气道介入联合光动力疗法治疗晚期中央型肺癌中心气道重度狭窄的有效性和安全性  

Efficacy & Safety : Dealing Severe Central Airway Stenosis in Advanced Central Lung Cancer Jointly with Airway Interventional Therapy and Photodynamic Therapy

作　　者：赵晨茜 牛建明[1] 赵薇[1] 张旭宇[1,2] 许雪林 李润浦 谭艳辉 ZHAO Chenxi;NIU Jianming;ZHAO Wei;ZHANG Xuyu;XU Xuelin;LI Runpu;TAN Yanhui(Department of Respiration&the Second Critical Care,the Second Central Hospital of Baoding,Baoding 072750,China;Department of Respiration,the People's Hospital of Zunhua)

机构地区：[1]保定市第二中心医院呼吸与危重症二科,保定市072750 [2]遵化市人民医院呼吸科

出　　处：《中国激光医学杂志》2022年第2期82-88,共7页Chinese Journal of Laser Medicine & Surgery

基　　金：河北省2019年度医学科学研究项目(20191738);保定市科技计划项目(2041ZF031)。

摘　　要：目的综合评估气道介入联合光动力疗法(photodynamic therapy,PDT)治疗晚期中央型肺癌中心气道重度狭窄的临床疗效,以及对肿瘤标志物和并发症的影响。方法选取2017年2月至2020年5月,晚期中央型肺癌中心气道重度狭窄患者32例,设定为研究组,采用气道介入联合光动力治疗。另选取与纳入研究患者身体情况相似并接受介入治疗的晚期中央型肺癌中心气道重度狭窄患者32例,设定为对照组。分析治疗前、治疗后2周,两组患者细胞角蛋白19片段抗原21-1(cytokeratin-19-fragment antigen 21-1,CYFRA21-1)、血清鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)、癌胚抗原(carcinoembryonic antigen,CEA)及神经元特异性烯醇化酶(neuron-specific enolase,NSE)血清肿瘤标志物水平;气促指数、气道管径、Karnofsky功能状态(karnofsky functional status,KPS)评分、第1秒用力呼吸容积(forced expiratory volume,FEV)占预计值百分比FEV 1%和6 min步行距离(6 minute walking test,MWD),判定临床疗效,并记录并发症发生情况。结果治疗后2周,研究组显效22例,有效7例,总有效率为90.6%;对照组显效5例,有效7例,总有效率为71.9%,两组临床疗效比较,差异具有统计学意义(P<0.05)。治疗后2周,两组患者血清肿瘤标志物水平较治疗前均有所下降,研究组血清肿瘤标志物水平改善水平显著高于对照组(P<0.05)。治疗后2周,两组患者气促指数较治疗前降低,气道管径较治疗前增大,KPS评分、FEV1%、6MWD等相关指标也不同程度得到改善。研究组治疗后2周各相关指标改善情况显著高于对照组,差异具有统计学意义(P<0.05)。对照组患者并发症总发生率(28.1%)高于研究组(6.25%),差异具有统计学意义(P<0.05)。结论气道介入联合光动力疗法治疗晚期中央型肺癌中心气道重度狭窄,可提升临床效果,降低血清肿瘤标志物水平及并发症发生率。Objective To comprehensively evaluate the joint clinical efficacy of airway interventional therapy and photodynamic therapy(PDT) for severe central airway stenosis in advanced central lung cancer as well as their effect on tumor markers and complications.Methods Totally 32 patients of advanced central lung cancer with severe central airway stenosis given jointly airway intervention and photodynamic therapy over the period from Feb.2017 to May 2020 were selected to form the study group.In addition,32 patients of advanced central lung cancer with severe central airway stenosis given only interventional therapy,having physical conditions similar to those in the study group,were selected to compose the control group.For both groups,the clinical efficacy was observed,and cytokeratin-19-fragment antigen 21-1(CYFRA21-1),serum squamous cell carcinoma antigen(SCCA)carcino embryonic antigen(CEA),serum tumor markers(NSE),included breathability index,airway diameter,Karnofsky functional status(KPS)score,percentage of forced expiratory volume in one second and 6 min walking distance(6 MWD)were detected and recorded before and 2 weeks after the treatment respectively.In addition,the complications of both groups were observed and recorded.Results There was a significant difference in clinical efficacy between the two groups(P<0.05).The total effective rate was 90.6% in the study group and 71.9% in the control group.After the treatment,the levels of serum tumor markers decreased in both groups.The improvement of the study group was greater than that of the control group,and the difference was statistically significant(P<0.05).After the treatment,the breathlessness index decreased in both groups,and the airway diameter increased.The improvement of related indexes in the study group was significantly greater than that in the control group 2 weeks after the treatment(P<0.05).In the control group,the total incidence of complications was 28.1%.As to the study,the total incidence of complications was 6.25%.The total incidence of compl

关 键 词：气道介入 光动力疗法 晚期中央型肺癌 气道重度狭窄 癌胚抗原 

分 类 号：R616.4[医药卫生—外科学] R734.1[医药卫生—临床医学]