超细支气管镜检查在2例异基因造血干细胞移植后BOS的临床应用价值  

Clinical Application Value of Ultrafine Bronchoscopy in 2 Cases of BOS after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：陈青霞 何雪峰[3] 曾大雄 吴德沛[3] 蒋军红[1] CHEN Qing-xia;HE Xue-feng;ZENG Da-xiong;WU De-pei;JIANG Jun-hong(Department of Respiratory and Critical Care Medicine,Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu,215126,China;Suzhou Medical College of Soochow University,Suzhou,Jiangsu,215123,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属独墅湖医院呼吸与危重症医学科,江苏苏州215126 [2]苏州大学苏州医学院,江苏苏州215123 [3]苏州大学附属第一医院血液科,江苏苏州215006

出　　处：《现代生物医学进展》2024年第8期1530-1534,共5页Progress in Modern Biomedicine

基　　金：江苏省重点研发计划项目(BE2016672);苏州市科技计划发展项目(SKY2021026);苏州市临床重点病种诊疗技术专项项目(LCZX202234)。

摘　　要：目的:探讨超细支气管镜检查在异基因造血干细胞移植(Allo-HSCT)后闭塞性细支气管炎综合征(BOS)中的诊断和治疗作用。方法:回顾性分析2例移植术后3月诊断为BOS患者的临床资料,分析BOS的诊断和治疗特点。结果:我院2例患者从Allo-HSCT到诊断为BOS时间均为移植后3月内,临床表现活动后胸闷气促,肺功能呈混合性通气功能障碍,超细支气管镜检查直视下,观察到左右多部位6级及以上细支气管管腔口薄膜样增生物阻塞管腔,使用活检钳机械扩张或冷冻等方式可以打通闭塞气道,术中、后未发生检查相关并发症,经治疗后患者症状较前明显改善,其中1例患者后续随访其气管镜镜下见原闭塞细支气管管腔治疗后呈持续开放状态。结论:超细支气管镜检查可有效诊断Allo-HSCT后发生BOS,还可通过呼吸介入治疗打开细支气管达到短期肺功能改善。Objective:To explore the diagnostic and therapeutic effect of ultra-fine bronchoscopic interventional in bronchiolitis obliterans syndrome(BOS)after allogeneic hematopoietic stem cell transplantation(Allo-HSCT).Methods:Retrospective analysis of clinical data of 2 patients with BOS diagnosed 3 months after transplantation were collected,and the characteristics of diagnosis and therapeutics of BOS were analyzed.Results:The time from Allo-HSCT to diagnosed of BOS in 2 patients in our hospital was within 3 months after transplantation,the clinical manifestations were chest tightness and shortness of breath after activity,and mixed ventilation dysfunction in lung function,Under the direct vision of ultra-fine bronchoscopy,the membrane-like hyperplasia of the lumen orifice of the bronchioles of grade 6 and above in the left and right sides could block the lumen was observed,and the occluded airway could be opened by mechanical expansion or freezing with biopsy forceps,no examination-related complications occurred during and after the operation,the symptoms of the patients were significantly improved compared with the previous ones after treatment,One patient was followed up and the original occluded bronchiole lumen was continuously open after treatment under bronchoscopy.Conclusion:Ultra-fine bronchoscopy can effectively diagnose BOS after Allo-HSCT,and can also open bronchioles through respiratory interventional therapy to improve short-term lung function.

关 键 词：造血干细胞移植 闭塞性细支气管炎 支气管镜检查 诊断价值 疗效 

分 类 号：R331.2[医药卫生—人体生理学] R332[医药卫生—基础医学] R655.3