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[介入肺脏病学的现状]

[Present status of interventional pulmonology].

作者信息

Ohtani Keishi, Ikeda Norihiko

机构信息

Department of Surgery 1, Tokyo Medical University, Tokyo, Japan.

出版信息

Kyobu Geka. 2014 Jul;67(8):710-4.

Abstract

Endobronchial intervention has been well established in therapeutic and palliative methods for patients with malignant and benign airway obstruction. Central airway tumor obstruction could lead to significant dyspnea or hemoptysis and dramatically lower the quality of life. Such symptoms can be relieved immediately via bronchoscopic intervention. Endobronchial therapies such as neodymium yttrium aluminum garnet( Nd:YAG) laser therapy, argon plasma coagulation and microwave coagulation or stent placement are well-established treatment options. Each of these modalities has its specific advantages and disadvantages. Laser therapy is direct thermal ablation applied to endobronchial tumors. It has sufficient power to vaporize tissues and produces an excellent coagulation effect. However, the risk of perforation is high. On the other hand, photodynamic therapy has the curative potential for patients with early superficial lung cancer using low power laser. Moreover, it has recently been approved for the treatment of other cancers including advanced lung cancer. Stent placement is an effective treatment to re-establish airway patency and immediately relieve the patient from life-threatening dyspnea. Stent restenosis, migration, mucus plug and hemoptysis are common short-term and longterm problems. It is important to select the appropriate treatment method for each patient to avoid complications and achieve successful results.

摘要

支气管内介入治疗在恶性和良性气道阻塞患者的治疗及姑息治疗方法中已得到广泛应用。中央气道肿瘤阻塞可导致严重的呼吸困难或咯血,并显著降低生活质量。通过支气管镜介入治疗可立即缓解此类症状。支气管内治疗方法,如钕钇铝石榴石(Nd:YAG)激光治疗、氩等离子体凝固术、微波凝固术或支架置入术,都是成熟的治疗选择。这些治疗方式各有其特定的优缺点。激光治疗是应用于支气管内肿瘤的直接热消融。它有足够的能量汽化组织并产生良好的凝固效果。然而,穿孔风险较高。另一方面,光动力疗法对早期浅表性肺癌患者使用低功率激光具有治愈潜力。此外,它最近已被批准用于治疗包括晚期肺癌在内的其他癌症。支架置入是重建气道通畅并立即缓解患者危及生命的呼吸困难的有效治疗方法。支架再狭窄、移位、黏液栓形成和咯血是常见的短期和长期问题。为每位患者选择合适的治疗方法以避免并发症并取得成功结果非常重要。

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