氩等离子体凝固切除中心气道内阻塞性病变的疗效

The efficacy of endobronchial argon plasma coagulation in the management of intraluminal obstructive lesions of the central airway

目的了解氩等离子体凝固切除中心气道内阻塞性病变的疗效。方法 2003年11月至2006年12月收治的53例伴有中心气道阻塞性病变患者,男37例,女16例,平均年龄55(14～82)岁,其中恶性肿瘤28例,良性肿瘤13例,其他疾病12例。使用局部麻醉或全身麻醉,支气管镜下应用德国 ERBE 公司氩等离子体凝固300型机切除病变。根据病变切除程度、狭窄再通和临床资料判断疗效。结果 53例患者的病变分布于86处,有效切除病变的成功率分别为:气管内病变97%(35/36),主支气管79%(22/28),叶支气管和中间段支气管64%(14/22);良性病变的成功率(92%,34/37)高于恶性病变(76%,37/49)。中心气道严重阻塞致呼吸衰竭的患者18例,全身麻醉下经氩等离子体凝固治疗即刻缓解。结论氩等离子体凝固适用于切除中心大气道的腔内增生性病变;治疗后即刻起效,可以用于抢救急诊重症病例。重症患者应该给予全身麻醉和机械通气,以提高介入治疗的成功率和安全性。

Objective To evaluate the efficacy of endobronchial argon plasma coagulation （APC） in the management of intraluminal obstructive lesions of the central airway. Methods A total of 53 patients （37 males, 16 females）, aged from 14 to 82 years（ mean 55 ）, with intraluminal obstructive lesions of the central airways were selected, including 28 cases of malignancies, 13 cases of benign tumors and 12 cases of other diseases. Endoscopic management of these lesions with APC 300 （ERBE, Germany） was performed under local or general anesthesia. The result of treatment was evaluated according to recanalization of the obstructed airway and clinical data. Results There were 86 lesions in the 53 cases. Success rates for resecting the lesions were 〉 97% （35/36） in the trachea, 79% （22/28） in the mainstem bronchi, and 64% （14/22） in the intermediate bronchus and lobe bronchi. The success rate for resecting benign lesions （92%, 34/37） was higher than for malignant lesions （76%, 37/49）. Eighteen cases with respiratory failure caused by the lesions were immediately relieved after APC therapy under general anaesthesia and mechanical ventilation. Conclusions APC is an effective method for resecting intraluminal obstructive lesions of the central airways. APC produces immediate effects, and may be life-saving for patients with airway obstructing lesions requiring emergent endoscopic treatment. General anaethesia and mechanical ventilation can be used to increase successful rates and safety of interventional therapy in severe cases.