光动力疗法联合气道支架或冷冻治疗恶性中心气道狭窄的效果

Photodynamic therapy combined with airway stent or cryotherapy in the treatment of malignant central airway stenosis

目的探讨光动力疗法联合气道内支架植入或冷冻治疗恶性中心气道狭窄的临床疗效。方法回顾性分析2009年10月至2019年10月浙江省人民医院因恶性肿瘤引起中心气道狭窄患者45例的临床资料,根据介入治疗方法的不同分为两组,给予光动力治疗后行支架植入的20例患者为支架组,给予冷冻治疗光后行动力治疗的25例患者为冷冻组,比较两组患者治疗后气道直径增加值、呼吸困难评分、气道病变临床表现评分、体质情况评分、呼吸功能、治疗后并发症发生情况、治疗后生存率和平均生存期。结果治疗后冷冻组气管、左主支气管、右主支气管直径增加值大于支架组(P<0.01)。治疗后两组气管、左主支气管、右主支气管狭窄程度均低于治疗前(P<0.01),冷冻组气管狭窄程度低于支架组(P<0.05,P<0.01)。治疗后,两组呼吸困难评分、气道病变临床表现评分均低于治疗前,第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、体质状况评分(KPS评分)均高于治疗前(P<0.01),但组间比较差异无统计学意义(P>0.05)。两组均无严重治疗后并发症发生。两组生存率和平均生存期比较差异无统计学意义(P>0.05)。结论光动力疗法联合支架植入或冷冻治疗均是缓解恶性气道狭窄的有效治疗方法,两者均可以迅速扩张狭窄管腔,减轻患者呼吸困难症状,改善呼吸功能,提高生活质量。

Objective To evaluate the clinical efficacy of photodynamic therapy combined with endobronchial stent implantation or with cryotherapy in the treatment of malignant central airway stenosis.Methods Forty-five patients with central airway stenosis caused by malignant tumor in Zhejiang Provincial People′s Hospital from October 2009 to October 2019 were retrospectively analyzed.According to the different interventional therapy,patients were divided into stent group(treated with stent implantation after photodynamic therapy,n=20)and cryotherapy group(treated with photodynamic therapy after cryotherapy,n=25).The increase of airway diameter,dyspnea score,clinical manifestation score,physical condition score[karnofsky performance scale index(KPS)],respiratory function,complications,survival rate and average survival time after treatment were compared between two groups.Results After treatment,the diameters of trachea,left main bronchus and right main bronchus increased in cryotherapy group compared with stent group(P<0.01).The degrees of stenosis were decreased after treatment in two groups and were decreased in cryotherapy group than those in stent group(P<0.05,P<0.01).The dyspnea score and the clinical manifestation score were lower,and the forced expiratory volume in the first second cryotherapy(FEV1),forced vital capacity(FVC)and KPS score were higher than those before treatment in two groups(P<0.01),but there were no significant differences in these indicators between two groups(P>0.05).No serious complications occurred in both groups,and there were no significant differences in survival rate and average survival time between two groups(P>0.05).Conclusions Photodynamic therapy combined with stent implantation or cryotherapy are effective treatments to alleviate the symptoms of malignant airway stenosis.Both methods can rapidly dilate the narrow lumen,relieve the symptoms of dyspnea,and improve the respiratory function and the quality of life of patients.