支气管结石气管镜下表现及处理方式分析  

Analysis of the bronchoscopic manifestations and treatment of broncholithiasis

作　　者：辛涛 王琰 姜华 闫岩 南岩东 金发光 Xin Tao;Wang Yan;Jiang Hua;Yan Yan;Nan Yandong;Jin Faguang(Department of Pulmonary and Critical Care Medicine,Tangdu Hospital,The Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学唐都医院呼吸与危重症医学科,西安710038

出　　处：《中华肺部疾病杂志（电子版）》2024年第3期416-420,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(81970076)。

摘　　要：目的分析支气管结石(broncholithiasis)患者的气管镜下表现及处理方式。方法收集2019年1月到2021年7月我院收治的经内镜完全清除的5例支气管结石患者临床资料,分析气管镜下表现、处理方式及并发症。其中男1例,女4例;合并肺癌术后1例,合并肺结核并支气管结核1例,3例无基础病。支气管结石发病部位:左主支气管2例,左肺上叶1例,右肺上叶尖段1例,右肺下叶基底段1例。镜下表现:白色干酪样坏死样结石3例,灰黑色质硬结石2例,合并有病变部位管腔狭窄或堵塞,同时病变周围合并肉芽组织增生者3例。采用钬激光+活检钳1例,钬激光+活检钳+异物网篮+冷冻1例,冷冻+异物钳1例,鳄鱼口钳1例,活检钳1例。结果5例患者完全取出结石,管腔再通。3例患者少量出血,给予镜下喷洒冰盐水级止血药物止血;1例中量出血,镜下喷洒止血药物,静脉给予垂体后叶素止血;无心衰、恶性心律失常、气胸。结论支气管镜下治疗是治疗支气管结石的重要手段,容易暴露、松动、可经钬激光松解的支气管结石大多可经气管镜完全清除。Objective To investigate the bronchoscopy manifestations and treatment of patients with broncholithiasis.Methods The bronchoscopy manifestations,treatment methods and complications of 5 patients with broncholithiasis that completely removed by bronchoscopy admitted to Tangdu Hospital of Air Force Military Medical University from January 2019 to July 2021 were retrospectively analyzed.Among the 5 patients,1 case was male and 4 cases were female;1 case was complicated with lung cancer after operation,1 case was complicated with pulmonary tuberculosis and bronchial tuberculosis,and 3 cases had no other disease.The location of broncholithiasis:2 cases of left main bronchus,1 case of left upper lobe,1 case of apical segment of right upper lobe,and 1 case of basal segment of right lower lobe.Bronchoscopy findings of broncholithiasis were white or gray⁃blackc hard caseous necrotic stone,associated with lumen stenosis or blockage at the lesion site,and 3 cases were associated with granulation tissue hyperplasia around the lesion.Treatment methods:1 case of holmium laser combined with biopsy forceps,1 case of holmium laser,biopsy forceps,foreign body mesh basket and freezing in 1 case,1 case of freezing,foreign body forceps,1 case of crocodile jaw forceps,1 case of biopsy forceps.Results The lesions of 5 patients were completely removed and the lumen was recanalized.3 patients had a small amount of bleeding,and the bleeding was stopped by spraying ice⁃salt⁃grade hemostatic drugs under the microscope.1 patient with moderate bleeding was sprayed with hemostatic drugs under the microscope,and vasopressin was given intravenously to stop the bleeding.There were no other complications like heart failure,malignant arrhythmia,and pneumothorax.Conclusion Bronchoscopy is an important method for the treatment of broncholithiasis.Most of the broncholithiasis that are easily exposed,loosened and can be decomposition by holmium laser can be completely removed by bronchoscopy,and should be performed in an endoscopy center with ric

关 键 词：支气管结石 气管镜 气道狭窄 治疗 预后 

分 类 号：R563[医药卫生—呼吸系统]