经支气管镜应用针形电刀治疗气道腔内疾病的临床研究  

A clinical research on treatment of airway stenosis using needle-shaped electric knife via bronchoscope

作　　者：常金来 张杰[1] 邱小建[1] 王娟[1] 裴迎华[1] 王玉玲[1] 王婷[1] 徐敏 张晨阳[1] Chang Jinlai, Zhang Jie, Qiu Xiaojian, Wang Juan, Pei Yinghua, Wang Yuling, Wang Ting, Xu Min, Zhang Chenyang.(Department of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, Chin)

机构地区：[1]首都医科大学附属北京天坛医院呼吸科,100050

出　　处：《国际呼吸杂志》2018年第8期566-572,共7页International Journal of Respiration

摘　　要：目的 通过对临床资料的回顾性分析,了解经支气管镜应用针形电刀治疗气道腔内疾病的种类、病变部位及疗效,同时了解应用针形电刀的相关并发症,为呼吸介入医师在临床实践工作中提供参考及借鉴.方法 回顾2007年4月至2015年3月首都医科大学附属北京天坛医院呼吸科收治的经支气管镜应用针形电刀治疗的患者资料.分析其治疗的气道疾病种类、病变部位及严重程度、疗效及相关并发症、通气方式的选择、联合其他介入技术等情况,并进行汇总及结果统计.结果 230例气道狭窄患者中增生性病变112例（48.70%）,瘢痕性病变118例（51.30%）,其中增生性病变中91例为恶性疾病,瘢痕性病变均为良性病变.声门下、气管上段、气管中段、气管下段病变141例,左主支气管及其以下支气管病变33例,右主支气管及其以下支气管病变34例,累及隆突病变22例.气道狭窄程度以重度气道狭窄为主,气道狭窄程度达Ⅲ ～ Ⅳ级的共288例次（88.89%）.术前、术后呼吸困难指数差异有统计学意义（Z = -19.602,P 〈0.05）.气管镜检查气道腔内总再通疗效有效率为91.66%.术中、术后无严重并发症.结论 针形电刀能够迅速有效解除气道阻塞,缓解气促症状,既可用于治疗增生性病变,也适于治疗瘢痕性病变引起的气道狭窄.该介入治疗技术简单、有效、安全、并发症少、经济实用,值得在临床中推广应用.Objective Through the retrospective analysis of clinical data,to understand the lesions types,locations,efficacy and complications in the treatment of airway diseases using needle-shaped electric knife via bronchoscope,in order to provide reference for interventional physicians in clinical practice. Methods The clinical data of patients who received interventional bronchoscopy treatment with application of needle-shaped electric knife in Beijing Tiantan Hospital affiliated to Capital Medical University from April 2007 to March 2015 were analyzed retrospectively.The types,locations,severity of the lesion,efficacy,related complications,choice of ventilation mode,and other interventional techniques were analyzed.Results 230 patients were admitted.112 patients （48.70% ） had hyperplastic lesions,in which 91 were malignant cases.118 patients （51.30% ） had cicatricial lesions,and all of them were benign cases.Lesions location of 141 patients were at subglottic and trachea,33 patients at left bronchus,34 patients at right bronchus,and 22 patients at carina.Most patients in this study were severe airway stenosis,and 288 cases （88.89% ） had stenosis of grade Ⅲ-Ⅳ.The dyspnea index before and after operation had statistical significance （ Z = -19.602, P 〈 0.05）.The efficacy rate of recanalization therapy for airway was 91.66%.There were not severe complications during and after operation. Conclusions Needle-shaped electric knife can rapidly relieve airway obstruction and shortness of breath.It could not only be used to treat hyperplastic lesion,but also be used to treat airway stenosis caused by cicatricial lesion.This technique has the advantages of simple operation,efficacy,safety,and fewer complications,which is worthy of clinical application and promotion.

关 键 词：针形电刀 支气管镜 呼吸内镜 介入治疗 气道狭窄 

分 类 号：R56[医药卫生—呼吸系统]