两种CT成像技术辅助支气管镜介入治疗空洞性菌阳肺结核患者的对比研究

Comparative study of two kinds of adjuvant interventional therapy by fiberoptic bronchoscopy based on CT imaging technique in patients with smear positive pulmonary tuberculosis with cavity

目的 观察基于CT气道多平面重建（multi-planar reconstruction,MPR）与CT平扫两种方法辅助支气管镜介入治疗空洞性菌阳肺结核患者的近期治疗效果,为临床选择合适的治疗方法提供参考.方法 选择2015年2月至2016年2月西安市胸科医院收住院的121例痰菌阳性的空洞性肺结核患者,按抽签法随机分为两组,传统治疗组62例（最终48例完成疗程）,采用CT平扫后行纤维支气管镜肺结核空洞介入治疗;MPR治疗组59例（最终48例完成疗程）,采用64层螺旋CT气道MPR技术定位后行纤维支气管镜肺结核空洞介入治疗.观察治疗1个月和3个月后患者的痰菌阴转率、空洞治疗有效率及病灶播散情况.两组数据采用SPSS 18.0统计软件进行统计学处理,率的比较采用卡方检验,以P＜0.05为差异有统计学意义.结果 （1）两组治疗1个月和3个月后,MPR治疗组痰菌阴转率均高于传统治疗组,阴转率分别为56.3％（27/48）和35.4％（17/48）;91.7％（44/48）和75.0％（36/48）,两组比较差异有统计学意义（x2=4.20,P＜0.05;x2=4.80,P＜0.05）;（2）两组治疗1个月和3个月后,MPR治疗组空洞治疗有效率均高于传统治疗组,有效率分别为45.8％（22/48）和20.8％（10/48）;83.3％（40/48）和60.4％（29/48）,两组比较差异有统计学意义（x2=6.75,P＜0.05;x2 =6.24,P＜0.05）;（3）传统治疗组的病灶播散发生率高于MPR治疗组,两组播散发生率分别为33.3％（16/48）和14.6％（7/48）,差异有统计学意义（x2 =4.63,P＜0.05）.结论 经MPR定位后行纤维支气管镜介入治疗空洞性菌阳肺结核可以提高患者的痰菌阴转率及空洞治疗有效率,同时降低了病灶的播散发生率,是一种空洞性肺结核治疗的可靠方法.

Objective To observe short term efficacy in patients with smear positive pulmonary tuberculosis with cavity with adjuvant interventional therapy by fiberoptic bronchoscopy of two kinds of CT imaging technique in cluding multi-planar reconstruction （MPR） and CT plain scan,in order to provide reference for clinical optional treatment.Methods One hundred and twenty-one smear positive pulmonary tuberculosis patients with cavity admitted in Xi＇an Chest Hospital were enrolled and divided randomly into two groups during Feb.2015 to Feb.2016.Sixty-two cases were given fiberoptic bronchoscopy adjuvant interventional bases on CT plain scan as traditional treatment group and another 59 cases were given fiberoptic bronchoscopy adjuvant interventional bases on 64 slice spiral CT MPR as MPR treatment group.Sputum negative conversion rate,effective rate of cavity and lesions dissemination were observed after treatment in one and three months.The data from two groups were analyzed using SPSS software version 18.0.The ratio was compared with Chi-square test and P〈0.05 was considered difference significantly.Results The sputum negative conversion rates （56.3%（27/48） and 91.7% （44/48）） in the MPR treatment group were higher than those （35.4 % （17/48） and 75.0% （36/48）） in the traditional group with significant difference after treatment in one and three months （x2 =4.20,P〈0.05;x2 =4.80,P〈0.05）.The effective rates of cavity （45.8% （22/48） and 83.3% （40/48）） in the MPR treatment group were higher than those （20.8% （10/48） and 60.4% （29/48）） in the traditional group with significant difference after treatment in one and three months （x2 =6.75,P〈0.05;x2 =6.24,P〈0.05）.However,the rate of lesions dissemination （33.3 % （16/48）） in the traditional group was higher than that （14.6% （7/48）） in the MPR group with significant difference （x2 =4.63,P〈0.05）.Conclusion The adjuvant interventional therapy technique by bronchoscopy based on MPR can improve the sputum negative conversion rate and the effective rate of cavity,and decrease lesions dissemination.It is a reliable method for treatment of pulmonary tuberculosis with cavity.