经支气管镜氩等离子体凝固联合冷冻技术治疗中央型肺癌伴大气道阻塞  

Study of bronchoscopic argon plasma coagulation combined with cryotherapy in treating airway obstruction caused by central lung cancer

作　　者：桂坤[1] 朱辉[2] 张先明 雷显萍[1] 

机构地区：[1]贵州医科大学附属医院呼吸科,贵州贵阳550004 [2]四川大学华西医院支气管镜室,四川成都610041

出　　处：《现代医学》2017年第6期794-799,共6页Modern Medical Journal

摘　　要：目的:探究支气管镜下氩等离子体凝固术(APC)联合冷冻治疗中央型肺癌患者伴大气道阻塞的临床疗效。方法:选取2010年1月至2016年11月收治的80例中央型肺癌伴大气道阻塞患者,根据随机数表法将其分为观察组和对照组各40例。对照组实施气管腔内放疗,观察组于支气管镜下对突入大气道的肿物行氩等离子体凝固术及冷冻治疗。比较两组治疗后临床症状改善情况、肺功能参数[用力肺活量(FVC)和第一秒用力呼气容积(FEV_1)]、气促等级、生活质量Karnofsky评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分及气道再通效果。结果:观察组咳嗽、胸痛、呼吸困难及咯血症状的改善率均高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者FVC和FEV_1均有所提高,观察组改善更加明显,组间比较差异均有统计学意义(P<0.05)。治疗后两组患者气促等级、SAS评分和SDS评分下降,生活质量Karofsky评分提高,观察组改善更加明显,组间比较差异均有统计学意义(P<0.05)。两组的不良反应发生率差异无统计学意义(P>0.05)。观察组治疗有效率为97.5%(39/40),对照组为65.0%(26/40),差异有统计学意义(P<0.05)。结论:对于晚期中央型肺癌造成的大气道阻塞,支气管镜下氩等离子体凝固术联合冷冻治疗可迅速改善症状,提高患者生活质量,减轻心理负担,短期内效果优于气管腔内放疗。Objective： To study the clinical value of argon plasma coagulation combined with cryotherapy in treating lung cancer patients with central airway obstruction. Methods： 80 lung cancer patients with central airway obstruction,who were treated in our hospital from Jan. 2014 to Jan. 2015,were registered in the study. The subjectives were divided into observation group（ n = 40） and control group（ n = 40） according to the Random Number Table. The observation group was treated with argon plasma coagulation combined with cryotherapy,while the control group was given radiotherapy in tracheal cavity. Improvement of symptoms,parameters of lung function（ by the forced vital capacity,FVC）,one-second forced expiratory volume（ FEV1）,life quality Karnofsky score,anxiety SAS score,depression SDS score and airway recanalization status were compared and analyzed between the two groups. Results： More patients improved theire symptoms of cough,chest pain,dyspnea and hemoptysis status in the observation group than those in the control group in（ P〈0.05）. After the treatment,the FVC and FEV1 of observation group were higher than those of control group（ P〈0. 05）; Comparing to the control group,the polypnea level,SAS and SDS scores were lower in the observation group（ P〈0. 05）. Furthermore,the Karofsky score in the observation group was significantly higher than that of the control group（ P〈0. 05）. There were no statistical differences in adverse reaction rate between the two groups（ P〉0.05） and the efficiency rate of was higher in the observation group[97. 5%（ 39/40） ] when compared to the control group[65.0%（ 26/40） ]（ P〈0. 05）. Conclusions： Argon plasma coagulation combined with cryotherapy is promising in improving life quality and relieving psychological burden in lung cancer patients with central airway obstruction,and the overall clinical efficacy is better than tracheal cavity radiotherapy.

关 键 词：中央型肺癌 气道阻塞 支气管镜 氩等离子体凝固术 冷冻疗法 

分 类 号：R655.3[医药卫生—外科学]