激光治疗器质性呼吸道阻塞

Treatment of airway stenosis with laser

目的 观察激光在器质性呼吸道阻塞性疾病治疗中的应用价值。方法 应用Nd :YAG激光治疗 40例器质性呼吸道阻塞患者 ,观察治疗前后患者症状、肺功能、血气分析、气道内径的改善情况及治疗的安全性。结果 应用Nd :YAG激光治疗后患者气道全部通畅 ,气道内径明显扩大 :治疗前 (2 9± 1 7)mm ,治疗后 (8 0± 1 6)mm ,P <0 0 1;气促明显缓解 :气促指数治疗前 3 2± 0 8,治疗后 1 3± 0 9,P <0 0 1;PaO2 明显升高 :治疗前 (9 4± 1 81)kPa ,治疗后 (11 6± 1 1)kPa ,P <0 0 1;FEV1明显改善 :治疗前 (1 4± 0 3 )L ,治疗后 (2 4± 0 4)L ,P <0 0 1;FVC明显增加 :治疗前 (2 3±0 7)L ,治疗后 (3 3± 0 6)L ,P <0 0 1;治疗过程中 3 2例出现一过性低氧血症 ,2例出血 ,5例术后呼吸困难 ,2例术后发热。术后随访 :17例患者术后 3～ 4个月出现气道再次狭窄 ,11例经再次激光治疗后气道再次通畅。结论 Nd :YAG激光治疗器质性呼吸道阻塞是安全有效的手段并可反复应用 。

Objective To study the efficacy of laser in the treatment of airway stenosis.Methods 40 cases with airway stenosis were treated by Nd:YAG laser from June 1998 to September 2000. Dyspnea index, airway diameter, pulmonary function and complications were observed.Results All airways were restructured following a single or multiple laser treatments. Dyspnea index was immediately improved from 3.2±0.8 to 1.3±0.9( P <0.01), airway diameter from 2.9±1.7 mm to 8.0±1.6 mm( P <0.01), P aO 2 from 9.6±1.4 kPa to 11.6±1.1( P <0.01), FEV 1 from 1.4±0.3 to 2.4±0.4( P <0.01), and FVC from 2.3±0 7 to 3 3±0 6( P <0.01), respectively. Complications included thirty-two hypoxemia, two hemorrhage, five postoperative dyspnea and two fever. Follow-up information showed that the stenoses recurred in 17 case 3～4 month postoperation, and 11 cases were retreated successfully with a second laser treatment.Conclusion Nd:YAG laser treatment is effective and safe in the treatment of patients with occluded airways and can be repeated.