无痛麻醉下电圈套器联合氩气刀治疗老年中央型晚期肺癌疗效观察

Clinical observation of the treatment of argon knife combined with electric trap in painless anesthesia in senile advanced lung cancer

目的探讨支气管镜下电圈套器联合氩气刀治疗老年中央型晚期肺癌气道狭窄的临床疗效及安全性。方法选取2014年7月至2017年8月连云港市第二人民医院收治的老年中央型晚期肺癌患者68例(鳞癌38例,腺癌22例,小细胞肺癌8例),均在无痛麻醉下采用支气管镜介导下联合应用电圈套器和氩气刀治疗。应用氩气刀时,调节气流速度为0.3~2.0 L/min,输出功率20~40 W,导管前端距离病灶上方约1 cm;应用高频电刀时,电凝探头须直接接触病灶进行灼烧,治疗时间一般为0.5~2.0 h/次,治疗间隔时间3~5 d/次。结果68例患者共行电圈套器及氩等离子体凝固治疗105次,其中1例患者治疗最多达8次。治疗结束时的即刻临床疗效:完全有效38例(55.9%),部分有效23例(33.8%),轻度有效7例(10.3%),即时有效率为100%。所有患者术中、术后均未出现大出血、穿孔等严重并发症,轻微并发症均经对症处理后痊愈。结论无痛麻醉下行电圈套器联合氩气刀治疗老年中央型晚期肺癌,操作性强,患者耐受好,可明显缓解症状,疗效佳,值得临床推广。

Objective Effect of electric trap combined with argon plasma coagulation in the treatment of elderly patients with central advanced lung cancer.Methods From July 2014 to August 2017,68 elderly patients with advanced lung cancer admitted to the Second Hospital of Lianyungang were selected.Under painless anesthesia,all patients were treated by bronchoscopy combined with electric snare and argon knife coagulation.When the argon knife was applied,the airflow velocity was adjusted to be 0.3~2.0 L/min,the output power was 20~40 W,and the catheter was about 1 cm above the lesion.During the application of high-frequency electrotome,the electrocoagulation probe should directly contact the lesion for burning.The treatment time is generally 0.5~2.0 h each time,and the treatment interval is 3~5 d each time.Results 68 patients were treated for 135 times with electric entrap and argon knife,generally 1~4 times for each patient,and one patient was treated 8 times at most.The immediate clinical effect at the end of treatment:38 cases(55.9%)were completely effective,23 cases(33.8%)were partially effective,7 cases(10.3%)were mildly effective,and the immediate effective rate was 100%.There were no serious complications such as hemorrhage and perforation in patients during and after operation.Conclusion The treatment of argon knife combined with electric trap in painless anesthesia is effective in the senile advanced lung cancer,the patients have good tolerance,strong maneuverability,excellent curative effect,can obviously alleviate symptoms,worthy of reference and clinical promotion.