单纯球囊扩张术与冷冻联合球囊扩张术治疗疤痕型结核性气道狭窄的疗效及安全性分析
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摘要
目的探究单纯球囊扩张术与冷冻联合球囊扩张术运用于疤痕型结核性气道狭窄患者的临床疗效及安全性。方法本研究纳入2016年2月至2018年4月期间,深圳市第三人民医院肺病科收治的60例疤痕型结核性气道狭窄的住院患者,依据密封信封法分为对照组和实验组,对照组(n=30)仅采取单纯球囊扩张术进行治疗,试验组(n=30)采取支气管镜下冷冻与球囊扩张联合治疗。比较两组患者手术后治疗有效率、并发症发生率以及治疗后第3个月气管再次狭窄发生率,测定两组患者治疗前以及治疗后第1个月的第一秒用力呼气容积与用力肺活量之比、气道内径测量值。结果对照组与试验组的治疗有效率分别为66.67%(20/30)、93.33%(28/30),两者相比差异有统计学意义(P<0.05)。试验组治疗后第1个月的第一秒用力呼气容积与用力肺活量之比、气道内径测量值分别与对照组比较,差异均有统计学意义(P<0.05)。试验组患者的胸痛、咯血、气胸的发生率分别为43.33%、6.67%、6.67%,较对照组患者的发生率50.00%、10.00%、10.00%稍低,但差异无统计学意义(P>0.05)。试验组与对照组患者治疗后第3个月气管再次狭窄的发生率分别为6.67%、26.67%,两者比较差异有统计学意义(P<0.05)。结论对疤痕型结核性气道狭窄患者实行支气管镜下冷冻与球囊扩张联合治疗具有良好的临床效果及安全性,值得临床应用及推广。
Objective To investigate the efficacy and safety of balloon dilatation compared with cryotherapy combined with balloon dilatation in the management of airway stenosis caused by scar stenosis type of tracheobronchial tuberculosis. Methods A total of 60 patients who were diagnosed as airway stenosis caused by scar stenosis type of tracheobronchial tuberculosis from February 2010 to April 2015 in the partment of Tuberculosis of the Third people's hospital of Shenzhen were enrolled.All patients were divided into 2 groups according to seal the envelope method. Simple balloon expansion treatment method was implemeted in the control group(n=30), and cryotherapy combined with balloon expansion through bronchoscopewas implemented in the experimental group(n=30). The effective rate of postoperative treatment, the incidence of complications with andtracheal restenosis at the third month after treatment were compared between the two groups and the ratio of forced expiratory volume to forced vital capacity and airway inner diameter were measured before treatment and 1 second after treatment. Results The effective rates of treatment in the control group and the experimental group were 66.67%(20/30) and 93.33%(28/30), respectively, with statistically significant differences between the two groups(P < 0.05). Compared with the control group,patients in the experimental group had higher 1 month of the first second forced expiratory volume and the ratio of the forced vital capacity, airway diameter measured values, and there was also a difference in the two group of patients(all P < 0.05).Patients in the experimental group had lower incidence of chest pain,hemoptysis, aerothorax(43.33%, 6.67%, 6.67%) compared with in control group patients(50.00%,10.00%, 10.00%), However, the difference was not statistically significant(P > 0.05).In the experimental group and control group,the incidence of tracheal restenosis in the third month after treatment was 6.67%、26.67%, indicating that index comparison test of statistical significance(P <0.05). Conclusion Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very effective and safe method in the management of airway stenosis caused by scar stenosis of tracheobronchial, and it deserves to be applied and spreaded in the clinic.
Objective To investigate the efficacy and safety of balloon dilatation compared with cryotherapy combined with balloon dilatation in the management of airway stenosis caused by scar stenosis type of tracheobronchial tuberculosis. Methods A total of 60 patients who were diagnosed as airway stenosis caused by scar stenosis type of tracheobronchial tuberculosis from February 2010 to April 2015 in the partment of Tuberculosis of the Third people's hospital of Shenzhen were enrolled.All patients were divided into 2 groups according to seal the envelope method. Simple balloon expansion treatment method was implemeted in the control group(n=30), and cryotherapy combined with balloon expansion through bronchoscopewas implemented in the experimental group(n=30). The effective rate of postoperative treatment, the incidence of complications with andtracheal restenosis at the third month after treatment were compared between the two groups and the ratio of forced expiratory volume to forced vital capacity and airway inner diameter were measured before treatment and 1 second after treatment. Results The effective rates of treatment in the control group and the experimental group were 66.67%(20/30) and 93.33%(28/30), respectively, with statistically significant differences between the two groups(P < 0.05). Compared with the control group,patients in the experimental group had higher 1 month of the first second forced expiratory volume and the ratio of the forced vital capacity, airway diameter measured values, and there was also a difference in the two group of patients(all P < 0.05).Patients in the experimental group had lower incidence of chest pain,hemoptysis, aerothorax(43.33%, 6.67%, 6.67%) compared with in control group patients(50.00%,10.00%, 10.00%), However, the difference was not statistically significant(P > 0.05).In the experimental group and control group,the incidence of tracheal restenosis in the third month after treatment was 6.67%、26.67%, indicating that index comparison test of statistical significance(P <0.05). Conclusion Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very effective and safe method in the management of airway stenosis caused by scar stenosis of tracheobronchial, and it deserves to be applied and spreaded in the clinic.
引文
[1]覃红娟,谭守勇,邝浩斌,等.727例气管支气管结核临床特点分析[J].中国防痨杂志,2017,39(3):238-241.
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[8]马升军,黄海东,王琴,等.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值[J].四川医学,2016,37(2):196-198.
[9]张庆.支气管镜下冷冻结合球囊扩张治疗支气管结核所致气道狭窄24例[J].中国现代药物应用,2016,10(3):34-35.
[10]李王平,金发光,傅恩清,等.改良高压球囊扩张法对支气管结核性瘢痕样狭窄治疗的作用[J].中华肺部疾病杂志(电子版),2015,8(3):14-18.
[11]Fang Y,You X,Sha W,et al.Bronchoscopic balloon dilatation for tuberculosis-associated tracheal stenosis:a two case report and a literature review[J].J Cardiothorac Surg,2016,11(1):21.
[12]Cho YC,Kim JH,Park JH,et al.Tuberculous tracheobronchial strictures treated with balloon dilation:a single-center experience in 113 patients during a 17-year period[J].Radiology,2015,277(1):286-293.
[2]徐春燕,邱忠民,吕寒静,等.支气管镜APC联合CO2冷冻术治疗结核性大气道狭窄的效果及其对气道,动脉血气,肺功能的影响[J].疑难病杂志,2016,15(4):358-361.
[3]丁卫民,傅瑜.气管支气管结核诊断和治疗指南(试行)[J].中华结核和呼吸杂志,2012,35(8):230-238
[4]陈敏,薄丽艳,王琰,等.支气管镜介入技术治疗结核性瘢痕性中心气道狭窄的对照研究[J].国际呼吸杂志,2017,37(8):590-594.
[5]Webster I,Goussard P,Gie R,et al.The indications and role of paediatric bronchoscopy in a developing country,with high prevalence of pulmonary tuberculosis and HIV[J].Expert Rev Respir Med,2017,11(2):159-165.
[6]Kim M,Kang ES,Park JY,et al.Fistula Formation between Right Upper Bronchus and Bronchus Intermedius Caused by Endobronchial Tuberculosis:A Case Report[J].Tuberc Respir Dis,2015,78(3):286-288.
[7]黄珺君,张红,章巍,等.支气管镜下介入治疗早期并发症的独立危险因素[J].北京大学学报(医学版),2016,48(6):1006-1011.
[8]马升军,黄海东,王琴,等.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值[J].四川医学,2016,37(2):196-198.
[9]张庆.支气管镜下冷冻结合球囊扩张治疗支气管结核所致气道狭窄24例[J].中国现代药物应用,2016,10(3):34-35.
[10]李王平,金发光,傅恩清,等.改良高压球囊扩张法对支气管结核性瘢痕样狭窄治疗的作用[J].中华肺部疾病杂志(电子版),2015,8(3):14-18.
[11]Fang Y,You X,Sha W,et al.Bronchoscopic balloon dilatation for tuberculosis-associated tracheal stenosis:a two case report and a literature review[J].J Cardiothorac Surg,2016,11(1):21.
[12]Cho YC,Kim JH,Park JH,et al.Tuberculous tracheobronchial strictures treated with balloon dilation:a single-center experience in 113 patients during a 17-year period[J].Radiology,2015,277(1):286-293.