经电子支气管镜局部化疗治疗支气管内膜结核的近远期疗效对照研究

A comparative analysis of short and long term effect of local chemotherapy of endobronchial tuberculosis by electronic bronchoscope

目的探讨经电子支气管镜局部化疗治疗支气管内膜结核的近远期疗效。方法将226例确诊的初治涂阳支气管内膜结核病例随机分为两组,观察组116例采用全身化疗联合电子支气管镜局部化疗,对照组110例采用全身化疗联合超声雾化化疗,对比观察两组病例痰菌转阴时间、胸片及胸部CT病变吸收情况,以及支气管内膜病变好转情况。结果观察组痰菌阴转时间显著少于对照组(P<0.001),随访2年,痰菌复发率观察组低于对照组(P<0.05)。治疗4周和终止时胸片及胸部CT病变吸收情况显示,观察组总有效率(53.77%、64.15%)高于对照组(29.59%、39.80%)(P<0.05)。随访2年,病灶范围增加(复发率)观察组低于对照组(P<0.05)。观察组治疗3及6个月支气管内膜病变好转率(48.28%、58.62%)均高于对照组(28.19%、40.91%)(P<0.05),第12及24个月两组好转率差异无统计学意义(P>0.05)。结论经电子支气管镜局部化疗结合全身化疗,可加快痰菌转阴和局部病变好转的速度,并降低复发率。

Objective To explore the effect of local chemotherapy of endobronchial tuberculosis by electronic bronchoscope.Methods 226 new cases of smear-positive endobronchial tuberculosis were divided randomly into 2 groups.Observation group including 116 cases received a combined method of whole-body chemotherapy and electronic bronchoscope local therapy,and the control group including 110 cases received a combined method of systemic chemotherapy with ultrasound atomization chemotherapy.Smear-negative conversion time,chest radiography and CT focus absorption situation,and endobronchial focus curing situation were compared between the 2 groups.Results The smear-negative conversion time in the observation group was less than the control group（P0.001）.Recurrence of smear-positive in the observation group was lower after the following up for 2 years（P 0.05）.After 4 weeks of treatment,there was 53.77%（chest radiography） and 64.15%（CT focus absorption situation） improvement in the observation group,and the figure was greater than the control group（29.59% for chest radiography and 39.80% CT focus absorption situation）（P0.05）.Observation group＇s expanding incidence of focus scope was lower comparatively after 2 years＇ follow up（P0.05）.The incidence of endobronchial focus was improved in the observation group at 3（48.28%） to 6（58.62%） months after treatment,and the result was better than the control group（3 months,28.19% ;6 months,40.91%）（P 0.05） but the difference at the 12 th and 24 th months was not significant（P0.05）.Conclusion Local chemotherapy with electronic bronchoscope combined with systemic chemotherapy can accelerate the smear-negative conversion and endobronchial focus improvement and reduce the incidence of recurrence.