介入性肺脏病学技术在中心气道狭窄治疗中的作用及安全性分析:附389例报告

Retrospective analysis on efficacy and safety of interventional therapy for pulmonary disease with central airway stenosis:a report of 389 cases

目的探讨介入性肺脏病学技术在中心气道狭窄治疗中的作用及安全性评价。方法对389例确诊为中心气道狭窄的患者,根据病因和病情轻重不同,在积极治疗原发病的同时,经支气管镜引导进行电刀、激光、氩离子凝固术、冷冻、高压球囊扩张、支架置入、局部注射药物和灌洗清理术。根据狭窄再通和气促评分情况评价疗效。结果所有患者中,电刀治疗154例,激光治疗18例,冷冻治疗76例,APC治疗69例,高压球囊扩张35例,支架置入21例,局部多点注射药物16例。患者经支气管镜介入治疗1个月后评价疗效。完全有效152例(39.1%),部分有效138例(35.5%),轻度有效67例(17.2%),总有效率为91.8%;无效32例(8.2%),其中死亡17例(4.4%)。389例患者术后气促评分(0.7±0.4)较术前(1.8±0.5)明显降低(P<0.05)。结论对于中央气道狭窄的患者及时选择正确的介入治疗方法,有利于迅速解除气道梗阻,改善呼吸功能。介入性肺脏病学技术较为安全、有效、简便,易被患者接受,值得临床推广应用。

Objective To investigate the efficacy and safety of interventional therapy for central airway stenosing pulmonary disease. Methods In 389 petients diagnosed as central airway stenosis, their primary diseases were handled timely and correctly. On the basis of handling the primary disease, eetral airway stenosis was treated by interventional techniques, including electrosurgical unit （ESU）, laser, argon plasma coagulation, freezing, high-pressure balloon expansion, stent implantation, local injection and toilet with lavag.Following the American College of Chest Physicians （ACCP） guidelines, the therapeutic effects were evaluated based on correction of stenosis after interventional treatment and the dyspnea scores. Results Of the 389 patients, 154 were treated with electrosurgical unit under bronchoscopy, 18 with laser, 76 with freezing, 69 with argon plasma coagulation, 35 with high-pressure balloon expansion, 21 with tracheobronchial stent implantation, and 16 with local injection and laving clearance Evaluation of the therapeutic effects was made one month after the interventional treatment. As a result of the interventional treatment, a complete relieve was observed in 152 cases（39. 1%）, partial relieve in 138 cases （35.5%）, mild response in 67 cases （17.2%）, no response in 32 cases （8.2%）, and with 17 deaths （4.4%）. The total effective rate was 91.8%. The dyspnea scores were 1.8±0.5 before the treatment, and 0.7±0.4 after the treatment, with statistically significant difference （P〈0.05）. Conclusions A timely and correct interventional treatment for the patients with central airway stenosis is beneficial in relieving airway obstruction and amelioration of respiratory function. Interventiorlal treatment for such pulmonary pathology is safe, effective, easy-to-handle and acceptable, and is worthy to be recommended for clinical application.