支气管镜介入热消融术治疗中央型晚期肺癌的临床观察

Clinical observation of bronchoscopic thermal ablation therapy for central advanced lung cancer

目的 探讨支气管镜介入热消融术治疗中央型晚期肺癌气道狭窄的临床效果及安全性。方法 回顾性分析56例经支气管镜活检病理确诊的合并中心气道狭窄的晚期肺癌患者，在局部麻醉下采用支气管镜介导下联合应用氩气刀和高频电刀治疗；以病变狭窄获得再通、临床症状改善进行即时疗效评价，疗效判断标准：完全有效，患者呼吸困难症状消失，腔内新生物完全清除，气道恢复通畅；部分有效，患者呼吸困难症状改善，腔内新生物大部分被清除，超过50％的狭窄管腔重新开放；轻度有效，患者呼吸困难症状改善，腔内新生物小部分被清除，管腔狭窄改善不足50％，经引流狭窄远端肺部炎症消散；无效，腔内新生物未清除，患者呼吸困难无改善。结果 56例患者共行肿瘤热消融术治疗105次，一般每个患者治疗1—4次，最多一例治疗11次。临床评价完全有效8例（14．3％），部分有效27例（48．2％），轻度有效21例（37．5％），即时有效率为100％。术中、术后患者未出现严重并发症。结论 局部麻醉下行支气管镜介入热消融术治疗中央型晚期肺癌疗效佳，并发症少，麻醉风险低，患者耐受好，值得借鉴和临床推广。

Objective To evaluate the clinical efficacy and safety of thermal ablation therapy for airway stenosis with central advanced lung cancer. Methods A total of 56 cases with central airway stenosis diagnosed as advanced lung cancer by bronchoscopic biopsy were analyzed retrospectively, who were bronchoscope mediated treatment with combination of argon plasma coagulation and high-frequency electric knife under local anesthesia. The timely therapeutic effects were evaluated based on recanalization of stenosis and improvement of clinical symptoms after interventional treatment. The curative effect judgment standard： Fully effective, patients＇dyspnea disappeared, mass in the airway lumen was completely removed, and the airway patency was restored; Partly effective： patients＇dyspnea improved, most of mass in the lumen had been cleared, more than 50% stenosis of lumen reopened ; Mildly effective ： patients＇dyspnea improved, only small part of mass in the lumen was cleared, luminal stenosis improved less than 50%, and the distal lung inflammation dissipate after drainage; Invalid： mass in the airway lumen wasn＇t removed, and patients＇dyspnea didn＇t improve. Results A total of 56 patients underwent thermal ablation of 105 times. Generally, each for 1- 4 times, only one case up to 11 times. The clinical effect evaluation results were as follow： completely effective 8 cases （ 14.3% ）, partially effective 27 cases （48.2%）, mildly effective 21 cases （ 37.5% ）, total timelyeffective rate was 100%. During and after the operation, no patients had serious complications. Conclusion Bronchoscopic thermal ablation therapy for airway stenosis with central advanced lung cancer under local anesthesia is effective, with fewer complications, low anesthetic risk, and better patient tolerance. It is worthy of reference and clinical application.