硬质支气管镜和球囊分别联合针形电刀及二氧化碳冷冻治疗瘢痕性插管后气管狭窄的有效性及安全性

Effectiveness and safety of rigid bronchoscopy and balloon combined with needle-shaped electric knife and carbon dioxide cryotherapy in treatment of postintubation tracheal stenosis

目的探讨硬质支气管镜和球囊分别联合针形电刀及二氧化碳冷冻治疗瘢痕性插管后气管狭窄的有效性及安全性。方法以应急总医院呼吸与危重症医学科2017年1月至2019年12月就诊的52例瘢痕性插管后气管狭窄患者为研究对象。所有患者均用针形电刀"十"字切开瘢痕狭窄,分别以硬质支气管镜(硬镜组)和球囊(球囊组)进行狭窄段扩张,待气道开放后继续行二氧化碳冷冻治疗,每周重复治疗1次,共4次。于首次治疗后1个月及6个月进行疗效及安全性评估。结果2组患者在初次介入治疗1个月后,气促评分及管腔狭窄程度均较治疗前显著改善(P值均<0.05),而狭窄长度无明显变化,球囊组狭窄程度高于硬镜组(P<0.05);初次治疗6个月后2组患者的气促评分及管腔狭窄程度均较治疗前明显下降,狭窄长度均较治疗前有所缩短(P值均<0.05)。与球囊组比较,硬镜组的管腔狭窄程度更轻,额外介入治疗次数更少(P值均<0.05)。2组患者在支气管镜下介入治疗过程中无严重相关并发症。结论硬质支气管镜、球囊扩张联合针形电刀及二氧化碳冷冻均对瘢痕性插管后气管狭窄有良好的治疗作用,且安全性好。硬镜联合治疗能够减少额外介入治疗次数,从远期疗效来看,较球囊组维持更宽的管腔。

Objective To explore the effectiveness and safety of rigid bronchoscopy and balloon combined with electric knife and carbon dioxide cryotherapy to treat postintubation tracheal stenosis(PITS).Methods A total of 52 patients with PITS in Department of Pulmonary and Critical Care Medicine,Emergency General Hospital from January 2017 to December 2019 were analyzed.The stenosis were cut by needle-shaped electric knife,the lesions were dilated by rigid bronchoscopy and balloon seperately.Carbon dioxide cryotherapy was used to treat the tears.The combined modalities were repeated once a week,and the total duration was four weeks.The effectiveness was evaluated at the 1st and 6th month after the first treatment.Results One month after initial treatment,the dysnea score decreased,and tracheal stenosis relieved in two groups(all P<0.05).There was no significant change in the length of stenosis,and the degree of stenosis in balloon group was more serious than that in rigid bronchoscopy group(P<0.05).Six months after initial treatment,the dysnea score decreased,and tracheal stenosis relieved in two groups(all P<0.05).The length of stenosis was shortened compared with before treatment(P<0.05).The degree of stenosis and the number of additional interventions in rigid bronchoscopy group were less than those in balloon group(all P<0.05).The two groups had no serious complications during the interventional procedure.Conclusions Both rigid bronchoscopy and balloon dilation can be effectively and safely used to treat PITS.Rigid bronchoscopy can reduce the number of additional interventional treatments,and maintain a larger lumen than balloon dilation.