硬质气管镜联合电子气管镜在中心气道重度狭窄治疗中的价值  

The value of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of severe central airway stenosis

作　　者：宫蓓蕾[1] 王开勤 李伟[1] 郇霞 李勤 格桑德吉 高华[1] 武静[1] 许圆圆 沈圆兵[1] 陈余清[1] GONG Beilei;WANG Kaiqin;LI Wei;HUAN Xia;LI Qin;GESANG Deji;GAO Hua;WU Jing;XU Yuanyuan;SHEN Yuanbin;CHEN Yuqing(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004;Department of Respiratory Medicine,People's Hospital of Bozhou City,Bozhou 236800;Department of Respiratory Disease,People's Hospital of Shannan District,Shannan 856000,China)

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科,安徽蚌埠233004 [2]亳州市人民医院呼吸内科,安徽亳州236800 [3]西藏自治区山南市人民医院呼吸科,西藏山南856000

出　　处：《西安交通大学学报（医学版）》2020年第2期268-274,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：安徽省教育厅自然科学研究重点项目(No.KJ2019A0389);西藏自治区组团式援藏医疗项目(No.XZ2017ZR-ZY033);国家自然科学基金面上项目(No.81772493)~~

摘　　要：目的评估硬质气管镜联合电子气管镜在良恶性中心气道重度狭窄治疗中的临床疗效及安全性。方法回顾性分析2015年2月至2019年1月在蚌埠医学院第一附属医院呼吸内镜室行硬质气管镜联合电子气管镜治疗的46例良恶性中心气道狭窄患者的临床资料。分析患者的一般资料、诊断结果、临床表现、影像学及介入治疗情况,评估气道狭窄严重程度、气道狭窄类型、狭窄部位分布,使用呼吸困难指数(MRC DI)、卡氏功能状态评分(KPS)评估临床症状及生活质量改善程度,通过定期随访动态观察评价临床疗效,据术中、术后并发症发生情况进行安全性评估,评价术后转归。结果46例患者年龄(62.43±12.34)岁。气管狭窄36例(78.26%),左主支气管6例(13.04%),右主支气管10例(21.74%),右中间段支气管2例(4.35%);其中恶性中心气道狭窄33例(71.74%),良性病变13例(28.26%)。46例患者共进行58次介入治疗,根据病情选择支架置入、冷冻、球囊扩张等介入治疗方法。介入治疗前气管狭窄程度(85.42±7.81)%,术后为(24.17±5.79)%;右主支气管狭窄程度由介入治疗前的(81.00±17.13)%改善为(20.50±6.43)%,术后左主支气管狭窄程度(24.17±9.14)%,较术前(77.50±16.66)%明显改善,差异均有统计学意义(t=42.73,t=22.43,t=19.02,P均<0.001)。术后MRC DI 0.98±0.62,明显低于术前的3.42±0.57(t=19.65,P<0.001);介入治疗术后KPS(83.91±8.96)明显高于术前(34.01±13.14)(t=21.28,P<0.001)。并发症包括低氧血症4例(8.70%,4/46),一过性室早1例(2.17%,1/46),牙齿脱落2例(4.35%,2/46)。恶性中心气道狭窄患者首次介入治疗后1年生存率为13.79%(4/29),另有4例恶性肿瘤患者随访中;13例良性气道狭窄者目前生活质量良好。结论硬质气管镜联合电子气管镜治疗可迅速缓解中心气道狭窄,安全、可行、有效,能够提高患者的生存质量。Objective To evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis.Methods We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room,The First Affiliated Hospital of Bengbu Medical College.We analyzed the patients'general data,diagnosis results,clinical manifestations,imaging and interventional treatment.The severity,type and distribution of stenosis were evaluated.The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index(MRC DI)and Karnofsky Performance Score(KPS).Through regular follow-up,dynamic observation and evaluation of clinical efficacy,according to the occurrence of intraoperative and postoperative complications,safety assessment was carried out to evaluate the postoperative outcome.The clinical efficacy,safety evaluation and prognosis were observed.Results The average age of 46 patients was(62.43±12.34)years old.36(78.26%)had tracheal stenosis,6(13.04%)had stenosis in the left main bronchus,10(21.74%)in the right main bronchus,and 2(4.35%)in the right middle bronchus.Among them,33 patients(71.74%)had malignant central airway stenosis and 13(28.26%)had benign lesions.Forty-six patients underwent 58 interventional therapies,including stent placement,cryotherapy and balloon dilatation.Endoscopic estimation of the degree of tracheal stenosis was(85.42±7.81)%before the first intervention and(24.17±5.79)%after operation.The degree of stenosis in the right main bronchus was improved from(81.00±17.13)%to(20.50±6.43)%.The degree of left main bronchus stenosis(24.17±9.14)%was significantly improved compared with preoperative(77.50±16.66)%.The difference was statistically significant(t=42.73,t=22.43,t=19.02,P<0.001).The degree of dyspnea was relieved in all the patients.Postoperative MRC DI was 0.98�

关 键 词：硬质气管镜 电子气管镜 中心气道狭窄 

分 类 号：R562.1[医药卫生—呼吸系统]