纤维支气管镜下球囊扩张术治疗中心气道狭窄

Fiberoptic bronchoscopic dilation for central airway stenosis

目的 探讨应用单纯纤维支气管镜下球囊扩张术治疗良性中心气道狭窄的疗效及安全性。方法 静脉镇静加气管内局部麻醉条件下 ,为支气管内膜结核、外伤或平滑肌纤维瘤切除术后出现中心气道狭窄的 5例患者的 9个部位进行了纤维支气管镜直视下球囊扩张术。球囊自纤维支气管镜的活检孔插入 ,直视下扩张。一次扩张不满意者需重复进行。结果 所有患者扩张即刻支气管管径均有不同程度扩大。经过复查 ,5例患者中 4例扩张成功 ,1例失败 ,此例最终经手术确诊为肿瘤性疾病复发 ,已非此类手术的适应证。结论 单纯纤维支气管镜下球囊扩张术安全、见效快 ,可作为各种病变所致的良性瘢痕性中心气道狭窄的首选治疗。

Objective To evaluate the efficacy and safety of fiberoptic bronchoscopic balloon dilation in the treatment of benign central airway stenosis. Methods Five patients with constrictive tracheo-bronchial stenosis underwent balloon dilation through fiberoptic bronchoscopy under intravenous sedation and topical anesthesia. Nine constrictive sites were dilated. Balloon catheter, threaded over the guidewire, was passed through the working cannel of bronchoscope to the target site. Dilatation processes were under the guidance of bronchoscopy. The balloon would be inflated for 30 seconds to 2minutes for each inflation and the constrictive sites were dilated several times with 2～3minutes intervals in a procedure. The dilation would be repeated every week if the airway narrowing remained. The highest pressure was limited to 12 atm for MaxForce dilator and 8 atm for CRE dilator. Results The stenosis was alleviated immediately after each dilatation for most procedures. 8 of 9 sites of airway stenosis acquired permanent improvement. The symptoms, signs, roentgenography and sprirometry showed improvement with different degree in 4 patients. The failed one was proved to have a relapse of leiomyoma. Conclusion Fiberoptic bronchoscopy guided balloon dilation is safe and effective for constrictive stenosis of central airways. Long-term outcome should be investigated in the future.