高频电凝联合冷冻治疗结核干酪样坏死的价值  

Value of high-frequency electrocoagulation combined with cryotherapy for tuberculosis associated caseous necrosis

作　　者：罗莉 周磊 雷战平 肖阳宝 Luo Li;Zhou Lei;Lei Zhanping;Xiao Yangbao(Endoscopy Center,Hunan Chest Hospital,Changsha 410016,China;Department of Pathology,Human Chest Hospital,Changsha 410016,China)

机构地区：[1]湖南省胸科医院内镜中心,长沙410016 [2]湖南省胸科医院病理科,长沙410016

出　　处：《国际呼吸杂志》2022年第3期211-217,共7页International Journal of Respiration

基　　金：湖南省临床医疗技术创新引导项目(2020SK50701);长沙市自然科学基金课题(kq2014187)。

摘　　要：目的探讨经支气管镜高频电凝联合冷冻治疗结核干酪样坏死的应用基础及疗效。方法本研究为病例对照研究。采用非随机抽样方法纳入2019年1月至2021年12月湖南省胸科医院通过支气管镜诊治的气管支气管结核患者101例。根据冷冻及高频电凝治疗前,钳夹病变气道坏死物难易程度;HE染色及Masson染色分析坏死物结构及纤维化程度,分为质软组(34例,经支气管镜下冷冻治疗)和质韧组(67例)。其中2019年1月至2020年12月的病例为质韧对照组(35例,经支气管镜下冷冻治疗),2021年1月至2021年12月的病例为质韧实验组(32例,经支气管镜下高频电凝联合冷冻治疗)。运用免疫组织化学对比质软、质韧2种坏死物的转化生长因子β1、Ⅰ型胶原蛋白表达。对比3组介入疗效。结果Masson染色定量分析示质韧组的胶原纤维表达高于质软组[(0.155±0.058)μm2比(0.077±0.054)μm2],免疫组织化学示质韧组转化生长因子β1、Ⅰ型胶原蛋白的蛋白阳性表达率高于质软组(P值均<0.05)。质韧实验组冷冻治疗次数低于质韧对照组[5.0(4.0,5.8)次/例比6.0(4.0,10.0)次/例,Z=2.76,P=0.006]。质韧实验组的气道坏死物消失时间短于质韧对照组[8.0(6.0,10.0)周比10.0(6.0,13.0)周,Z=2.49,P=0.013]。结论结核质韧坏死物的炎症及纤维化明显,可能加重气道狭窄。采用高频电凝联合冷冻治疗可加快结核质韧坏死物清除,减少冷冻次数,安全有效。Objective To explore the basic application and therapeutic effect of bronchoscopic high-frequency electrocoagulation(HFEC)combined with cryotherapy for tuberculosis associated caseous necrosis.Methods This case-control,non-random study included 101 patients with tracheobronchial tuberculosis,who diagnosed by bronchoscopy in Hunan Chest Hospital from January 2019 to December 2021.Before intervention of HFEC combined with cryotherapy,according to the difficulty of using clamp technique in airway necrosis,the structure and fibrosis of necrosis being analyzing by HE staining and Masson staining,those patients were divided into soft group(n=34,received bronchoscopic cryotherapy)and tough group(n=67);the patients in tough group were also divided into tough control group(n=35,received bronchoscopic cryotherapy from January 2019 to December 2020)and tough experimental group(n=32,received bronchoscopic HFEC combined with cryotherapy from January 2021 to December 2021).Immunohistochemistry was used to compare the expression of transforming growth factor beta 1(TGF-β1)and collagen-1(Col-1)of soft and tough necrosis;as well as the therapeutic effect among three groups were compared after intervention.Results Masson staining quantitative analysis showed that the expression of collagen fibers in caseous necrosis in tough group was higher than that in soft group([0.155±0.058]μm2vs[0.077±0.054]μm2);immunohistochemistry results indicated that the protein positive expression rate of TGF-β1,Col-1 in caseous necrosis were increased in tough group than in soft group(all P<0.05);the frequency of bronchoscopy cryotherapy was decreased in tough experimental group than in tough control group(5.0[4.0,5.8]times/cases vs 6.0[4.0,10.0]times/cases,Z=2.76,P=0.006);the disappearance time to airway necrosis was shorter in tough experimental group than in tough control group(8.0[6.0,10.0]weeks vs 10.0[6.0,13.0]weeks,Z=2.49,P=0.013).Conclusions When inflammation and fibrosis of tuberculous tough necrosis were obvious,tuberculous airway steno

关 键 词：结核 肺 支气管疾病 支气管镜检查 溃疡 坏死 瘢痕狭窄 高频电凝 

分 类 号：R521[医药卫生—内科学]