电视激光硬质气管镜的应用体会

Primary experience of video-assisted rigid laser bronchoscopy in treatment of tracheobronchial tumors

目的 探讨电视激光硬质气管镜治疗大气道内良、恶性肿瘤及外压性恶性狭窄的方法和特点。方法 2 0 0 2年9月至2 0 0 4年11月,应用电视激光硬质气管镜为13例大气道肿瘤病人进行了15次手术治疗。窄蒂良性肿瘤完全镜下取出;宽蒂或延伸至管壁外者中转开胸手术切除;大气道恶性狭窄者采用放置支架,或用电刀、氩气刀或激光灼烧瘤体使之再通的姑息治疗;可切除的原发气管恶性肿瘤,硬质气管镜作为根治术前的准备。结果 良性肿瘤5例次手术:4例镜下完整切除,1例中转开胸切除。恶性肿瘤8例10次手术:3例置入支架,2例姑息切除肿瘤恢复气道通畅,3例开胸完成根治切除吻合。无围术期死亡和严重并发症。结论 硬质气管镜对大气道腔内窄蒂良性肿瘤的完整切除、恶性肿瘤所致大气道狭窄的姑息治疗及原发大气道肿瘤开胸治疗的术前准备有较高的临床价值,而且安全。

Objective To review the primary experience of video-assisted rigid laser bronchoscopy in the treatment of tracheobronchial tumors. Methods From Sep.2002 to Nov.2004, 13 patients (15 procedures) with tracheobronchial tumors were treated with video-assisted rigid bronchoscope. Benign tumors with small pedicles were removed directly. For benign tumors with wide pedicles or tumors extending beyond the wall of air-way, total enucleating through thoracotomy were employed. In cases with malignant tumors, stenosis or obstructions were relieved by implantation of stents or cautering with electric argoulaser knife. For malignant but resectable primary tumors of trachea and main bronchi, rigid bronchoscopy might serue as a preparation of radical resection. Results Of the 5 patients with benign tumors, 4 received endoscopic total resection and 1 were conversed into thoracotomy. For the 8 malignant cases, 3 received stent implantation, 2 had palliative ablation and 3 got curative resections through thoracotomy. No peri-operative complications or death occurred in this group. Conclusion Total resection of benign tracheobronchial tumors or palliative therapy for tracheobronchial malignant stenosis or preparation of radical resection can be performed safely and efficiently by video-assisted rigid bronchoscopy.