支气管镜下冷冻联合氩等离子电凝治疗中央气道肺癌

The technique of cryosurgery combined with argon plasma coagulation for resecting central airway obstructive tumor via the flexible bronchoscope

目的了解支气管镜下冷冻联合氩等离子电凝治疗中央气道肺癌的效果。方法共35例中央气道肺癌患者接受治疗,采用局部麻醉,支气管软镜下,应用氩等离子凝固治疗仪治疗中央气道阻塞性病变。术中采用冷冻、氩等离子电凝、冻切重复进行。对于较大的病变可分次手术,全部治疗结束1周后评价疗效。评价指标包括术前、术后呼吸困难指数,支气管镜检查等。结果35例患者,共接受治疗76次。术前呼吸困难指数3.1±0.47,术后1.6±0.43,缓解率为84.0%;复查支气管镜,完全有效11例(31.4%),部分有效15例(42.9%),轻度有效5例(14.3%),无效4例(11.4%)。主要副作用包括:术后一过性呼吸困难加重11例(31.4%),咳嗽加重13例(37.1%),少量咯血15例(42.9%)。结论在局麻下采用冷冻联合氩等离子电凝治疗中央气道肺癌近期疗效满意,可有效缓解症状,安全性较高。

Objective To evaluate the effect of cryosurgery combined with argon plasma coagulation for resecting central airway obstructive tumor via the flexible bronchoscope. Methods Endobronchial therapy was performed via flexible bronchoscope by K300 cryosurgery equipment and APC300 equipment for patients who suffered central airway obstructive tumor. The surgery methods include 3 steps, that are cryosurgery, argon plasma coagulation and cryosurgery resection. These 3 steps could be repeated. If the tumor was too large to resect with one surgery, the surgery can be repeated. The effect evaluation was performed at the time of one week after the surgery. The main index included the score of dyspnea and bronchoscope. Results There were 35 patients received 76 therapy procedures. The dyspnea score of preoperative was 3.1 ±0. 47 and the postoperative was 1.6±0. 43. The quantity of complete success patients were 11 （31.4%）, partial success were 15（42. 9% ）, little success were 5（ 14. 3% ） and no success were 4（ 11.4% ）. The main side-effects were transient aggravation of dyspnea（31.4% ）, aggravation of cough（37.1% ） and a little hemoptysis（42.9% ）. Conclusion The method of cryosurgery combined with argon plasma coagulation for resecting central airway obstructive tumor via the flexible bronchoscope is effective and safe.