经支气管镜钬激光碎石在支气管结石患者治疗中的应用  

Holmium： yttrium-aluminum-garnet （ Ho： YAG） laser lithotripsy in the treatment of broncholithiasis

作　　者：程渊[1] 章巍[1] 张红[1] 刘莹[1] 李楠[1] 曹菊[1] 王广发[1] 

机构地区：[1]北京大学第一医院呼吸和危重症医学科,100034

出　　处：《中华结核和呼吸杂志》2017年第1期29-33,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨经支气管镜钬激光碎石在支气管结石治疗中的应用。方法回顾性分析2012年5月至2015年10月北京大学第一医院收治的因支气管结石行经支气管镜钬激光碎石的6例患者，其中男2例，女4例，中位年龄60岁；临床表现为慢性咳嗽2例，咯血2例，反复发生肺炎2例；支气管结石位于右侧5例，左侧1例，主支气管2例，段支气管及以下4例；结石类型为腔内型2例，透壁型4例。所有患者在全身麻醉和硬质气管镜或支气管镜下采取钬激光碎石。钬激光设置参数范围：脉冲频率5-10Hz，脉冲能量0．8-1．2J，使用365汕m光导纤维。对钬激光碎石的方法、效果及并发症进行分析和总结。结果患者症状均明显缓解；2例腔内型结石完全清除，4例透壁型患者中，1例完全清除，3例部分清除。并发症：术中大出血1例，术后支气管瘘1例，术后肺炎2例。远期无明显并发症。结论经支气管镜钬激光碎石在支气管结石治疗中效果及安全性较好，常见近期并发症为出血、支气管瘘和感染，远期未见明显并发症。Objective To assess the effectiveness of Ho： YAG Laser in the treatment of broncholithiasis. Methods We retrospectively reviewed the clinical data of 6 patients who underwent Ho： YAG Laser lithotripsy in Peking University First Hospital during May 2012 to October 2015. 4 females and 2 males, with a median age of 60 years, were enrolled. Among 6 patients, persistent cough （ n = 2 ） , hemoptysis（ n = 2） , recurrent pneumonia（ n = 2） were the main clinical symptoms. Broncholiths were found in the left side in 1 patient and right side in 5 patients. 2 broncholiths were located in main bronchus and 4 in segmental bronchus. There were 2 patients with intraluminal broncholiths and 4 with transbranchial broncholiths. All 6 patients received Ho：YAG Laser（0. 8 - 1.2 J pulse energies, 5 - 10 Hz frequencies, 365 ~xm laser fibers） under rigid bronchoscopy in general anesthesia and experienced relief of symptoms. Results Complete removal of broncholith was accomplished in intraluminal broncholith group and 1 patient in transbracnhial broncholith group, the other 3 transbracnhial broncholiths were partly removed. Complications included perioperative massive hemolysis （ n = 1 ）, bronchoesophageal fistula （ n = 1 ） and postoperative pneumonia （n = 2） , no long term complications were encounted. Coneluslon The Ho： YAG were associated with acute complications including fistula, perioperative massive hemolysis, infections and no long-term side effects. It represents a safe and effective therapy option for broncholithiasis.

关 键 词：钬 碎石术 激光 支气管结石 

分 类 号：R655.3[医药卫生—外科学]