经支气管镜冷冻切除在气管阻塞中的应用  

Application of bronchoscopic cryodebridement for tracheal obstruction

作　　者：王娟[1] 王婷[1] 岳红丽[2] 王玉玲[1] 邱小建[1] 龙剑海 徐敏 张晨阳[1] 张杰[1] Wang Juan;Wang Ting;Yue Hongli;Wang Yuling;Qiu Xiaojian;Long Jianhai;Xu Min;Zhang Chenyang;Zhang Jie(Department of Respiratory and Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院呼吸与危重症医学科,100070 [2]首都医科大学附属北京天坛医院麻醉科,100070

出　　处：《国际呼吸杂志》2021年第16期1212-1218,共7页International Journal of Respiration

基　　金：北京市自然科学基金资助项目(7202042)。

摘　　要：目的:评价经支气管镜冷冻切除术治疗气管阻塞的疗效及安全性并总结应用经验。方法:回顾性研究。分析2009年8月至2020年8月在首都医科大学附属北京天坛医院应用支气管镜冷冻切除技术作为首选方法治疗气管阻塞患者的病历资料。记录病变性质、阻塞程度、长度、类型、形态、位置、麻醉及通气方式、联用器械、手术时长、手术疗效及并发症等情况。结果:共纳入患者67例,均为广基底的内生型或混合型阻塞,主要病因为恶性(43例,64.2%)和肉芽组织增生(18例,26.9%)。声门下气管阻塞28例(41.8%)。术前气管阻塞程度80.0%(20.0%),阻塞长度为(29.04±14.71)mm。术毕气管再通率100.0%,术后呼吸困难缓解率100.0%。术中出血均为轻中度,无严重出血,严重并发症1例(1.5%),无术中、术后死亡。结论:冷冻切除治疗内生型或混合型气管阻塞安全、高效,可用于抢救肉芽组织、多种类型肿瘤引起的严重气管阻塞。对于宽基底、阻塞长度长、病变组织多以及声门下的阻塞有优势。Objective To evaluate the efficacy and safety of bronchoscopic cryodebridement for tracheal obstruction and summarize our experiences.Methods The medical records of patients undergoing bronchoscopic cryodebridement for tracheal obstruction in Beijing Tiantan Hospital,Capital Medical University,from August 2009 to August 2020 were reviewed retrospectively.The reason of lesion,the degree,length,type,shape,location of obstruction,the method of anesthesia and ventilation,combined endoscopic instruments,duration and outcome of operation,and complications were recorded.Results A total of 67 patients were included,all of which were wide-based endogenic or mixed type obstruction.The main reasons were malignant(43 cases,64.2%)and granulation tissue hyperplasia(18 cases,26.9%).Subglottic tracheal obstruction occurred in 28 cases(41.2%).Before operation,the degree and length of tracheal obstruction was 80.0%(20.0%)and(29.04±14.71)mm,respectively.The postoperative tracheal recanalization rate and the dyspnea relief rate were both 100.0%.Intraoperative bleeding was mild to moderate,there was no severe bleeding.Severe complication occurred in 1 case(1.5%)and there was no intraoperative or postoperative death.Conclusions Bronchoscopic cryodebridement is safe and effective in the treatment of endoluminal or mixed type tracheal obstruction,and can be used to rescue severe tracheal obstruction caused by granulation tissue and various type of tumors.It has advantages for wide-based,extended obstruction,bulky tissues and subglottic obstruction.

关 键 词：气管阻塞 支气管镜 冷冻切除 

分 类 号：R653[医药卫生—外科学]