支气管镜下冷冻治疗支气管结核效果研究

Study on the efficacy of bronchoscopic cryotherapy for endobronchial tuberculosis

目的探讨支气管镜下冷冻治疗联合全身化疗溃疡坏死及肉芽增殖型支气管结核患者的临床疗效。方法确诊为支气管结核合并菌阳肺结核52例患者作为研究对象,随机分为观察组(26例)和对照组(26例),对照组患者口服异烟肼(INH)、利福平(RFP)、吡嗪酰胺(PZA)、乙胺丁醇(EMB)治疗,观察组患者除了上述方案规范抗结核治疗外,行支气管镜下冷冻治疗,比较2组患者治疗后3个月及6个月的临床症状缓解率、痰菌转阴率、影像学疗效、支气管镜下疗效。结果治疗3个月后观察组症状缓解率(96.15%)、痰菌转阴率(88.46%)、影像学病灶吸收有效率(88.46%)、镜下病灶清除有效率(96.15%)均优于对照组症状缓解率(69.23%)、痰菌转阴率(61.54%)、影像学病灶吸收有效率(61.54%)、镜下病灶清除有效率(65.38%);治疗6个月后观察组症状缓解率、痰菌转阴率、影像学病灶吸收有效率及镜下病灶清除有效率均为100%,均优于对照组症状缓解率(84.61%)、痰菌转阴率(76.92%)、影像学病灶吸收有效率(77.08%)、镜下病灶清除有效率(76.92%),差异有统计学意义(P<0.05)。结论支气管镜下冷冻治疗溃疡坏死型及肉芽增殖型支气管结核患者,可以迅速缓解干咳等支气管病变症状,有利于降低传染性,避免患者支气管病变恶化并严重影响呼吸功能,值得应用于临床工作中。

Objective To explore the effect of bronchoscopic cryotherapy combined with systemic chemotherapy in patients with ulcerative necrotic and granulation proliferative endobronchial tuberculosis.Methods 52 patients with bronchial tuberculosis complicated with sputum-positive pulmonary tuberculosis were enrolled in the study.The patients were randomly divided into experimental group(n=26)and control group(n=26).The control group was treated with isoniazid(INH),rifampicin(RFP),pyrazinamide(PZA)and ethambutol(EMB).The experimental group was treated with bronchoscopic cryotherapy and the systematic chemotherapy.Evaluation index included symptom remission rate,sputum negative conversion rate,the curative effect of imaging and bronchoscopy were recorded at three months and six months after treatment.Results After three months of treatment,the symptom remission rate(96.15%),sputum negative conversion rate(88.46%),pulmonary lesion absorption rate(88.46%)and bronchial lesion absorption rate(96.15%)in the experimental group were better than those in the control group.After 6 months of treatment,the symptom remission rate,sputum negative conversion rate,pulmonary lesion absorption rate and bronchial lesion absorption rate in the experimental group were all 100%.All of them were superior to those in the control group symptom remission rate(84.61%),sputum negative rate(76.92%),pulmonary lesion absorption rate(77.08%)and bronchial lesion absorption rate(76.92%).The differences were statistically significant(P<0.05).Conclusion Bronchoscopic cryotherapy and the systematic chemotherapy can quickly relieve the symptoms of end obronchial tuberculosis,and decrease the infectivity,avoid the deterioration of bronchial lesions.