硬质气管镜结合纤维支气管镜治疗气管支气管病变

Combined application of rigid bronchoscopy and flexible fibrobronchoscopy in the treatment of tracheobronchial tumors

目的探讨硬质气管镜（硬质镜）结合纤维支气管镜（纤支镜）治疗气管支气管疾病的价值.方法2002年9月至2005年10月,应用硬质镜结合纤支镜为23例气管支气管病变者进行了25次手术.男17例,女6例;年龄24～79岁,平均（53.9±14.5）岁;良性肿瘤9例次,恶性肿瘤14例/16次.采用静脉全身麻醉,经硬质镜腔内置入纤支镜对气管进行全面的检查和评估,再利用硬质镜器械进行冷冻、肿瘤切除及放置支架等操作,最后以纤支镜止血并处理管壁残余病变.结果全组病例手术均顺利,无死亡病例和严重并发症发生.除2例恶性肿瘤根治及1例肿瘤基底浸润广而中转开胸外,无1例因内镜操作原因而中转开胸的病例.术后随访3～32个月,良性病人均生存;恶性者中3例于术后2周至3个月死于其他疾病,其余11例目前生存,最长已达8个月.结论硬质气管镜结合纤维支气管镜治疗气管支气管病变安全、可靠,效果确实.

Objective To evaluate the application of rigid bronchoscopy combined with fibrobronchescopy in the management of tracbeobrouchial tumors. Methods From Sep.2002 to Oct.2005, 23 patients with tracheobronchial tumors, including 17 males and 6 females, aged 24-79 years [average （53.9±14.5） years]underwent rigid bronchoscopic operations. 14 cases were malignant, the other 9 were benign tumors. All 25 operations were carried out under venous general anesthesia with high frequency jet ventilation （HFJV）. After the rigid bronchoscope was placed in the main trachea, the airway was firstly chocked with fibrobrouchoocope, and the tunmor was removed by repeated freezing, cauterization or mechanical ablation, and a stent was implanted when needed. Results In this group, no mortality or major morbidity occurred. All 25 procedures were accomplished endoscopicaUy. 3 patients afterward underwent segmental tracheotomy through thoracotomy. No tumor recurrence occurred in the 9 patients with benign tumors. Of the 14 malignant cases, 3 patients died two weeks to three months post-operatively of other disease; the rest 11 patients are still alive. Conclusion Rigid brouchescopy combined with flexible fibrobronchoocopy can be applied safely and effoctively in the ~nt of trachenbronchial tumors.