经支气管镜氩离子凝固术治疗中心型肺癌咯血的临床研究

Clinical research on treatment of hemoptysis in central lung cancer with argon plasma coagulation by bronchoscope intervention

目的评价和分析经支气管镜氩离子凝固术(APC)治疗中心型肺癌咯血的临床疗效。方法用不同方法对84例中心型肺癌咯血患者APC治疗并观察其疗效。结果全组患者均顺利完成治疗,未出现严重并发症及咯血加重。所有患者治疗后均即刻止血,有效率100%,但治疗后有不同程度的咯血复发。单用APC治疗与联合止血药物灌洗治疗在3天内复发、1周后复发率和总复发率的差异均无统计学意义(均P>0.05),不同出血病灶部位在各时段咯血复发率的差异具有统计学意义(均P<0.05)。结论经支气管镜APC治疗中心型肺癌咯血是一种简便、有效、安全的方法,但有不同程度的复发。短期咯血复发与咯血量、出血部位有关,与TNM分期无关。联合止血药物灌洗对防治咯血复发帮助不大,需进一步研究其它方法联合APC以更好控制远期咯血复发。

Objective To evaluate and analyze the clinical effect on the treatment of hemoptysis in central lung cancer with argon plasma coagulation（APC） by bronchoscope intervention.Methods The clinical data and curative effect of 84 hemoptic patients with central lung cancer treated by APC were retrospectively analyzed.Results All patients completed the treatment.No serious complication or aggravated hemoptysis was observed.Hemoptysis was stopped immediately in all patients after the treatment and the effective rate was 100%.No significant difference could be observed in recurrence of hemoptysis between APC treatment group and combined treatment of APC and hemostatic drug lavage group within 3 days,over 1 week period or total period（P0.05）.Considering the different bleeding lesions,the recurrence rate of hemoptysis was clearly different in each period of time（P0.05）.Conclusion It is a simple,efficient and safe method to treat hemoptysis in central lung cancer with APC by bronchoscope intervention.However hemoptysis may recur sometimes.Recurrence of short-term hemoptysis is relevant to the hemoptic amount and bleeding position but not to the TNM staging.Combined treatment of APC and hemostatic drug lavage contributes very little to the prevention of hemoptic recurrence.Further research is necessary to develop some other methods combined with APC to better control the long-term hemoptic recurrence in central lung cancer.