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[电子支气管镜下冷冻治疗联合球囊扩张术治疗瘢痕狭窄型气管支气管结核气道闭塞的疗效及安全性]

[Efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis].

作者信息

Qin L, Ding W M, Zhang J Y, Wang W J, Fu W X, Guo Y

机构信息

Department of Endoscopic Diagnosis & Treatment, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2018 Nov 12;41(11):857-862. doi: 10.3760/cma.j.issn.1001-0939.2018.11.006.

Abstract

To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10±4) times, and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53% and 72.45% after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (-15.012, 0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1±0.7), (1.2±0.7) and (1.2±0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (30.398-31.058, 0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.

摘要

探讨经电子支气管镜冷冻治疗联合球囊扩张术治疗瘢痕狭窄型气管支气管结核(TBTB)所致气道狭窄的有效性及安全性。2008年12月至2016年5月,98例TBTB瘢痕狭窄所致气道狭窄患者经微生物学、组织病理学、CT(计算机断层扫描)、支气管重建及支气管镜检查确诊。所有患者均接受常规抗结核化疗及支气管镜下冷冻治疗。气道成功再通的患者随后接受支气管镜下球囊扩张术。通过临床疗效、改良医学研究委员会(mMRC)呼吸困难量表及并发症等指标评估治疗效果。98例患者中,87例气道狭窄经冷冻治疗(10±4)次成功再通,随后接受支气管镜下球囊扩张术(7±3)次。治疗后3个月和12个月的总有效率分别为76.53%和72.45%。对不同治疗效果患者的病程分析显示,治愈病例的中位病程为3个月,有效病例为5个月,无效病例为9个月。无效病例与总有效病例的病程差异有统计学意义(-15.012,0.01)。mMRC评分平均值从术前的(3.8±0.5)分别变为治疗后即刻、3个月和12个月的(1.1±0.7)、(1.2±0.7)和(1.2±0.7)。治疗前后评分差异有统计学意义(30.398 - 31.058,0.01),但治疗后3个评分之间差异无统计学意义。所有病例均未观察到严重并发症。经电子支气管镜冷冻治疗联合球囊扩张术是治疗瘢痕狭窄型气管支气管结核所致气道狭窄的一种非常安全有效的方法。病程较短对患者更有益。

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