硬质支气管镜联合纤维支气管镜在气管支气管病变中的应用  

Rigid bronchoscopy combined with flexible bronchoscopy in the management of tracheobronchial diseases

作　　者：张毅[1] 范虹[1] 张新[2] 袁云峰[1] 郭卫刚[1] 钱成[1] 王群[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032 [2]复旦大学附属中山医院呼吸内科,上海200032

出　　处：《复旦学报（医学版）》2012年第5期511-514,共4页Fudan University Journal of Medical Sciences

摘　　要：目的探讨硬质支气管镜联合纤维支气管镜在成人气管支气管病变诊治中的作用和安全性。方法回顾分析2010年9月至2011年6月期间20例大气道疾病患者(8例良性病变,12例恶性病变)进行26次硬质支气管镜联合纤维支气管镜手术的临床资料。全部患者全身麻醉后置入成人通用硬镜,经硬镜腔内置入纤支镜进行全面的检查和评估,酌情选用消融、冷冻、切除、取出及支架放置等操作。结果全部患者均一次成功置入硬镜,无死亡病例和严重并发症发生,1例术中气道创面大量出血,在硬镜下控制出血后,为完整切除肿块而转开胸手术。术中主要并发症为低氧血症(3例,11.5%),均为一过性症状;术后主要并发症为咽喉疼痛(7例,26.9%),经对症治疗后均恢复。结论硬质气管镜联合纤维支气管镜诊治成人大气道疾病安全、有效。Objective To evaluate the feasibility and safety of the application of rigid bronchoscopy combined with flexible bronchoscopy in the treatment of tracheobronchial diseases. Methods We analyzed the clinical data of a cohort of 20 patients with tracheobronchial diseases retrospectively. In this series of cases,8 patients with benign lesions and 12 patients with malignant lesions totally received 26 procedures in the application of rigid bronchoscopy combined with flexible bronchoscopy. The operations were performed under general transvenous anesthesia. After the rigid bronchoscopy was placed in the main trachea through the mouth, the airway was checked out by flexible bronchoscopy and then the lesions were treated by appropriate means such as argon plasma coagulation, repeated freezing, cauterization or mechanical ablation and stent. Results In all patients, the rigid bronchoscopies were placed successfully and all procedures were accomplished without mortality. Intra-tracheal bleeding occurred in one patient with mucoepidermoid carcinoma in the left bronchus, then open thoracotomy was performed immediately after controlling the bleeding through rigid bronchoscopy. Other complications were slight including intra-operative temporary hyoxernia （3 cases,11. 5%） and postoperative pharyngalgia （7 cases,26.9%）. Conclusions Procedures in the application of rigid bronchoscopy combined with flexible bronchoscopy are technically safe and feasible for tracheobronchial diseases.

关 键 词：支气管镜 气管肿瘤 气管异物 气道阻塞 

分 类 号：R562[医药卫生—呼吸系统] R655.3[医药卫生—内科学]