可弯曲支气管镜下冷热联合消融治疗中央气道淋巴结瘘型支气管结核的价值

The clinical effect of thermo ablation and cryoablation treatment of lymph nodes fistula type of central airway tracheobronchial tuberculosis (TBTB) under flexible bronchoscopy

目的探讨可弯曲支气管镜(以下简称“支气管镜”)下冷热联合消融治疗中央气道淋巴结瘘型支气管结核的疗效。方法选取2013年1月至2017年1月在安徽省胸科医院就诊并明确诊断为中央气道淋巴结瘘型支气管结核患者78例,经伦理学委员会批准后,其中对照组39例患者采用全身抗结核治疗方案,同时支气管镜下治疗予以活检钳反复清理及病灶处经导管注入异烟肼;观察组39例患者采用全身抗结核治疗方案,同时支气管镜下治疗采用冷热联合消融治疗及病灶处经导管注入异烟肼,均在病灶稳定后终止镜下处理并随访至1年。计算平均治疗次数,并在治疗后1、3、6、12个月随访观察患者临床症状及支气管镜下表现,并评估治疗有效率。结果观察组和对照组进行介入治疗的平均次数分别为(12.49±3.34)次和(17.28±3.64)次,观察组较对照组治疗的平均次数明显减少,差异有统计学意义(t=6.055,P<0.001);观察组在治疗后3个月、6个月及12个月的治疗有效率分别为48.72%(19/39)、82.05%(32/39)、92.31%(36/39),均高于对照组[20.51%(8/39)、53.85%(21/39)、71.79%(28/39)],差异均有统计学意义(χ^2=6.854,P=0.009;χ^2=7.123,P=0.008;χ^2=5.571,P=0.018)。两组患者治疗中共43例患者局部出现少许出血,予以1∶20000肾上腺素、冰生理盐水及矛头蝮蛇血凝酶内镜下喷洒等对症处理后均可好转,未出现大出血、穿孔、气胸等严重并发症。结论支气管镜下冷热联合消融治疗中央气道淋巴结瘘型支气管结核可减少平均治疗次数,提高患者的治疗有效率。

Objective To evaluate the efficacy of combined thermoablation and cryoablation treatment of lymph nodes fistula type of central airway tracheo-bronchial tuberculosis (TBTB) under flexible bronchoscopy (referred to as “bronchoscopy”).Methods A total of 78 patients with TBTB were enrolled in the Anhui Provincial Chest Hospital from January 2013 to January 2017. After approval by the Ethics Committee, 39 patients in the control group were treated with systemic anti-tuberculosis treatment and bronchoscopy which biopsy forceps were repeatedly cleaned and the isoniazid was injected through the catheter at the lesion. The observation group were treated with systemic anti-tuberculosis treatment and bronchoscopy which combined with cryo-thermo ablation and the isoniazid was injected through the catheter at the lesion. All of them were ended up with endoscopic treatment after stable lesions and followed up for 1 year. The average number of treatments was calculated, and the clinical symptoms and bronchoscopy findings were observed at 1, 3, 6, and 12 months after treatment, and the treatment efficiency was evaluated.Results The average number of interventional treatments in the observation group and the control group were (12.49±3.34) times and (17.28±3.64) times. The average number of treatments in the observation group was significantly lower than that in the control group. The difference was statistically significant (t=6.055, P<0.001);The effective rates of treatment in the observation group at 3 months, 6 months, and 12 months were 48.72%(19/39), 82.05%(32/39), and 92.31%(36/39) respectively, which were higher than that in the control group (20.51%(8/39), 53.85%(21/39), 71.79%(28/39)), the difference was statistically significant (χ^2=6.854, P=0.009;χ^2=7.123, P=0.008;χ^2=5.571, P=0.018). A total of 43 patients in the two groups were treated with a small amount of hemorrhage, which was improved after endoscopic spray of 1∶20000 adrenaline, ice physiological saline and Bothrops atrox hemocoagulase, and there were no serious complications such as major bleeding, perforation, and pneumothorax.Conclusion The combined thermoablation and cryoablation treatment of lymph nodes fistula type of central airway tracheo-bronchial tuberculosis under flexible bronchoscopy can reduce the average number of treatments and improve the patients’ treatment efficiency.