From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea.
Radiology. 2015 Oct;277(1):286-93. doi: 10.1148/radiol.2015141534. Epub 2015 May 7.
To evaluate the safety and effectiveness of balloon dilation in the treatment of tuberculous tracheobronchial strictures (TTBSs) in a series of 113 patients at a single institution.
The institutional review board approved the study and waived the requirement to obtain informed consent. Between 1997 and 2014, under bronchoscopic and fluoroscopic guidance, a total of 167 balloon dilation sessions were performed in 113 consecutive patients (14 male and 99 female patients; mean age, 37 years [age range, 17-73 years]), with a range of one to eight sessions per patient (mean, 1.5 sessions). Outcomes were number and/or frequency of balloon dilations, technical success, primary and secondary clinical success, improvement in respiratory status, airway patency rate, and alternative treatment after balloon dilation. A two-tailed paired t test and the Kaplan-Meier method were used to evaluate the improvement in respiratory status and airway patency rate after balloon dilation, respectively.
Dilation was successful in 82 patients (73%) after single (n = 67) or multiple (n = 15) balloon dilations, with a mean follow-up of 30.3 months. Clinical failure occurred in 31 patients (27%). In these 31 patients, symptoms recurred 1 day to 113 months (mean, 13 months) after repeat balloon dilations. These 31 patients required alternative treatment, including temporary stent placement (n = 12), cutting balloon dilation (n = 12), radiation-eluting balloon dilation (n = 3), and surgery (n = 4). Before, immediately after, and 1 month after the procedure, pulmonary function test results showed significant improvements in mean forced vital capacity (P < .001), forced expiratory volume in 1 second (P = .001), forced expiratory flow in the midexpiratory phase (P = .020), and peak expiratory flow (P = .005).
Balloon dilation of TTBSs is a safe, minimally invasive primary treatment that relieved symptoms in a large percentage of patients (73%). In patients with TTBSs refractory to balloon dilation, temporary stent placement, cutting balloon dilation, or radiation-eluting balloon dilation can be an alternative treatment.
在一家机构的 113 例患者中评估球囊扩张治疗结核性气管支气管狭窄（TTBS）的安全性和有效性。
机构审查委员会批准了该研究，并豁免了获得知情同意的要求。1997 年至 2014 年，在支气管镜和透视引导下，对 113 例连续患者（14 例男性和 99 例女性患者；平均年龄 37 岁[年龄范围 17-73 岁]）进行了总共 167 次球囊扩张，每个患者的球囊扩张次数为 1 至 8 次（平均 1.5 次）。结果包括球囊扩张次数和/或频率、技术成功率、主要和次要临床成功率、呼吸状况改善、气道通畅率以及球囊扩张后的替代治疗。使用双尾配对 t 检验和 Kaplan-Meier 法分别评估球囊扩张后呼吸状况和气道通畅率的改善。
113 例患者中有 82 例（73%）在单次（n = 67）或多次（n = 15）球囊扩张后成功扩张，平均随访 30.3 个月。31 例（27%）患者出现临床失败。在这 31 例患者中，症状在重复球囊扩张后 1 天至 113 个月（平均 13 个月）时复发。这 31 例患者需要替代治疗，包括临时支架置入（n = 12）、切割球囊扩张（n = 12）、放射洗脱球囊扩张（n = 3）和手术（n = 4）。在手术前、手术后即刻和 1 个月时，肺功能测试结果显示平均用力肺活量（P <.001）、1 秒用力呼气量（P =.001）、用力呼气中期流速（P =.020）和呼气峰流速（P =.005）均有显著改善。
TTBS 的球囊扩张是一种安全、微创的主要治疗方法，可使大部分（73%）患者的症状得到缓解。对于对球囊扩张有抵抗性的 TTBS 患者，临时支架置入、切割球囊扩张或放射洗脱球囊扩张可作为替代治疗方法。
