呼吸内镜介入治疗原发气管、支气管良性肿瘤45例临床分析

Clinical analysis on respiratory endoscopy intervention therapy in 45 patients with primary trachea or bronchus benign tumor

目的总结分析呼吸内镜介入治疗在原发气管、支气管良性肿瘤的应用价值。方法总结我院2005—2011年间收治的45例原发气管、支气管良性肿瘤患者的临床表现、体征、影像学、支气管镜下表现、病理类型、内镜下介入治疗方法及转归，并加以分析。结果本组患者病程在2周至10年；男女之比为2．21：1；病理类型以多形性腺瘤发病率最高（28．89％），其他依次为神经纤维瘤、脂肪瘤、乳头状瘤、平滑肌瘤、错构瘤。45例患者中32例在全麻下，13例在局麻下进行内镜下介入治疗手术，术中88．89％应用氩气刀，42．22％应用冷冻技术，3例患者病变清除后出现气管塌陷而放置了支架。所有病例术后气道完全开通，解除了气道梗阻，均达到完全有效标准。73．33％一次性手术清除病灶，3例2次手术、4例3次手术清除病灶，而且到目前为止回访未见复发病例。术中、术后未发生大出血、支气管壁穿孔、坏死物脱落致肺不张等严重并发症。结论呼吸内镜下介入治疗原发气管、支气管良性肿瘤疗效确切，创伤较小，并发症较少，患者耐受性好，具有临床推广价值。

Objective To summarize and analyze application value of respiratory endoscopy intervention therapy for primary trachea and bronchus benign tumor. Methods It was summarized and analyzed that the clinical features, signs, imaging and bronehoseope characteristics, pathology type, endoscopy intervention therapy method, and outcome of 45 patients with primary trachea or bronchus benign tumor treated in our hospital from 2005 to 2011. Results The disease duration of patients was between two weeks to ten years. The ratio of male and female was 2.21 ： 1. The major pathology type was pleomorphic adenoma （28.89%）, then including neurofibroma, lipoma, papilloma, leiomyoma, and hamartoma successively. Thirtytwo of the 45 patients received endoscopy intervention therapy in condition of general anesthesia and 13 patients in local anesthesia. Argon plasma coagulation therapy was used in 88.89% of them and cryotherapy was used in 42.22%. Stents were planted in three patients due to trachea collapse after cleaning the lesions. Complete effective criteria were achieved in all patients with air passage complete open, air passage obstruction removed after surgery. 73.33% of the patients had lesions cleaned after once surgery, three patients had twice surgeries and four patients had three times of surgeries to clean lesions. No relapse was found in follow up so far. No severe complication such as major haemorrhage, perforation of bronchus wall, pulmonary atelectasis caused by dropped necrosis occurred during and after surgery. Conclusions Respiratory endoscopy intervention therapy for primary trachea or bronchus benign tumor has definite efficacy, minor wound, less complication, and good tolerance in patients, therefore, it is valuable for spreading in clinical practice.