经可弯曲支气管镜介入治疗管内型肺错构瘤疗效分析

Flexible bronchoscopic intervention for endobronchial hamartoma

目的 探讨经可弯曲支气管镜介入治疗管内型肺错构瘤的安全性、有效性.方法 回顾性分析南京医科大学第一附属医院2009年5月至2012年1月病理确诊并经可弯曲支气管镜介入治疗的8例管内型肺错构瘤患者的临床资料、介入治疗结果.介入治疗技术包括应用高频圈套器对管内型肺错构瘤进行套切、高频电刀、氩等离子体凝固（APC）、冷冻消融及钳取.采用胸部CT影像测量气道直径及狭窄气道情况并辅以支气管镜检查进行疗效判断.结果 8例患者,男7例,女1例,平均年龄（62±8）岁.共进行13次介入治疗,4例一次介入治疗获得痊愈,3例在首次介入治疗后出现复发,再次介入治疗后获得痊愈.1例复发了2次,先后进行3次介入治疗,腔内狭窄程度稳定在40％.治愈率87.5％,总有效率为100％.1例出现气胸,经吸氧后痊愈.所有患者无大出血、管壁穿孔、气道内燃烧及窒息等严重并发症.结论 经可弯曲支气管镜介入治疗管内型肺错构瘤安全、有效.

Objective To evaluate the effectiveness and safety of interventional treatment in the removal of endobronchial hamartoma by flexible bronchoscopy. Methods A retrospective analysis was conducted in 8 inpatients with histologically confirmed endobronchial hamartoma , diagnosed between May 2009 to January 2012 in the First Affiliated Hospital of Nanjing Medical University. The clinical, radiological and bronchoscopic features of hamartoma, and the clinical outcomes after bronchoscopic intervention were described. The endoscopic interventional treatments included resection by electrosurgical snare, electrocautery, argon plasma coagulation （APC） and cryotherapy. Thoracic computed tomography （CT） and bronchoscopy were used to evaluate the airway stenosis during follow-up. Results The 8 patients, 7 males and 1 female, aged （62 _＋ 8 ） years, underwent 13 times of interventional treatment for endobronchial hamartoma. Four patients were cured after receiving a single endoscopic treatment, while 3 patients had recurrence after initial intcrventional treatment but were cured after the second treatment. Three times of interventional treatment was carried out in 1 patient who had two relapses but later became stable with a 40% stenosis of the airway lumen. The rates of cure and effectiveness were 87.5% and 100% , respectively. Following interventional treatment, pneumothorax occurred in 1 patient who was cured after oxygen therapy. There were no serious complications such as massive haemorrhage, airway perforation, airway ignition and suffocation. Conclusion Interventional treatments through flexible bronchoscopy appear to be safe and effective for removing endobronchial hamartoma.