支气管镜下氩等离子体凝固联合二氧化碳冷冻技术治疗小儿气道支架置入术后肉芽组织增生八例  

Argon plasma coagulation combined CO2 freezing through the flexible bronchoscope for treatment of airway granulation proliferation in children

作　　者：许煊[1] 刘玺诚[1] 祝彬[1] 任海丽[1] 封志纯[1] 祝益民[2] 

机构地区：[1]北京军区总医院附属八一儿童医院儿童重症科,100700 [2]湖南省儿童医院

出　　处：《中华儿科杂志》2014年第5期368-372,共5页Chinese Journal of Pediatrics

基　　金：十二五国家科技支撑计划项目（2012BA04B01）

摘　　要：目的 探讨支气管镜下氩等离子体凝固（APC）联合CO2冷冻治疗方法治疗小儿气道支架置入术后肉芽组织增生的安全性和有效性.方法 2010年4月至2012年12月,对8例气道支架置入术后出现肉芽组织增生的患儿进行APC联合CO2冷冻治疗,分析患儿临床资料、并发症及术后转归、随访情况.结果 （1）8例中男5例,女3例,支架置入时年龄2～17（8.6 ±5.5）个月.肉芽组织增生出现于支架覆盖范围,以支架两端多见,从置入支架到发现肉芽组织增生的时间为20 d～19个月,肉芽组织阻塞支架处,造成气道狭窄的百分比为30％ ～ 100％.（2）经支气管镜检查发现病灶后,先应用APC治疗仪清除病灶,随即应用CO2冷冻治疗,持续冷冻1 min,需2～3个冷冻-复温周期,将APC烧灼区域全部冷冻.（3）8例疗效显著6例,有效1例,部分有效1例.患儿呼吸困难均明显改善,2例肺不张均完全复张.8例术后均有低中度发热和轻度咳嗽,3例患儿APC治疗后镜下可见活动性出血,对症处理后3d好转.冷冻过程未见特殊并发症.结论 APC联合CO2冷冻治疗方法可用于儿童气道良性病灶的处理,是快速消除肉芽组织增生,解除气道梗阻可选方法之一.Objective To explore the safety and the efficacy of bronchoscopic argon plasma coagulation （APC） combined with CO2 freezing for the treatment of airway granulation hyperplasia after pediatric airway stenting.Method From April 2010 to December 2012,APC combined CO2 cryotherapy was performed for granulation tissue hyperplasia in 8 children after airway stenting,their clinical data,complications and postoperative outcomes and follow-up data were analyzed.Result Five of the 8 cases were male and 3 female,when stenting their age was 2 to 17 months,the average age was （8.63 ± 5.50） months.Granulation tissue hyperplasia appears in the range of bracket covering,common to both ends of the stent.The time from stentinging to find hyperplasia of granulation tissue was 20 days to 19 months.As a result,in 30％-100％ of children airway narrowing was found.We applied APC treatment when the bronchoscopy found hyperplasia lesions,then we used CO2 cryotherapy,i.e.,freezing was persisted for 1 min twice and more,then the probe was moved until the APC burning area was entirely frozen,dyspnea in children were significantly improved and two cases of atelectasis patients＇ lung were completely re-expanded.Eight patients had varying degrees of postoperative low to moderate fever,three cases had a small amount of active bleeding after APC treatment,hemostasis was achieved after topical application of endoscopic injection of epinephrine or reptilase bleeding and freezing,no complications occurred with CO2 cryotherapy.According to the efficacy criteria in this article,the result was significantly effective in 6 cases,effective in 1 case,and partially effective in 1 case.Conclusion APC combined with CO2 cryotherapy may be one of the optional methods that rapidly eliminates granulation tissue and remove the airway obstruction,so it can be used in treatment of pediatric airway＇benign lesions.

关 键 词：支气管镜 氩等离子体凝固 冷冻 肉芽组织 儿童 

分 类 号：R726.5[医药卫生—儿科]