Luo L Z, Luo L, Lu Z B, Ding Y, Luo H L, Zhou L, Xiao Y B
Endoscopic Centre, Hunan Chest Hospital, Changsha 410013, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2021 Mar 12;44(3):237-242. doi: 10.3760/cma.j.cn112147-20210108-00022.
To investigate the efficacy of balloon dilatation performed for patients who suffered from actively caseating endobronchial tuberculosis (EBTB) and central airway stenosis in clinical improving period who's bronchus has not formed mature scar tissue. A total of 152 tuberculous unilateral main bronchus stenosis patients (23 male and 129 female) who received treatment in Hunan Chest Hospital from January 1 2014 to December 31 2018 were included in this retrospective analysis. The age was 15-66 (33.3±11.9) years old. All patients received routine anti-tuberculosis chemotherapy. Sixty-four of them who suffered from actively caseating EBTB and unilateral main bronchus stenosis received cryotherapy and endobronchial isoniazid (INH) administration till the caseating necrosis in stenotic bronchus was disappeared and ulcers were recovered, and then received balloon dilatation combined with cryotherapy, were test group. Eighty-eight of them who suffered from fibrostenotic EBTB received balloon dilatation combined with cryotherapy were control group. We analyzed the efficacy and complications after treatments. The lung re-expansion rate after treatment in test group was higher than the control group, and the differences were statistically significant [74.0%(37/50) 37.9%(22/58), 14.094, <0.001]. The 6-month re-stenosis rate in test group was lower than control group, and the differences were statistically significant [10.9%(7/64) . 30.7% (27/88), 8.318, =0.004]. The differences of diameter and diameter variation after balloon dilatation, immediate effective rates, average times of balloon dilatation and procedure-related bleeding (<10 ml) rates, chest pain rates had no statistical signification in two groups. Severe complications including fatal bleeding (>100 ml) and mediastinal emphysema did not occur during our procedures. Performing balloon dilatation for patients who suffered from actively caseating EBTB and central airway stenosis in the clinical improvement period, when caseous necrosis tissue disappeared and ulcers were recovered, not only helps to perform interventional procedures on distal bronchus in time, increase the rate of lung re-expansion, can also reduce the rate of re-stenosis after 6 months, so it is effective and safe.
为探讨对处于临床好转期、支气管尚未形成成熟瘢痕组织的活动性干酪样支气管内膜结核（EBTB）合并中央气道狭窄患者进行球囊扩张术的疗效。本回顾性分析纳入了2014年1月1日至2018年12月31日在湖南省胸科医院接受治疗的152例结核性单侧主支气管狭窄患者（男23例，女129例）。年龄为15 - 66（33.3±11.9）岁。所有患者均接受常规抗结核化疗。其中64例患有活动性干酪样EBTB且单侧主支气管狭窄的患者，先接受冷冻治疗及支气管内注射异烟肼（INH），直至狭窄支气管内的干酪样坏死消失、溃疡愈合，然后接受球囊扩张联合冷冻治疗，为试验组。另外88例纤维狭窄性EBTB患者接受球囊扩张联合冷冻治疗，为对照组。我们分析了治疗后的疗效及并发症。试验组治疗后的肺复张率高于对照组，差异有统计学意义[74.0%（37/50）对37.9%（22/58），χ² = 14.094，P <0.001]。试验组6个月再狭窄率低于对照组，差异有统计学意义[10.9%（7/64）对30.7%（27/88），χ² = 8.318，P =0.004]。两组球囊扩张后的直径及直径变化、即刻有效率、平均球囊扩张次数及术中相关出血（<10 ml）率、胸痛率差异均无统计学意义。术中未发生包括致命性出血（>100 ml）和纵隔气肿在内的严重并发症。对处于临床好转期、干酪样坏死组织消失且溃疡愈合的活动性干酪样EBTB合并中央气道狭窄患者进行球囊扩张术，不仅有助于及时对远端支气管进行介入操作，提高肺复张率，还能降低6个月后的再狭窄率，因此是有效且安全的。
