冷冻联合球囊扩张术治疗瘢痕狭窄型支气管结核气道闭塞的有效性及安全性

Efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis

目的探讨经支气管镜冷冻术联合球囊扩张治疗瘢痕狭窄型支气管结核气道闭塞的有效性及安全性。方法回顾性分析2008年12月至2016年5月首都医科大学附属北京胸科医院收治的98例瘢痕狭窄型支气管结核气道闭塞患者，支气管结核诊断依据支气管镜检查及细菌学或病理学检查，胸部CT、气道三维重建及支气管镜检查提示支气管结核瘢痕狭窄致气道闭塞。所有病例均接受全身抗结核药物治疗及气道闭塞处冷冻消融治疗，闭塞气道打通者后续行球囊扩张治疗，比较治疗前后的效果。观察指标包括临床疗效评估（包括治疗前后气道直径变化及肺复张情况）、呼吸困难指数及并发症等。结果98例瘢痕狭窄型支气管结核气道闭塞患者经（1±4）次冷冻治疗后，87例成功打通闭塞气道，后续行（7±3）次球囊扩张治疗。扩张结束3个月及12个月后进行随访，治疗总有效率分别为76．53％（75／98）和72．45％（71／98）。统计不同治疗效果患者的病史时间发现，“治愈”患者病史的中位时间为3．0个月，“有效”患者病史的中位时间为5．0个月，“无效”患者病史的中位时间为9．0个月，治疗有效（包括治愈和有效）者与无效者的病史时间的差异有统计学意义（t=-15．012，P〈0．01）。所有闭塞气道打通患者治疗后呼吸困难症状均较前明显改善，治疗结束时改良英国医学研究委员会呼吸困难指数（mMRC）评分由治疗前的3．8±0．5降为1．1±0．7，治疗结束3个月及12个月后mMRC评分分别为1．2±0．7和1．2±0．7。治疗后3个时段与治疗前比较，差异均有统计学意义（均P〈0．01）；治疗后各时段比较，差异均无统计学意义（均P〉0．05）。所有病例均未出现明显并发症。结论经支气管镜冷冻术联合球囊扩张治疗是治疗瘢痕狭窄型支气管结核气道闭塞非常安全、有效的治疗方法，而且病史时间越短，治疗效果越好。

Objective To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis （TBTB）. Methods From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT （computer tomography）, bronchial reconstructions and bronchoscopy. All patients underwent routine anti- tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council （mMRC） dyspnea scale and complications. Results Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for （10± 4） times, and then these patients received balloon dilatation through bronchoscope for （7±3） times subsequently. The total effective rates were 76.53% and 72.45% after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses （t=-15.012, P〈0.01）. The average of mMRC score changed from （3.8＋0.5） before the procedure, to （1.1±0.7）, （1.2± 0.7） and （1.2 ± 0.7） immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy （t=30.398-31.058, P〈 0.01）, but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions Cryotherapy combined with balloon dilatation through electronic bronehoseope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronehial tuberculosis. A shorter course of disease indicated more benefits for patients.