纤维支气管镜下剑鞘状气管观察及其与COPD关系

Observation of Saber-Sheath Trachea under Fiberbronchoscope and Relationship Between Saber-Sheath Trachea and Chronic Obstructive Pulmonary Disease

目的研究纤维支气管镜下气管剑鞘状形态改变及其临床意义。方法观察2000-2006年到我院纤维支气管检查室行支气管镜检查,镜下显示胸腔段气管呈剑鞘状改变的74例患者,测量患者内镜下和胸部CT其胸腔段主动脉弓上方10mm层面气管内横径与内矢状径,使用该段气管内横径与内矢状径比值（气管指数）来表示剑鞘状气管形态变化程度。同时分析临床资料及其肺功能检查结果。结果剑鞘气管74例,气管内冠状径的长度范围是6.3-17.6mm,均值为（9.3±3.6）mm,内矢状径的长度范围是13.4-31.8mm,均值为（19.5±6.4）mm,气管指数的范围是0.41-0.68。74例患者均有慢性咳嗽、咳痰病史,68例有慢性阻塞性肺疾病（C0PD）的影像表现,肺功能检查结果显示49例可诊断为中重度阻塞性肺通气功能障碍。结论剑鞘气管的形成是由于COPD气管软骨环的损伤、重塑和营养不良性骨化所致,可协助临床诊断中重度COPD。

Objective To investinate the change of shape of the saber - sheath trachea and its clinical significance. Methods Seventy four patients with both saber - sheath trachea were collected during the period of 2000 - 2006. All cases were recruited from the patients who received broncho- scope examination in bronchoscopic room of second affiliated hospital of Zhengzhou university. Continuous 10mm slice axial CT scans of the chest were performed in all cases. The internal coronal and sagittal diameters of the trachea were measured at the level of 10mm above the aortic arch. The distorted degree or saber - sheath shaping was expressed by the ratio of the internal coronal diameter to the sagittal diameter（ trachea index）. The clinical data and the results of the lung function examination were considered in all cases. Results The internal coronal diameter ranged from6. 3mm to 17.6mm, with the mean of（9. 3 ± 3.6）mm, while the internal sagittal diameter ranged from 13.4mm to 31.8mm, with the mean of（ 19.5±6.4）mm. The tracheal index was 0. 41 ±0. 68. All cases have the case history of chronic cough and expectoration. Sixty eight patients have the image of chronic obstructive pulmonary disease （COPD）. The results of the lung function examination have showed that 49 cases can be diagnosed as midst and heavy degree of obstructive pulmonary ventilation function disturbance, close relationship between saber - sheath trachea and COPD was found. Conclusion The formation of saber - sheath trachea is caused by the injury of the tracheal cartilage due to chronic coughing, resulting in remodeling and dystrophic ossification of the cartilage. Saber - sheath trachea is a helpful sign for the diagnosis of rather severe COPD,