经支气管镜治疗淋巴结瘘型(Ⅵ型)气管支气管结核的几种方法比较  

Comparison of Several Methods of Bronchoscopic Treatment of Lymph Nodes Fistula Type(Ⅵ) Tracheobronchial Tuberculosis(TBTB)

作　　者：胡智敏[1] 詹枝华[1] 王飞 

机构地区：[1]武汉市医疗救治中心呼吸病介入诊疗科,湖北武汉430023 [2]武汉市结核病防治所检验科,湖北武汉430030

出　　处：《中外医疗》2014年第19期15-17,共3页China & Foreign Medical Treatment

摘　　要：目的通过临床病例资料分析,评价支气管镜下不同组合方式治疗淋巴结瘘型气管支气管结核(TBTB)的效果,以提出最佳治疗方案。方法选择2009年6月—2012年12月收治的38例淋巴结瘘型TBTB患者,根据介入方式分为3组,A组采用局部注如抗结核药物及活检钳病灶清除术,B组采用局部注如抗结核药物及活检钳病灶清除术及冷冻消融术,C组采用局部注如抗结核药物及冷冻消融术。评价不同介入组合的疗效及并发症,各组间病例资料采用四格表χ2检验。结果 38例患者中治疗12月时治愈25例,治愈率为65.8%(25/38),好转13例,总体有效率100%。A组平均支气管镜介入次数(20±4.0)次,B组平均支气管镜介入次数(12±3.0次),C组平均支气管镜介入次数(11±4.0)次,C组与A组比较差异有统计学意义(P<0.05)。3组出血发生率分别为A组77.0%,B组84.0%,C组60.0%,与A B组比较(P<0.05)。C组患者治疗第2、第6月、12月的治愈率显著高于A B两组(P<0.05)。结论淋巴结瘘型TBTB采用支气管镜下局部注如抗结核药物及冷冻消融术可减少支气管镜介入治疗次数,出血并发症少。Objective To evaluate the effect of different combinations of bronchoscopic treatment of lymph nodes fistula type tracheobronchial tuberculosis （TBTB） by analyzing the clinical data so as to put forward the best treatment. Methods 38 cases of lymph nodes fistula type TBTB patients admitted in our hospital from June, 2009 to December, 2012 were divided into 3 groups according to the intervention method. Patients in A group were treated with local injection of anti-TB drugs and biopsy forceps debridement. Patients in B group were treated with local injection of anti-TB drugs and biopsy forceps debridement and cryoablation. Patients in C group were treated with local injection of anti-TB drugs and cryoablation. The efficacy and complications of different intervention combinations were evaluated, the data of the groups of patients adopted chi-square test of four-fold table. Results Of the 38 cases of patients, at the 12 months＇ treatment, 25 cases were cured, the cure rate was 65.8%（25/38）, improved in 13 cases, the overall efficiency was 100%. The average bronchoscopic interventional times of A group were （20±4.0）times, and those of B group were（12±3.0） times, those of C group were 11±4.0 times, the difference between A group and C group was statistically significant（P〈0.05）. the incidence of bleeding of A group, B group, C group was 77.0%, 84.0%, 60.0%, respectively, compared with A group and B group（P〈0.05）. The cure rate of C group at the treatment of 2 months, 6 months and 12 months was much higher than that of A group and B group （P〈0.05）. Conclusion Lymph nodes fistula type tracheobronchial tuberculosis （TBTB） using bronchoscopic local injection of anti-TB drugs and cryoablation therapy can reduce the number of interventional bronchoscopy with less bleeding complications.

关 键 词：淋巴结瘘型气管支气管结核 支气管镜介入 冷冻消融 

分 类 号：R4[医药卫生—临床医学]