经支气管镜介入冷冻治疗支气管结核22例临床分析

Treating 22 cases of endobronchial tuberculosis with endoscopic interventional cryotherapy

目的探讨经支气管镜介入冷冻治疗支气管结核的疗效。方法经支气管镜介入对22例溃疡坏死型及肉芽增殖型的支气管结核患者进行病变局部冷冻治疗,同时进行全身综合抗结核及雾化治疗,比较治疗前后患者临床症状、镜下表现及影像学检查,以观察其疗效。结果 22例患者经过平均治疗1.5个月,(5±3)次/例的冷冻治疗,临床症状改善明显,原气管、支气管内膜病变绝大部分吸收,肺部病变明显吸收,原狭窄的管腔通畅,阻塞性肺炎和肺不张均消退,但仍有7例残留轻度病变支气管狭窄。显效68.18%(15/22),有效31.81%(7/22),总有效率100%。未见明显不良反应。结论支气管镜介入冷冻治疗可使溃疡坏死型及肉芽增殖型支气管结核患者迅速改善咳嗽、呼吸困难等临床症状,加速气管、支气管局部病变的吸收好转,有效解除病变造成的阻塞性肺炎及肺不张,明显提高抗结核治疗效果,是一种简便、有效、安全的微创方法。

【Objective】To approach the effectiveness of treating endobronchial tuberculosis with endoscopic interventional cryotherapy.【Methods】In addition to chemotherapy and pulverizing inhalation,doing endoscopic focal freezing on 22 cases of endobronchial tuberculosis,which composed of ulcerative necrotic type and proliferating type.The symptoms,endoscopic appearances and rentogenographic films before and after treatment was compared.【Results】The 22 cases patient underwent（5±3） times cryotherapy in the mean course of 1.5 months,showed marked improvement in clinical symptoms,absorption of luminal foci in bronchi,disappearance of plaques in chest plain film,reconstruction of stenotic lumen,cure of atelectasis and secondary pneumonia;only 7 cases of patient carried reminiscent stenosis of bronchial;the regime is proved markedly effective in 68.18% of our cohort;effective in 31.81%,so 100% effective with no adverse reaction.【Conclusions】Treating endobronchial tuberculosis with endoscopic interventional cryotherapy showed antitussive and relieve respiretary distress in short term,promoting the absorption of luminal foci,effectively alleviating the atelectasis and obstructive pneumonia.So this regime is simple effective and safe.