经支气管镜钬激光治疗气管乳头状腺瘤1例并文献复习

The clinical features of endotracheal papillomatosis and treatment of it with holmium:YAG laser under electron-bronchoscope-A report of 1 case

目的加强对气管乳头状腺瘤临床特点的认识及观察经支气管镜钬激光治疗的临床疗效。方法对1例28岁男性气管乳头状腺瘤患者,经电子支气管镜钬激光进行切除术,并复习文献。结果气管乳头状腺瘤少见。临床表现为逐渐出现喘鸣、活动后呼吸困难、打鼾、双侧呼吸音减低,呼吸频率和心率增快、血压增高、血氧饱和度(SaO2)下降、血氧分压(PaO2、)下降及二氧化碳(PaCO2)升高。本例经支气管镜钬激光治疗后患者喘鸣、呼吸困难消失,血气分析示pH、PaO2、SaO2分别由7.31、74 mm Hg和92%上升到7.40、95mm Hg和97%,PaCO2由46 mm Hg下降至38 mm Hg;治疗后30、60、180、360天复查未见复发。治疗中无并发症。结论成人气管乳头状腺瘤少见,早期容易误诊,行支气管镜检查可明确诊断;经支气管镜引导下钬激光切除疗效显著、安全可靠。

Objective To analyse the clinical features of the endotraeheal papillomatosis, and review article and evaluate the clinical efficacy and safety of holmium：YAG laser under eleetron-bronehoseope for the treatment of papillomatosis in a adult patient. Methods The patient was male,28 years old, suffering from endotraeheal papillomatosis and was treated with holmium：YAG laser under eleetron-bronehoseope in Beijing Hospital. Results There was lower incidence of endotraeheal papillomatosis. The early stage of endotraeheal papillomatosis formation was difficulty to he found and ease to he misdiagnosed to other diseases. The clinical manifestation gradually showed by wheezing and dyspnoea, The bilateral breathing sound gradually beeamed lower, the respiratory＇ rate, heart rate and blood pressure gradually increased more than before respectively. Arterial Blood gas analysis on room air showed that pH, PaO2 and SaO2 gradually decreased more than before respectively. PaCO2 gradually increased more than before during endotracheal papillomatosis formation. This patient had no more dyspnoea after the operation. Arterial Blood gas analysis on room air showed that pH,PaO2 and SaO2 increased from 7.31,74mm Hg,92% to 7.40,95mm Hg,97% respectively and PaCO2 decreased from 46mm Hg to 38mm Hg. The endotraeheal papillomatosis didn＇t recur when observed with eleetron-bronehoseope 30,60,180,360 days after operation. No complications were observed during the operation. Conclusions It is indicated that there is lower incidence of endotraeheal papillomatosis and is ease to he misdiagnosed, the holmium：YAG laser therapy under eleetron-bronchoseope is a safe and effective method for treating it.