支气管镜下气囊导管介入治疗复治菌阳肺结核的疗效观察

Clinical observation of balloon catheter interventional therapy under bronchoscope in the treatment of retreated sputum positive pulmonary tuberculosis

目的观察经纤维支气管镜(简称纤支镜)下气囊导管介入治疗复治菌阳空洞性肺结核的临床疗效。方法将临床明确诊断的首次复治菌阳空洞性肺结核60例随机分治疗组(30例)和对照组(30例),两组强化期均使用氨基水杨酸异烟肼、利福喷汀、盐酸乙胺丁醇、吡嗪酰胺、左旋氧氟沙星、丁胺卡那霉素抗结核治疗,治疗组强化期每周经支气管镜气囊导管注药治疗1次,然后比较两组强化期的临床疗效。结果强化期2月后痰菌阴转率、空洞病灶有效率、空洞闭合率治疗组分别为93.33%、93.33%、73.3%,未发生继发感染和结核播散。对照组分别为63.33%、63.34%、36.67%。两组比较差异有统计学意义(P<0.01)。结论经纤维支气管镜气囊导管注药治疗复治菌阳空洞性肺结核是一种安全有效的介入方法 ,其有净化空洞,促进痰菌转阴、空洞闭合的作用。无明显的并发症及毒副反应,值得临床推广使用。

Objective To evaluate the clinical effect of balloon catheter interventional therapy under bronchoscope in the treatment of retreated sputum positive pulmonary tuberculosis. Methods 60 retreated patients with sputum positive cavernous pulmonary tuberculosis were randomly into two groups. All patients were treated with aminosalicylates isoniazid,rifapentine,etambol,pyrazinamide,levofloxacin and amikacin,and the treatment group was additionally given balloon catheter interventional therapy under bronchoscope. Their curative effect was evaluated.Results 2 months after the treatment,the rate of sputum bacterial conversion to negative was 93. 33%,the improvement rate was 93. 33% and the cavity closing rate was 73. 3% in the treatment group,all of which were higher than in the controls（ 63. 33%,63. 34% and 36. 67% respectively）（ P〈 0.01）. Conclusion The balloon catheter interventional therapy under bronchoscope is effective and safe in the treatment of retreated sputum positive pulmonary tuberculosis,which can improve sputum conversion rate and cavity closure without obvious complication and adverse reaction.