局麻下氩等离子体凝固切除中心气道阻塞性病变

The Technique of Argon Plasma Coagulation for Resecting Central Airway Obstructive Lesions via the Flexible Bronchoscope under Local Anesthesia

目的了解局麻下氩等离子体凝固切除中心气道阻塞性病变的有效性。方法局部麻醉、支气管软镜下,应用ERBE的氩等离子体凝固(argon plasma coagulation,APC)300型氩气刀治疗中心气道阻塞性病变。结果31例伴有38处中心气道阻塞的患者,共接受氩等离子体凝固治疗71次。10例良性肿瘤、肉芽肿和瘢痕病变,有效率为90%,13例恶性肿瘤,有效率为53.8%。疗效还与病变位置有关,位于气管的病变有效率为77%,主支气管和右中间段支气管的病变为62%,而叶支气管的病变为50%。重症患者在局麻下难以完成手术,病变大者在局麻下治疗难度大。结论在局麻下采用氩等离子体凝固(APC300)可以有效、安全地切除部分小的中心气道阻塞性病变,特别是大气道的良性病变。

Objective To evaluate the effect of argon plasma coagulation for resecting central airway obstructive lesions via the flexible bronchoscope under local anesthesia. Methods Endobronchial therapy with APC300 made by ERBE in Germany was performed via flexible bronchoscopy under local anesthesia for patients with central airway obstructive lesions. Results Between November 2003 and June 2006, 31patients with 38 lesions received 71 APC procedures. Efficacy rates were 90% of cases with benign tumor, granulation and cicatricial tissue formation, 53.8% of cases with malignant tumor, efficacy rates were 77% of lesions in tracheal, 62% of lesions in main stem bronchi and bronchus intermedius; 50% of lesions in lobe bronchi. These patients in bad health and/or with large central airway lesions may not bear APC procedures. Conclusion APC is an effective and safe method to resect part small central airway obstructive lesions, especially those benign lesions in big airway.