支气管镜介入治疗肺移植术后中心气道狭窄的疗效分析

Clinical analysis of therapeutic bronchoscopy in the treatment of central airway stenosis following lung transplantation

目的探究经支气管镜球囊扩张和金属支架置入治疗肺移植术后中心气道狭窄的疗效。方法回顾性分析2011年1月至2019年6月我院收治肺移植术后中心气道狭窄患者临床资料,观察经支气管镜球囊扩张和金属支架置入治疗前后气道阻塞症状、第1秒用力呼气容积(FEV1)、6分钟步行距离(6MWD)及远期介入干预变化,评价其效果。结果34例肺移植术后中心气道狭窄患者接受209例次球囊扩张气道成形术,狭窄疏通、阻塞症状改善180例次,即时治疗有效率86%。7例难治性狭窄接受暂时性金属支架置入治疗,即时治疗有效率100%,FEV1由置入前(1.20±0.24)L增加至(1.71±0.20)L,平均提高45%,留置时间28~67 d。经系列治疗后,气促评分由治疗前(3.24±0.55)分减少至(1.91±0.62)分(t=14.4,P<0.01),FEV1由治疗前(1.43±0.21)L增加至(1.72±0.27)L(t=11.5,P<0.01),6MWD由治疗前(317.3±61.7)m增加至(372.9±52.6)m(t=17.0,P<0.01)。6例患者金属支架置入前半年内共接受介入手术33例次,支架取出后半年内接受介入手术10例次,介入干预频次减少。结论支气管镜球囊扩张和暂时性金属支架置入治疗肺移植术后中心气道狭窄即时症状缓解显著,肺功能改善,运动耐力提高,安全性好。支气管镜介入治疗是肺移植术后中心气道狭窄管理的有效手段。

Objective To evaluate the clinical efficacy of balloon bronchoplasty and metallic stents in lung transplant-related central airway stenosis.Methods Data of lung transplant recipients with central airway stenosis who underwent therapeutic bronchoscopic interventions between January 2011 and June 2019 at our institution were reviewed.The clinical follow-up included dyspnea index,forced expiratory Forced expiratory volume in one second(FEV1),sixminute walk distance(6MWD),and the rate of bronchoscopic dilation.Results Thirty-four lung transplant recipients with airway stenosis were included in our study.All these patients were treated by balloon bronchoplasty through flexural bronchoscopy,and 7 additionally needed temporary metal stent implantation for 28 to 67 days in order to palliate recurrent central airway stenosis.The percentages of immediate efficacy were 86%(180/209)and 100%(7/7),respectively.After serial balloon dilatation,the recipients with central airway stenosis had significantly lower dyspnea index(3.24±0.55 vs.1.91±0.62,P<0.01),higher FEV1[(1.43±0.21)L vs.(1.72±0.27)L,P<0.01]and longer 6MWD[(317.3±61.7)m vs.(372.9±52.6)m,P<0.01].Six recipients with central airway stenosis received 33 interventions in 6 months before stent implantation and 10 interventions in 6 months after stent extraction.Conclusions Lung transplant recipients with central airway stenosis have a good respond to balloon bronchoplasty and stent placement.Airway stenosis after lung transplantation can be successfully managed with bronchoscopic dilatation and temporary stent placement.