电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床观察

Clinical observation of stent implantation combined with argon plasma coagulation under electronic bronchoscope in the treatment of central airway constriction caused by malignant tumor

目的观察电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床疗效,缓解患者呼吸困难症状。方法回顾31例患者的临床资料,分析支架一次性置入成功率等、治疗前后p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、动脉血氧饱和度(Sa O2)、用力肺活量(FVC)、一秒用力呼气容积(FEV1)和气促评分变化,评价治疗后中央气道狭窄疗效,以及术后并发症及处理情况。结果30例患者支架一次性置入成功,成功率96.77%。治疗1周,患者气道阻塞症状减轻,p H值、Pa O2、Pa CO2、Sa O2及FVC、FEV1较治疗前明显改善,差异有统计意义(P<0.05)。气道支架置入后1周,呼吸困难症状均明显缓解,治疗后患者气促评分明显优于治疗前,差异有统计意义(P<0.05)。治疗即刻及治疗后3月患者中央气道狭窄疗效相似,差异无统计意义(P>0.05)。术后6例咽喉及胸骨后疼痛、10例刺激性咳嗽、7例痰中带血、3例术后再次狭窄、1例大咯血猝死和1例术后支架边缘出现瘘口。中央气道狭窄程度级别越高,并发症发生的例次越高,差异有统计意义(P<0.05)。结论电子支气管镜下支架植入联合氩气刀能有效缓解恶性肿瘤引起的中央气道狭窄,快速缓解患者呼吸困难症状,是非常有效的姑息治疗手段之一,但是中央气道狭窄程度越重,术后并发症发生率越高。

Objective To observe the clinical efficacy of stent implantation combined with argon plasma co-agulation under electronic bronchoscope in the treatment of central airway constriction caused by malignant tumor. Methods The clinical data of 31 patients were reviewed.The one-time success rate for stent implantation and chan-ges in pH value,arterial partial pressure of oxygen （PO2 ）,arterial partial pressure of carbon dioxide （PCO2 ）,arte-rial oxygen saturation （SaO2 ）,forced vital capacity （FVC）,forced expiratory volume in 1 second （FEV1 ）,as well as tachypnea score before and after the treatment were analyzed,and the efficacy for central airway constriction after the treatment as well as postoperative complications and the treatments were evaluated.Results A total of 30 pa-tients had their stents successfully implanted in one time,and the success rate was 96.77%.1 week after the treat-ment,the patients had significantly lightened airway obstruction symptom and significantly improved pH value,PO2 , PCO2 ,SaO2 ,FVC,and FEV1 when compared with those before treatment （P 〈0.05）.1 week after airway stent im-plantation,the patients had significantly relieved dyspnea and significantly better tachypnea score （P 〈0.05）.The patients had similar efficacy for central airway constriction at 0min and 3m after the treatmen （P 〉0.05）.After the surgery,6 patients had retrosternal pain,10 had irritable cough,7 had blood-stained sputum,3 had postoperative re-stenosis,1 had a sudden death secondary to serious hemoptysis,and 1 had an orificium fistulae at the edge of the stent.The severer the central airway constriction was,the higher the incidence of complications was （P 〈0.05）. Conclusion Bronchovideoscopic stent implantation combined with argon plasma coagulation can effectively relieve the central airway constriction resulted from malignant tumor and rapidly relieve the dyspnea,and consequently is one of the alleviative treatment methods with very excellent efficacy.But the severer the central airway constriction is,the higher the incidence of postoperative complications has.