经气管镜冷冻联合药物灌注对透壁型纵隔支气管旁淋巴结结核的治疗作用

Bronchoscopic cryotherapy combined with drugs infusion in the treatment of transbronchial tuberculous mediastinal lymphadenitis

目的总结并评价透壁型纵隔支气管旁淋巴结结核气管镜下特征和冷冻联合药物灌注治疗的临床疗效。方法回顾性分析2008年10月至2011年4月在第二军医大学附属长海医院呼吸内科行气管镜检查并接受冷冻联合抗结核药物灌注治疗的23例透壁型纵隔支气管旁淋巴结结核患者的支气管镜镜下表现，评价介入联合治疗的次数、时间、效果、并发症及复发率。结果23例患者中男8例，女15例，年龄17～47岁，平均（31±10）岁。透壁型纵隔支气管旁淋巴结结核镜下表现有干酪样坏死型、肉芽肿结节型或两者同时存在，部分病灶可见碳末沉着。共发现41个病灶，其中25个发生于右侧，通常发生在全身抗结核治疗后（3．4±0．6）个月，冷冻治疗中位次数为3（1—6）次，药物灌注的中位次数为8（6～11）次，多发病灶与单发病灶在冷冻治疗及药物灌注治疗次数方面无明显差别，38个病例治疗有效（38／41）。治疗后气管镜检查可见黏膜光滑、管腔通畅，个别患者管壁局部碳末沉着或轻度瘢痕组织增生。常见并发症为局部少量出血、支气管纵隔瘘，远期未见复发。结论冷冻治疗联合药物灌注是一种治疗透壁型纵隔淋巴结结核的简单、安全、有效的方法。

Objective To summarize the bronchoscopic features of transbronchial tuberculous mediastinal lymphadenitis and to observe the clinical efficacy of cryotherapy combined with drug infusion through bronchoscope. Methods Twenty-three cases of tuberculous mediastinal lymphadenitis diagnosed at Changhai Hospital were retrospectively analyzed. The bronchoscopic manifestations and the times, course, efficacy, complications and recurrence rate after treatment with eryotherapy combined with drug infusion were described. Results The mean age of the patients was （31 ~ 10） years and the male to female ratio was 1： 1.9. A total of 41 transmural lymph node lesions were found, usually after （3.4 ±0. 6） months with systemic anti-tuberculosis chemotherapy. The lesions occurred at the fight side in 21 cases （ 60. 98% ）. Endoscopic manifestations included caseous necrosis, granulomatous nodules, or both simultaneously, some lesions containing anthraeotic substances. The median treatments of cryotherapy and drug infusion were 3 （ 1 - 6） times and 8 （ 6 - 11 ） times respectively. No significant difference was found between multiple lesions and single lesion group in the treatment of combination therapy. Therapeutic efficacy was 38/41 with improvement of bronchoseopie manifestations to smooth mucosa, lumen pateney, mild anthracotie pigmentation or scar tissue. The rate of complications which included local bleeding and mediastinal bronchial fistula was 3.59%. No recurrence occurred in a long-term follow-up period. Conclusion Combination of cryotherapy and drug infusion through bronchoscope is a simple, safe and effective method to treat transbronehial tuberculous mediastinal lymphadenitis.