支气管镜冷冻术联合球囊扩张在瘢痕狭窄型支气管结核气道狭窄中的疗效分析

Analysis on the therapeutic efficacy of bronchoscopic cryosurgery combined with balloon dilatation in the treatment of airway stenosis of bronchial tuberculosis with scar stenosis

目的分析支气管镜冷冻术联合球囊扩张在瘢痕狭窄型支气管结核气道狭窄中的疗效。方法回顾性分析2014年7月~2019年10月于本院收治的90例瘢痕狭窄型支气管结核气道狭窄患者临床资料,根据治疗方案不同分为冷冻组(n=40)和冷冻联合组(n=50);其中冷冻组给予单纯支气管镜下冷冻消融,而冷冻联合组则予支气管镜下球囊扩张后进行冷冻消融;收集并比较两组治疗前后气道内径、肺功能指标、呼吸困难程度、临床疗效及不良反应。根据临床疗效不同又可将患者分为临床有效组和无效组,对比两组临床资料,并进行Logistic多因素回归分析。结果与治疗前比较,治疗后两组气道内径、FEV1和FEV1/FVC升高,呼吸困难程度降低,差异均有统计学意义(P<0.05),其中冷冻联合组明显优于冷冻组(P<0.05)。所有患者支气管镜介入术中术后均未见气胸、大咯血和支气管痉挛等严重不良反应。冷冻联合组临床总有效率明显高于冷冻组(P<0.05)。临床有效组和临床无效组在病程、狭窄程度、气管内径和呼吸困难程度比较,差异有统计学意义(P<0.05);经Logistic多因素回归分析得知,治疗方案和狭窄程度是影响瘢痕狭窄型支气管结核气道狭窄患者临床疗效的重要因素(P<0.05)。结论支气管镜冷冻术联合球囊扩张治疗瘢痕狭窄型支气管结核气道狭窄安全性良好,效果显著,值得推广。

Objective To analyze the therapeutic efficacy of bronchoscopic cryosurgery combined with balloon dilatation in the treatment of airway stenosis of bronchial tuberculosis with scar stenosis.Methods The clinical data of 90 patients with airway stenosis of bronchial tuberculosis with scar stenosis admitted to our hospital from July 2014 to October 2019 were analyzed retrospectively.According to different treatment schemes,they were divided into the freezing group(n=40)and the combined freezing group(n=50).Among them,the freezing group was given cryoablation under bronchoscope simply,while the combined freezing group was given cryoablation under bronchoscope after balloon dilatation.The airway diameters,pulmonary function indexes,dyspnea degrees,clinical efficacies and adverse reactions(ADRs)were collected and compared between the two groups before and after treatment.According to the difference of clinical efficacies,patients were divided into the clinically effective group and clinically ineffective group.The clinical data of the two groups were compared and logistic regression analyses were carried out.Results Compared with those before treatment,the airway diameter,FEV1 and FEV1/FVC of the two groups increased after treatment,the degree of dyspnea decreased,and the differences were statistically significant(P<0.05),among which the combined freezing group was significantly better than the freezing group(P<0.05).No serious ADRs such as pneumothorax,massive hemoptysis and bronchospasm were found in all patients during and after bronchoscopy intervention.The total clinical efficacy rate of the combined freezing group was significantly higher than that of the freezing group(P<0.05).There were significant differences in course of disease,stenosis degree,and inner diameter of trachea and dyspnea degree between the clinically effective group and clinically ineffective group(P<0.05).Logistic regression analysis showed that the treatment scheme and stenosis degree were the important factors impacting the clinical efficacy on patients with airway stenosis of bronchial tuberculosis with scar stenosis(P<0.05).Conclusion Bronchoscopic cryosurgery combined with balloon dilatation is obviously safe and effective in the treatment of airway stenosis of bronchial tuberculosis with scar stenosis,which is worth of promotion.