支气管镜下激光、球囊扩张联合冷冻治疗良性中心气道狭窄的疗效分析

Curative effect of laser, balloon dilatation and cryotherapy under bronchoscopy in treatment of central airway stenosis

目的研究支气管镜下激光、球囊扩张联合冷冻治疗良性中心气道狭窄(CAS)的疗效分析。方法本研究对象为2017年11月-2018年8月于我院治疗的42例良性CAS患者,随机数字表法均分为两组。对照组21例患者采用支气管镜下激光、球囊扩张治疗,观察组21例患者在此基础上联合冷冻治疗,随访10个月,记录围术期情况,比较术后当天、1月、10个月气道狭窄再通疗效,各随访时间采用美国胸科学会(ATS)气促评分标准评价呼吸困难指数,镜下观察肉芽肿、黏膜水肿、管腔通畅等情况。结果观察组术后早期呼吸困难发生率显著低于对照组(P<0.05),均无气胸、大咯血、纵隔气肿等发生;两组术后当天气道狭窄疗效评价差异无统计学意义(P>0.05),术后1月、10个月观察组气道狭窄疗效优于对照组(P<0.05);观察组术后当天、1月、10个月呼吸困难指数均显著低于对照组(P<0.05);观察组术后肉芽肿能够较快形成稳定非挛缩样瘢痕,并保持稳定管腔扩大状态;对照组易出现黏膜水肿,残留肉芽肿,容易出现管腔再狭窄。结论支气管镜下激光、球囊扩张联合冷冻治疗良性CAS疗效更佳,术后呼吸更畅通,同时冷冻治疗能改善激光、球囊扩张治疗后出现的医源性黏膜水肿及肉芽肿引起的气道再度狭窄。

Objective To study the curative effect of laser,balloon dilatation and cryotherapy under bronchoscopy in treatment of central airway stenosis(CAS).Methods 42 patients with benign CAS treated in our hospital from November 2017 to June 2018 were selected. Their medical records were retrospectively analyzed, and they were randomly divided into the control group and the observation group according. The control group was treated with bronchoscopy laser and balloon dilatation, and the observation group was combined with cryotherapy on this basis. The patients were followed up for 10 months. The perioperative period was recorded. The effect of airway stenosis was compared 1 and 10 months after treatment. At each follow-up time, the American thoracic society (ATS) shortness index was used to evaluate the dyspnea index, and granuloma, mucosal edema, and luminal patency were observed under microscope. Results The incidence of early dyspnea in the observation group was significantly lower than that in the control group ( P< 0.05). There was no pneumothorax, massive hemoptysis, mediastinal emphysema, etc. There was no significant difference in the curative effect of airway stenosis between the two groups on the same day after operation. The efficacy of airway stenosis in the observation group was better than that in the control group at 1 month and 10 months after operation ( P< 0.05). The dyspnea index of the observation group was significantly lower than that of the control group 1 and10 months after treatment ( P< 0.05). Postoperative granuloma could form stable non-retracted scars and maintain stable lumen expansion. The control group was prone to mucosal edema, residual granuloma, and luminal restenosis. Conclusion Bronchoscopy laser, balloon dilatation combined with cryotherapy for benign CAS is better, and postoperative breathing is smoother. At the same time, cryotherapy can improve the iatrogenic mucosal edema and granuloma caused by laser and balloon dilatation narrow.