Xu Xuan, Liu Xicheng, Zhu Bin, Ren Haili, Feng Zhichun, Zhu Yimin
Centre of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100007, China.
Zhonghua Er Ke Za Zhi. 2014 May;52(5):368-72.
To explore the safety and the efficacy of bronchoscopic argon plasma coagulation (APC) combined with CO2 freezing for the treatment of airway granulation hyperplasia after pediatric airway stenting.
From April 2010 to December 2012, APC combined CO2 cryotherapy was performed for granulation tissue hyperplasia in 8 children after airway stenting, their clinical data, complications and postoperative outcomes and follow-up data were analyzed.
Five of the 8 cases were male and 3 female, when stenting their age was 2 to 17 months, the average age was (8.63 ± 5.50) months. Granulation tissue hyperplasia appears in the range of bracket covering, common to both ends of the stent. The time from stentinging to find hyperplasia of granulation tissue was 20 days to 19 months. As a result, in 30%-100% of children airway narrowing was found. We applied APC treatment when the bronchoscopy found hyperplasia lesions, then we used CO2 cryotherapy, i.e., freezing was persisted for 1 min twice and more, then the probe was moved until the APC burning area was entirely frozen, dyspnea in children were significantly improved and two cases of atelectasis patients' lung were completely re-expanded. Eight patients had varying degrees of postoperative low to moderate fever, three cases had a small amount of active bleeding after APC treatment, hemostasis was achieved after topical application of endoscopic injection of epinephrine or reptilase bleeding and freezing, no complications occurred with CO2 cryotherapy. According to the efficacy criteria in this article, the result was significantly effective in 6 cases, effective in 1 case, and partially effective in 1 case.
APC combined with CO2 cryotherapy may be one of the optional methods that rapidly eliminates granulation tissue and remove the airway obstruction, so it can be used in treatment of pediatric airway' benign lesions.
探讨支气管镜下氩等离子体凝固术（APC）联合二氧化碳冷冻治疗小儿气道支架置入术后气道肉芽组织增生的安全性及有效性。
选取2010年4月至2012年12月期间8例气道支架置入术后肉芽组织增生患儿，对其进行APC联合二氧化碳冷冻治疗，分析其临床资料、并发症、术后转归及随访情况。
8例患儿中男5例，女3例，支架置入时年龄2～17个月，平均年龄（8.63±5.50）个月。肉芽组织增生出现在支架覆盖范围内，以支架两端多见。从支架置入到发现肉芽组织增生的时间为20天至19个月。结果发现30%～100%的患儿存在气道狭窄。支气管镜检查发现增生病变时应用APC治疗，之后采用二氧化碳冷冻治疗，即冷冻持续1分钟，重复2次及以上，然后移动探头直至APC烧灼区域完全被冷冻，患儿呼吸困难明显改善，2例肺不张患儿的肺完全复张。8例患儿术后均有不同程度的低热至中度发热，3例患儿APC治疗后有少量活动性出血，经内镜局部注射肾上腺素或立止血后出血停止并冷冻止血，二氧化碳冷冻治疗无并发症发生。根据本文疗效标准，结果显效6例，有效1例，部分有效l例。
APC联合二氧化碳冷冻治疗可能是快速消除肉芽组织、解除气道梗阻的可选方法之一，可用于小儿气道良性病变的治疗。
