全麻下氩等离子电凝联合冷冻治疗中央型肺癌的疗效观察

The curative effects of cryosurgery combined with argon plasma coagulation for resecting central airway obstructive tumor with general anesthesia

目的观察全麻下氩等离子电凝联合冷冻治疗中央气道肺癌的临床疗效。方法对32例中央型肺癌患者,采用全麻下经电子支气管镜下应用氩等离子凝固(argon plasma coagulation,APC,简称氩气刀)联合冷冻治疗中央气道阻塞性病变。术中采用氩等离子电凝、冻切重复进行。对于较大的病变可分次手术,全部治疗结束2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 32例患者共接受治疗52次。术前呼吸困难指数评分(5.01±1.47)分,术后(3.56±1.43)分,手术前后比较,差异有统计学意义(P<0.05);复查支气管镜,完全有效13例,部分有效12例,轻度有效4例,无效3例。主要副作用包括:术后一过性呼吸困难加重10例,少量咯血5例,咳嗽加重3例。结论在全麻下采用氩等离子电凝联合冷冻治疗中央气道肺癌,患者耐受性好,操作性强,近期疗效满意,可明显缓解症状,且安全性较高,具有临床应用价值。

Objective To evaluate the effect of cryosurgery combined with argon plasma coagulation for resecting central way obstructive tumor with general anesthesia.Methods 32 patients of central airway obstructive tumor underwent cryosurgery combined with argon plasma coagulation for resecting via the flexible bronchoscope on condition of general anesthesia.The surgery methods included 2 steps were cryosurgery and argon plasma coagulation.Both of steps could be repeated resection.If the tumor was too large to resect with one surgery,the surgery was 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 32 patients received 52 therapy procedures.The dyspnea score of preoperative was 5.01±1.47 and the postoperative was 3.56±1043.The quantity of complete success patients were 12.The partial success was 14.The little success was 4 and no success was 3.The main side-effects were transient aggravation of dyspnea（10 patients）,aggravation of cough（3 cases） and a little hemoptysis（5 cases）.Conclusion The method of cryosurgery combined with argon plasma coagulati on for resecting central air way obstructive tumor via the flexible bronchoscope on condition is effective and safe.