硅酮支架治疗气管支气管结核所致气道狭窄的效果分析（附17例总结）  

Efficacy of the silicone stent for the treatment of tracheobronchial tuberculosis

作　　者：周子青 陈愉[1] 钟长镐[1] 陈小波[1] 唐纯丽[1] 苏柱泉[1] 李时悦[1] ZHOU Zi-qing CHEN Yu ZHONG Chang-hao CHEN Xiao-bo TANG Chun-li SU Zhu-quan LI Shi-yue.(Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China)

机构地区：[1]广州呼吸疾病研究所广州医科大学附属第一医院呼吸疾病国家重点实验室国家临床医学研究中心,510120

出　　处：《中国防痨杂志》2017年第3期226-230,共5页Chinese Journal of Antituberculosis

基　　金：卫生部重大行业专项（201402024）;广东省科技厅项目（20130319c）

摘　　要：目的 评价硅酮支架置入治疗气管支气管结核（tracheobronchial tuberculosis,TBTB）的疗效和安全性.方法 回顾性分析2014年1月至2016年12月广州医科大学附属第一医院因气道狭窄符合置入硅酮支架手术的17例TBTB患者的疗效及并发症.结果 17例患者共成功置入16枚支架,术后主支气管平均直径从（3.44±0.69） mm增加到（10.81±1.52） mm,差异有统计学意义（t=16.43,P=0.001）;气管下段狭窄的4例患者气管直径从术前的7.0（5～8） mm增加到术后的15.5（14～16） mm,差异有统计学意义（Z=-2.34,P=0.019）;平均1s用力呼气容积（FEV1）从术前的（1.63±0.47）L增加到术后1周的（2.33±0.51）L、术后3个月的（2.35±0.46）L,差异均有统计学意义（t=4.24、4.52,P值均=0.001）,但FEV1术后3个月与术后1周差异无统计学意义（t=0.14,P=0.990）.呼吸困难评分（mMRC）从术前的2.0（1～4）分降低到术后的0.0（0～2）分,差异有统计学意义（Z=-4.64,P=0.001）.术后发生纵隔气肿并气胸1例、痰液潴留1例,随访过程中发现支架移位3例、肉芽组织增生5例,及时处理后均很快恢复.结论 使用硅酮支架置入治疗符合适应证的TBTB气道狭窄患者,疗效良好,安全性较高.Objective To evaluate the efficacy and the safety of the silicone stent in treatment of tracheobronchial tuberculosis.Methods The efficacy and complications in 17 patients of tracheobronchial tuberculosis with tracheal stenosis who had silicone stent insertion were analysed retrospectively from January,2014 to December,2016 in the First Affiliated Hospital of Guangzhou Medical University.Results Sixteen silicone stents were successfully inserted into 17 patients.Average diameter of main bronchus increased from （3.44 ± 0.69） mm to （10.81 ± 1.52） mm （t =16.43,P =0.001） after operation.The diameter of lower tracheal stenosis was increased from 7.0 （5-8） mm to 15.5 （14-16） mm in 4 patients （Z=-2.34,P=0.019）.Average forced expiratory volume in 1 second （FEV1） significantly improved after stent insertion for 1 week （（2.33±0.51） L） and 3 months （（2.35±0.46） L） （versus pre-planting （（1.63±0.47） L） （t=4.24,P=0.001;t=4.52,P=0.001）,but FEV1 for 1 week and 3 months after stent insertion was similar （t=0.14,P=0.990）.Modified medical research council （mMRC） dyspnea scale decreased from 2.0 （1-4） for pre-planting to 0.0 （0-2） for post planting （Z=-4.64,P=0.001）.Postoperative complications were occurred in 8 patients including pneumomediastinum （n=1）,stent migration （n=3）,mucus plugging （n=1）,granulomas hyperplasia （n=5）,but all complications were mild and were successfully managed endoscopically.Conclusion Inscerting silicone stent is a safe and effective treatment for patients suffering post-tuberculosis tracheobronchial stenosis.

关 键 词：结核 气管疾病 气管狭窄 弹性聚硅酮类 支架 治疗结果 

分 类 号：R523[医药卫生—内科学]