支气管镜下冷冻结合球囊扩张治疗支气管结核所致气道狭窄24例

Endoscopic cryotherapy combination with balloon expansion in 24 cases of bronchial stenosis caused by endobronchial tuberculosis

目的探讨经支气管镜冷冻治疗联合球囊扩张治疗支气管内膜结核导致的气道狭窄的疗效。方法回顾性分析新疆医科大学第一附属医院呼吸内科2009年1月～2012年1月收住院的首次确诊为支气管内膜结核合并气道狭窄的24例患者的临床资料,并结合相关资料对其治疗方法和疗效进行对比分析和评价。结果经支气管镜黏膜活检术或刷片确诊为支气管内膜结核合并气道狭窄的24例患者行冷冻联合球囊扩张术的介入治疗,同时给予标准抗结核药物治疗1年,24例患者临床症状均明显缓解,介入治疗后气道内径均明显增宽,其中18例狭窄气道完全复张,6例部分复张(小于2/3),1个月后复查电子支气管镜,其中治愈8例,有效15例,无效1例。结论支气管结核性狭窄应根据不同的病程和病变特点选择方案。球囊扩张术仍为瘢痕型支气管内膜结核的首选治疗手段,冷冻是肉芽增殖型支气管内膜结核比较理想的治疗方法 ,将两者结合治疗肉芽增殖型、瘢痕型支气管内膜结核所致的气道狭窄是通过临床研究后寻求到较为合理的治疗办法。

[Objective] To explore the curative effect of bronchoscopy in treating the airway stenosis caused by endobronchial tuberculosis.[Method] 24 cases were analyzed retrospectively from Jan 2009 to January 2012,the first time diagnosis of endobronchial tuberculosis with 24 patients of clinical material in the hospital,and in combination with relevant data treatment methods and effect to compare the analysis and evaluation.[Results] The 24 patients were first diagnosed by the bronchoscopy mucosal biopsy as endobronchial tuberculosis with the different intervention,cryotherapy and balloon dilatation,at the same time given standard antituberculosis drugs,the clinical symptoms of 24 patients were significant improved,the airway diameter became significantly wider after interventional treatment,including 18 cases＇airway completely open,6 cases partly open （less than two-thirds）,checked with electronic bronchoscopy after a month,8 cases cured,15 cases effective,one invalid.[Conclusion] Balloon expansion is the first of all treatment for Bronchial scar stricture.Cryotherapy is the ideal treatment method for granulation proliferation.A combination of Cryotherapy and Balloon expansion for granulation identified,scar bronchial type of tuberculosis is at present a reasonable treatment measures.