通气管辅助下气管球囊扩张成形术治疗良性气管狭窄——与常规气管球囊扩张成形术的比较  

Management of benign tracheal stenosis by small-diameter tube-assisted bronchoscopic balloon dilatation： compared with conventional bronchoscopic balloon dilatation

作　　者：梁毅林 郑厚文[1] 陈乐城 姚伦凯 黎雨[1] 谭小玉[1] 柳广南[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：《国际呼吸杂志》2015年第16期1219-1225,共7页International Journal of Respiration

基　　金：广西自然科学基金（桂科攻12300015）

摘　　要：目的比较通气管辅助下与常规方法纤维支气管镜气管球囊扩张成形术治疗良性气管狭窄的疗效及安全性。方法对2009年8月至2013年12月因不同病因致良性气管狭窄收住广西医科大学第一附属医院呼吸内科的49例患者按首诊日期随机分为A、B两组，分别采用常规方法纤维支气管镜气管球囊扩张成形术和通气管辅助下纤维支气管镜气管球囊扩张成形术治疗。并测量术前、术后狭窄段气管内径、气促评分，检测球囊扩张成形术术前、术中、术后血气分析，监测操作过程中脉搏氧饱和度；评价疗效和并发症发生情况。结果A组22例患者进行了48次常规方法纤维支气管镜气管球囊扩张成形术治疗，B组27例患者进行了54次通气管辅助下纤维支气管镜气管球囊扩张成形术治疗。A、B两组患者治疗后呼吸困难症状均立即缓解，狭窄段气管内径分别由（5．61±1．21）mm增加到（12．06±1．17）mm（t=29．759，P〈0．001），由（5．68±1．53）mm增加到（12．88±1．36）mm（t=30．927，P〈0．001）；气促评分分别由3．44±0．85下降到0．52±0．62（t=20．065，P〈0．001），由3．43±0．84下降到0．48±0．57（t=25．278，P〈0．001）。术前、术中、术后血气分析检测结果PaO2、PaCO2变化分别为：A组：（98．13±24．59）mmHg、（84．73±17．62）mmHg、（97．22±21．21）mmHg（F=6．255，P=0．003）和（45．91±7．01）mmHg、（46．98±6．68）mmHg、（41．06±4．62）mmHg（F=12．616，P〈0．001）；B组：（101．38±27．26）mmHg、（99．55±30．70）mmHg、（98．61±22．07）mmH2g（F=0．176，P=0．839）和（43．64±3．96）mmHg、（49．99±6．81）mmHg、（40．01±3．51）mmHg（F=53．231，P〈0．001）。两组即时有效率均为100．0％；在经过1～4次纤维支气管镜气管球囊扩张成形术治疗后，A组、B组分别有59．1％和85．2％的患者在1个随访周期内症�Objective To compare the efficacy and safety of small-diameter tube-assisted bronchoscopic balloon dilatation and the conventional bronchoscopic balloon dilatation in the management of benign tracheal stenosis. Methods Forty-nine patients with benign tracheal stenosis were randomly divided into two groups according to the date of diagnosis. The patients in the group A were treated with conventional bronchoscopic balloon dilatation and the patients in the group B were treated with small-diameter tube-assisted bronchoscopic balloon dilatation. The tracheal diameter, dyspnea index, blood gas analysis results, pulmonary function, efficacy and complications were evaluated before, during, and after the bronchoseopic balloon dilatation procedure. Results 48 times of conventional bronchoscopic balloon dilatation procedures were performed in 22 patients in group A, and 54 times of small-diameter tube- assisted bronchoscopie balloon dilatation procedures were performed in 27 patients in group B. Dyspnea in all patients was immediately improved after bronchoseopic balloon dilatation. In group A, the tracheal diameter remarkably increased from （5.61±1.21） mm to （12.06±1.17） mm （t =29.759, P 〈 0. 001）, the dyspnea index showed significant decrease from 3.44± 0.85 to 0. 52 ± 0.62 （ t = 20. 065, P 〈 0. 001） ,PaO2 in procedure was followed as： before the operation （98.13 ± 24.59） mmHg, during the operation （84.73＋17.62） mmHg,aher the operation （97.22±21.21） mmHg （ F =6. 255, P =0. 003）, and PaCO2 was followed as：before the operation （45.91 ± 7.01） mmHg, during the operation （46.98± 6.68） mmHg,after the operation （41.06± 4.62） mmHg （ F = 12. 616, P 〈0. 001）. In group B, the tracheal diameter remarkably increased from （5.68±1.53） mm to （12.88±1.36） mm （ t = 30. 927, P 〈 0.001） ,the dyspnea index showed significant decrease from 3.43 ± 0. 84 to 0.48 ± 0.57 （t = 25. 278, P 〈 0. 001）,PaO2 was followed as： before the operation （101.38±27.

关 键 词：良性气管狭窄 气管球囊扩张成形术 纤维支气管镜 通气管 

分 类 号：R654.2[医药卫生—外科学]