支气管镜综合介入技术治疗恶性隆突病变的临床效果

Clinical effect of combined bronchoscopic interventional treatments on malignant carina disease

目的探讨支气管镜综合介入技术治疗恶性隆突病变的临床效果。方法回顾性分析2010年 1月至2016年12月哈尔滨市第一医院恶性隆突病变患者27例，根据气道狭窄的病因、长度以及狭窄远端肺组织和气道功能，选择高频电刀、冷冻、氩等离子体凝固术（APC）、支架置入4种技术中的2种以上方法进行治疗，评价Karnofsky活动状态（KPS）评分和美国胸科协会的气促分级，观察近期疗效及并发症发生情况。结果27例患者中，高频电刀＋冷冻＋APC治疗25例，高频电刀＋冷冻＋APC＋支架置入治疗2例。所有患者共行42次高频电刀治疗，48次冷冻治疗，32次APC治疗，置入Y型一体化自膨胀式金属支架2枚。治疗后KPS评分由治疗前的（55±10）分增加至（76±11）分；气促分级由治疗前的（3.1±0.8）级下降至（0.7±0.6）级，差异均有统计学意义（均P＜0.01）。近期总有效率为100%，术中及术后均未出现严重并发症。结论高频电刀、冷冻、APC、支架置入等气道介入技术联合应用对恶性隆突病变有较好的效果，且并发症少。

ObjectiveTo investigate the clinical effect of combined bronchoscopic interventional treatments on malignant carina disease. MethodsTotally 27 patients with malignant carina disease who had interventional therapy from January 2010 to December 2016 in Harbin the First Hospital were retrospectively analyzed. All patients had more than 2 kinds of interventional treatments, including high frequency electric knife, cryotherapy, argon plasma coagulation（APC） and stent implantation. Score of the Karnofsky Performance Status（KPS） and the American Thoracic Society（ATS） classification of polypnea were evaluated before and after treatment. Short-term therapeutic effect and occurrences of complications were analyzed. ResultsIn 27 patients, 25 patients had high frequency electric knife＋cryotherapy＋APC; 2 patients had high frequency electric knife＋cryotherapy＋APC＋stent implantation. All patients had 42 times of electric knife, 48 times of cryotherapy and 32 times of APC; 2 stents were implanted. Score of KPS significantly increased and the ATS polypnea grade significantly decreased after treatment compared to those before treatment[（76±11）points vs （55±10）points, （0.7±0.6）vs（3.1±0.8）]（P〈0.01）. The short-term effective rate was 100%. No severe complication was observed during perioperative period. ConclusionCombined application of high frequency electric knife, cryotherapy, APC and stent implantation is safe and effective in treatment of malignant carina disease.