支气管镜介入技术治疗气管插管、气管切开后中心气道狭窄的前瞻性随机对照研究

A comparative study of interventional bronchoscopy in treatment of central airway stenosis after tracheal intubation and tracheotomy

目的探索气管插管、气管切开后中心气道狭窄患者最佳的腔内介入治疗方法。方法气管插管、气管切开后中心气道狭窄患者79例,根据采用的不同介入治疗方法按随机数字表法将患者随机分为4组:单纯球囊扩张组、球囊扩张联合冷冻组、球囊扩张联合针形电刀组、球囊扩张联合局部应用注射用丝裂霉素组。每例患者给予每周1次、连续4周的介入治疗,并于初次治疗后第5、9、13、21、25、29周进行疗效评价。结果所有患者在接受介入治疗后气促评分、KPS评分、狭窄程度较治疗前显著改善,4组患者的有效率和临床受益率均在85%以上。第1次疗效评价最狭窄处截面积最大,随后管腔有部分回缩现象,但总体仍较治疗前明显扩张,且管腔通畅维持时间达半年以上,4组间比较差异无统计学意义。所有患者在治疗期间和治疗后未发生严重不良事件。结论上述方法均能有效治疗气管插管、气管切开导致的中心气道狭窄。出于减少治疗程序和节约治疗费用,推荐单独球囊扩张治疗气管插管、气管切开导致的中心气道狭窄。

Objective To explore the best interventional treatment for patients with central airway stenosis after tracheal intubation and tracheotomy. Methods Seventy-nine patients with central airway stenosis after tracheal intubation or tracheotomy were divided into four groups, group A was treated with balloon dilation alone, group B was treated with balloon dilation and freezing, group C was treated with needle-shaped electric knife and balloon dilation, group D was treated with balloon dilation and topical application of mitomycin for injection.Each patient was treated with interventional therapy once a week, and the total treatment duration was four weeks.The efficacy was evaluated at the 5th, 9th, 13th, 21st, 25th, and 29th week after the first treatment. Results Compared with before treatment, the dyspnea score, KPS and the degree of stenosis were significantly improved in all patients after treatment, and the efficiency and clinical benefit rate of the four groups were above 85%.The cross-sectional area of narrowest section was the largest in the first curative effect evaluation.Subsequently, the lumen was partly retracted, but overall was still significantly expanded, which lasted for more than half a year, there was no significant difference among the four groups.All patients had no serious adverse events during and after treatment. Conclusions The above methods can be effectively used to treat central airway stenosis after tracheal intubation or tracheotomy.In order to simplify the treatment program and lower the cost of treatment, it is recommend the use of balloon dilation alone for the treatment of central airway stenosis after tracheal intubation or tracheotomy among the four methods mentioned above.