[1] 

机构地区：[1]广西医科大学第一附属医院呼吸内科,南宁530021

出　　处：《中华医学杂志》2011年第42期2995-2998,共4页National Medical Journal of China

摘　　要：目的探讨纤维支气管镜（简称纤支镜）引导下气管插管扩张术治疗良性气管狭窄的效果和安全性。方法回顾分析广西医科大学第一附属医院呼吸内科2010年3月至2011年8月采用纤支镜引导下气管插管扩张术治疗的12例不同原因所致良性气管狭窄患者的临床资料，其中男5例，女7例，年龄27—65岁，平均（37±11）岁。经纤支镜引入不同管径气管插管逐渐扩张狭窄的气管，并联合气管球囊扩张术扩张左或右主支气管，视需要临时置人金属支架，分别于术前和最后一次球囊扩张术后的当天，对患者狭窄段的气道直径、气促评分和第1秒用力呼气量（FEV1）、血气分析进行测定，并对并发症的发生情况进行评价。结果12例患者分别接受气管插管及气管球囊扩张术1～5次后，呼吸困难迅速缓解，动脉血pH值、氧分压及血氧饱和度较治疗前明显升高，动脉血二氧化碳分压明显下降，即刻疗效达到了100％；狭窄气管，支气管的直径由治疗前的（5．7±1．2）mm增加至（12．2±2．1）mm，FEV，由术前的（0．67±0．13）L，升高至（1．73±0．37）L，差异均有统计学意义（均P〈0．01）。结论纤支镜引导下气管插管扩张术治疗良性中心性气道狭窄安全、有效。Objective To evaluate the efficacy and safety of intubation dilatation under flexible bronchoscopic guidance in the management of benign tracheal stenosis. Methods A retrospective analysis of the clinical data was performed for 12 patients with benign tracheal stenosis from March 2010 to August 2011. There were 5 males and 7 females with a mean age of 37 ± 11 years old （range： 27 -65）. They were treated by intubation dilatation with different sizes under bronchoscopie guidance. And balloon dilatation was also performed for left or right main stem bronchial stenosis. And metal stents were implanted if necessary. Airway diameter, dyspnea index, complications and blood gas analysis were evaluated in all patients. And the forced expiratory volume in one second （ FEV1 ） was tested in 9 cases before and after the treatments of intubation dilation, balloon dilation and other interventions. Results One to five attempts of intubation dilation were required to achieve satisfactory dilatation. There was immediate postoperative relief of dyspnea for all 12 cases. And PaO2 and SaO2 rose markedly, but PaCO2 declined after intervention. The effective rate of intubation dilation was 100%. The average airway diameter increased from （5.7 ±1.2） to （ 12. 2±2. 1 ） mm and FEV1 improved from （0. 67± 0. 13 ） to （ 1.73 ± 0. 37 ） L （ P 〈0. 01 ）. Conclusion The minimally invasive management of benign tracheal stenosis with intubation dilatation is both safe and efficacious.

关 键 词：气管狭窄 导管插入术 中央 支气管镜检查 

分 类 号：R655.3[医药卫生—外科学]