恶性阻塞性全肺不张支气管镜介入治疗的疗效分析

Efficacy analysis of bronchoscopy interventional therapy for complete postobstructive lung atelectasis due to malignant central airway obstruction

目的探讨支气管镜介入治疗全肺不张的临床意义,以及影响疗效的相关因素和预后指标。方法对2008年10月至2019年8月经病理证实的263例恶性阻塞性全肺不张的病例进行回顾性研究。其中左全肺不张137例,右全肺不张126例;男206例,女57例;年龄(60.0±0.9)岁,年龄范围为8~84岁。术前均行胸部CT检查,随后均行支气管镜介入削瘤治疗。按照术后疗效分为复张组226例,未复张组37例;复张组再分为完全复张组112例,部分复张组114例。通过组间对照了解影响疗效的相关因素。结果全肺不张的病因主要是原发性肺癌(219/263,83.3%),其中鳞癌所占比例最高(150/263,57.0%)。支气管镜介入治疗可使大部分患者复张(226/263,85.9%),术后KPS评分及气促评分较术前均有明显改善(P<0.01)。2015-2019年治疗的患者复张率明显高于2005-2014年,差异有统计学意义(P<0.05)。左肺不张的完全复张率高于右肺不张,差异有统计学意义(P<0.01)。左肺不张中,Ⅷ区阻塞的复张率高于Ⅶ区,完全复张率明显低于Ⅶ区,差异均有统计学意义(P值均<0.05)。由肺转移癌引起的肺不张的复张率及完全复张率均明显高于由原发性肺癌引起的肺不张,差异均有统计学意义(P值均<0.05)。结论支气管镜介入方法治疗恶性肿瘤引起全肺不张疗效肯定,疗效与术者经验、阻塞部位以及病因有关。

Objective To explore the clinical significance of bronchoscopy interventional therapy for complete lung atelectasis,as well as related factors and prognostic indicators that affect the efficacy.Methods Aspective analysis of 263 cases of malignant obstructive complete lung atelectasis confirmed by pathology from October 2008 to August 2019,including 137 cases of left atelectasis and 126 cases of right atelectasis.There were 206 males and 57 females,with an average age of(60.0±0.9)years old,from 8 to 84 years old.Chest CT examinations were performed before operation,and bronchoscopy interventional therapy was performed afterwards.According to the postoperative curative effect,they were divided into 226 cases in the recruitment group and 37 cases in the non-recruitment group.The recruitment group was further divided into 112 cases in the complete recruitment group and 114 cases in the partial recruitment group.Discuss the related factors affecting the curative effect through the comparison between groups.Results The main cause of complete lung atelectasis was primary lung cancer(219/263,83.3%),with squamous cell carcinoma accounting for the highest proportion(150/263,57.0%).Bronchoscopy interventional therapy can make most patients reopen(226/263,85.9%).Postoperative Karnofsky Physical Status scores and short breath scale are significantly improved compared with preoperative(P<0.01).The reopen rate from 2015 to 2019 was significantly higher than that from 2005 to 2014,with statistical differences(P<0.05).The left atelectasis complete reopen rate was higher than that of the right atelectasis,with a statistically significant difference(P<0.01).In left atelectasis,the obstructions located in zoneⅧhad a higher reopen rate(P<0.05)and a lower complete reopen rate(P<0.01)than those in zoneⅦ.The atelectasis caused by metastatic lung cancer,the reopen rate(all P<0.05)and the complete reopen rate(all P<0.01)were significantly higher than those caused by primary lung cancer,with statistical differences.Conclusions The bronchoscopy interventional therapy can effectively treat complete lung atelectasis due to malignant central airway obstruction.The efficacy depends on the surgeon′s experience,obstruction site and etiology.