冷冻联合局部药物灌注治疗淋巴结瘘型气管支气管结核的结果分析

The effect of cryotherapy combined with local drug infusion in lymph nodes fistula type tracheobronchial tuberculosis

目的 对支气管镜下冷冻联合局部药物灌注治疗淋巴结瘘型气管支气管结核的临床结果进行分析.方法 回顾性分析2012年9月至2014年3月在湖南省胸科医院内镜诊疗科接受冷冻联合局部药物灌注治疗的53例淋巴结瘘型气管支气管结核的住院患者,分析治疗的次数、治疗时间、治疗效果及并发症,采用秩和检验对单发和多发病灶患者治疗疗程和效果进行统计学分析,以P＜0.05为差异有统计学意义.结果 冷冻治疗的中位次数为6（1～13）次,中位治疗时间为50（7～104）d,局部药物灌注治疗中位次数为8（2～18）次,中位治疗时间为85（14～142）d,总的治疗有效率达到100.00％（53/53）.34例单发病灶患者治疗中位时间为85（14～130）d,完全有效例数为27例,部分有效例数为6例,轻度有效例数为1例;19例多发病灶患者治疗中位时间为84（21～142）d,完全有效例数为13例,部分有效例数为4例,轻度有效例数为2例.单发病灶与多发病灶治疗疗程及疗效差异均无统计学意义（Z=0.26,P=0.785;Z=1.53,P=0.120）.13例患者治疗过程中有少量出血（＜10 ml）,本组患者手术后未出现支气管纵隔瘘、纵隔气肿、大出血（≥100 ml）等严重并发症.结论 冷冻联合局部药物灌注治疗淋巴结瘘型气管支气管结核安全、有效,值得推广.

Objective To evaluate the curative effect of cryotherapy combined with local drug infusion in lymph nodes fistula type tracheobronchial tuberculosis.Methods The clinical date of 53 hospitalized patients with tracheobronchial tuberculosis of lymphatic fistula type from September 2012 to March 2014 in Hunan Chest Hospital was retrospectively analyzed.The times,course,efficacy,and complications after treatment with cryotherapy combined with local drug infusion were described.The course and efficacy between single lesion and multiple lesions group were compared using the Rank sum test.A P-value of 〈 0.05 was considered to be significant.Results The median treatment of cryotherapy and local drug infusion were 6 （1-13） times and 8 （2-18） times,the median duration of treatment of cryotherapy and local drug infusion were 50 （7-104） days and 85 （14-142） days,therapeutic efficacy was 100.00% （53/53）.The median treatment time of single lesion group was 85 （14 130） days,27 patients had a complete response,6 patients had a partial response,and 1 patient had a mild response.Compared with single lesion group,the median duration of multiple lesions group was 84 （21-142） days,13 patients had a complete response,4 patients had a partial response,and 2 patient had a mild response,no significant difference was found between single lesion and multiple lesions group in the duration （Z=0.26,P =0.785） or efficacy （Z=1.53,P=0.120）.Local bleeding during treatment （〈10 ml） occurred in 13 patients.Mediastinal bronchial fistula,mediastinal emphysema,fatal bleeding （≥ 100 ml） had not been found.Conclusion Combination of cryotherapy and local drug infusion through bronchoscope is a safe and effective method to tracheobronchial tuberculosis of lymphatic fistula type