经纤维支气管镜冷冻切除术治疗气管支气管结核的疗效评价

Evaluation of effect of bronchofibroscopic cryoresection in the treatment of tracheobronchial tuberculosis

目的综合分析经纤维支气管镜冷冻切除术治疗气管支气管结核的治疗效果,为该技术在临床中的推广应用提供科学指导与循证依据。方法以我院2006年6月至2016年6月41例确诊为气管支气管结核并行经纤维支气管镜冷冻切除术进行治疗的患者为研究对象,对其手术前后结核症状(咳嗽、发热、咳血)、气道堵塞(以堵塞气管/支气管横断面1/3以下、1/3~2/3、2/3以上分别划分为轻度、中度、严重堵塞)、肺不张等情况进行对比分析。结果经过2~3个疗程的手术治疗,74例患者结核症状的总体消除率为97.30%(72/74),但也有1例术前无咳血患者术后表现咳血症状;41例患者均有不同程度的气道堵塞,13例严重堵塞者术后8例变为轻度、4例变为中度,20例中度堵塞者术后17例变为轻度,8例轻度堵塞者术后堵塞情况未见明显改善,气道堵塞情况总体改善率为70.73%(29/41);16例肺不张患者中9例消失、6例明显好转、1例未能取得良好改善,好转率为93.75%(15/16)。结论经纤维支气管镜冷冻切除术治疗气管支气管结核,重度、中度气管/支气管堵塞患者将可普遍获益,而对轻度气管/支气管堵塞患者则疗效不佳。

Objective To provide scientific guidance and evidence-based basis for the clinical application of bronchofiberoscope cryotomy by comprehensively analyzing the treatment outcomes in the cases with tracheobronchial tuberculosis. Methods The data of treatment outcomes in 41 cases with tracheobronchial tuberculosis in our hospital from June 2006 to June 2016. The data of treatment outcomes included changes of tuberculous symptoms(e.g. cough,fever,haemoptysis)and blockage of the airway and atelectasis before and after bronchofiberoscopecryotomy,which were comprehensively analyzed. Blockage of the airway was categorized into the mild,moderate,severe grades according to less than one-third,between one-third and two-thirds and more than one-third blocked tracheobronchial cross-sectional area,respectively. Results Tuberculosis symptoms of 72 cases accounting for97.30% were disappearance among 74 cases after 2 to 3 courses of bronchofibero-scope cryotomy.But one case with no haemoptys was before operation had haemoptysis symptoms after operation. There were all varying degrees of airway blockage in 41 cases,in which there were 8 cases from the severe to the mild,and 4 cases from the severe to the moderate among 13 cases with severe blockage before operation. And there were 17 cases from the moderate to the mild among 20 cases with the moderate blockage before operation. We also observed that there was no significant improvement among 8 cases with the mild blockage before operation. The overall improvement rate of airway blockage was 70.73%(29/41). As to atelectasis,16 cases were searched and the improvement rate of atelectasis was 93.75%,in which 9 cases were full recovery and 6 cases improved significantly,but 1 case failed to achieve good improvement. Conclusion Patients with severe and moderate tracheal/bronchial blockage will generally achieve the benefits of treating tracheobronchial tuberculosis by bronchofiberoscope,while patients with mild tracheal/bronchial blockage will obtain poor effect.