纤维支气管镜下球囊扩张术在治疗结核性气道瘢痕狭窄中的应用

The application of balloon dilatation through fiberoptic bronchoscopy in tuberculous tracheobronchial scar stenosis

目的探讨纤维支气管镜介导下球囊扩张术在治疗结核性气道瘢痕狭窄中的应用价值。方法在局麻下,对11例结核性气管支气管患者的13处瘢痕狭窄部位实施球囊扩张术,每周1次,连续2～4次。X线胸片、CT扫描动态监测手术前后气道开放以及肺复张情况。于术前和最后一次球囊扩张后当天对狭窄气道直径、气促分数和第一秒用力呼吸容积(FEV1)和用力肺活量(FVC)进行测定。结果11例患者平均接受球囊扩张治疗2.7次,扩张后支气管管径较前明显增大,症状显著缓解,X线胸片和CT扫描显示肺复张,即刻疗效达100%,远期90.9%。术后狭窄段支气管直径、气促评分、肺功能指标(FEV1、FVC)均明显改善(P<0.05)。结论球囊扩张术治疗结核性气管支气管瘢痕狭窄操作简便、安全,疗效显著,可作为临床首选治疗方法。

Objective To investigate the clinical value of balloon dilatation through fiberoptic bronchoscopy in tuberculous tracheobronchial scar stenosis. Methods 11 patients were treated with balloon dilatation through flexible fiberoptic bronchoscopy under local anesthesia once a week and repeated 2-4 times continuously. The chest X-ray and CT were used to observe the situation of airway open and pulmonary reexpansion. Before the treatment and immediately after the last opera- tion, airway diameters, dyspnea index, FEV1 and FVC were evaluated in all patients. Results The average operation time of the balloon dilatation was 2.7 for per patient. After the op- eration, the bronchus diameter increased obviously, and the symptoms alleviated. The X-ray and CT showed the pulmonary reexpansion. The immediate curative effect reached to 100% and the long-term 90. 9%. The bronchus diameter, dyspnea index, FEV1 and FVC were improved significantly（P〈0.05）. Conclusion Bronchoplasty with ballnoon dilatation though flexible fiberoptic bronehoscopy is a handy, effective and safe method to treat tuberculosis tracheobronehial scar ste- nosis and can be preferred.