不同联合介入方式治疗恶性中心气道重度狭窄患者的疗效观察

Clinical efficacy of different combined interventions in treatment of patients with malignant severe central airway stenosis

目的评价支气管镜下不同联合介入方式在恶性中心气道重度狭窄治疗中的价值。方法选取48例恶性中心气道重度狭窄患者,分为给予高频电刀+氩等离子体凝固(APC)+冷冻联合介入治疗31例,高频电刀+APC+冷冻+气管支架置入治疗17例。观察患者首次介入治疗后的有效率,随访6个月的中短期疗效,并统计所有患者相关并发症及不良事件。结果所有患者介入治疗期有效率达100%,其中电刀+APC+冷冻+支架置入患者的气道直径增加值、横截面积增加率显著优于电刀+APC+冷冻治疗组(P<0.05),气促指数显著降低(P<0.05),而一秒用力呼气容积(FEV_1)占预计值水平的差异无统计学意义(P>0.05)。6个月随访期间,2组患者月平均介入治疗次数,平均缓解期差异有统计学意义(P<0.05)。所有患者未见介入操作的即刻并发症。随访6个月期间,出现不同程度胸痛、咯血、分泌物潴留等不适患者48例。结论支气管镜下不同联合介入方式治疗恶性中心气道重度狭窄即期效果明显。

Objective To evaluate the value of bronchoscope-guided different combined in- terventions in the treatment of patients with malignant severe central airway stenosis. Methods A to- tal of 48 patients with malignant severe central airway stenosis were selected and divided into group A treated with combined interventions including high-frequency electrotome ＋ argon plasma coagulation （APC） ＋ freezing （n = 31 ）, while another 17 with combined interventions including high-frequency electrotome ＋ APC ＋ freezing ＋ tracheal stent implantation were designed as group B. The re- sponse rate （RR） after initial interventional treatment and the middle- and short-term clinical efficacy after 6-month follow up were observed, and corresponding complications and adverse events were re- corded. Results The RR of all patients was 100%, in which group B was significantly better in the increase of airway diameter and increase rate of cross sectional area （CSA） （P 〈0.05）, but was sig- nificantly lower in polypnea index than group A （P 〈 0.05）, but there was no significant difference between two groups in forced expiratory volume in one second （FEV1 ） in the expected value （FEV1% ）（ P 〉0.05 ）. During 6-month follow-up, there were significant differences in the average monthly interventional therapeutic frequency and average remission period between two groups （P 〈 0.05）. No patients had complications immediately after interventional process. During the 6-month follow - up , 4 8 patients had different - degree chest pain , hemoptysis and retention of secretes .Conclusion Bronchoscope - guided different combined interventions have excellent efficacy in the treatment of patients with malignant severe central airway stenosis.