气管镜下介入治疗瘢痕性气道狭窄的有效性及影响因素分析

Efficacy and influencing factors of interventional bronchoscopy for the treatment of scarring airway stenosis:a multicenter retrospective investigation from China

目的对气管镜介入治疗瘢痕性气道狭窄的有效性进行评价,并对与治疗成功率及治疗后再狭窄相关的影响因素进行分析。方法回顾性分析2013年1月到2016年12月,全国18家医院的301例接受气管镜下介入治疗的瘢痕性气道狭窄患者的临床资料。气管镜下介入治疗的方式包括电刀切割、激光消融、球囊扩张、冷冻、局部用药和(或)支架置入。记录患者的一般信息、治疗前后呼吸困难指数、气道狭窄的参数(狭窄部位、狭窄长度、狭窄程度、狭窄类型)、患者接受气管镜介入治疗的方式、麻醉方法等,并记录第一次气管镜介入治疗后气道通畅的维持时间(前两次介入治疗之间的间隔天数)及最终治疗效果。结果气管镜下介入治疗瘢痕性气道狭窄的平均临床有效率为67.8%(204/301)。狭窄部位(OR 1.548;95%CI:1.038~2.307,P=0.032)、呼吸困难指数(OR 2.140;95%CI:1.604~2.855,P<0.001)及介入治疗方式(OR 0.458;95%CI:0.267~0.787,P=0.005)是与气管镜介入治疗瘢痕性气道狭窄有效性相关的影响因素。狭窄部位(OR 1.508;95%CI:1.273~1.787,P<0.001)、狭窄程度(OR 1.581;95%CI:1.029~2.067,P=0.001)、麻醉方法(OR 1.581;95%CI:1.029~2.067,P<0.001)和是否局部用药(OR 1.304;95%CI:1.135~1.497,P<0.001)是与第一次气管镜介入治疗后气道通畅维持时间有关的影响因子。结论气管镜介入治疗是治疗瘢痕性气道狭窄的有效方式。介入医生在治疗过程中应当重视与疗效相关的影响因素,以提高治疗效果。

Objectives To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate.Methods Between January 2013 to December 2016,301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively.The methods of interventional bronchoscopy included electric knife cutting,laser cauterization,balloon dilation,cryotherapy,local drug usage and/or stenting.Airway stenosis characteristics and patients′performance status at baseline and after interventional bronchoscopy were recorded.The interval days between the first two interventional bronchoscopy treatment(maintained patency time)and the final treatment efficacy were recorded.Results The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8%(204/301).Stenosis sites(OR 1.548;95%CI:1.038-2.307,P=0.032),dyspnea index(OR 2.140;95%CI:1.604-2.855,P<0.001),and interventional method(OR 0.458;95%CI:0.267-0.787,P=0.005)were independent predictors associated with the efficacy of interventional bronchoscopy treatment.Stenosis sites(OR 1.508;95%CI:1.273-1.787,P<0.001),stenosis grade(OR 1.581;95%CI:1.029-2.067,P=0.001),anesthesia method(OR 1.581;95%CI:1.029-2.067,P<0.001),and local drug usage(OR 1.304;95%CI:1.135-1.497,P<0.001)were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment.Conclusion Interventional bronchoscopy is a useful treatment method for scarring airway stenosis.Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.