经支气管镜高频电刀热消融联合冷冻术在气管支气管结核治疗中的应用价值

Application value of transbronchoscopic high-frequency electrosurgical thermal ablation combined with cryotherapy in the treatment of tracheobronchial tuberculosis

目的探讨经支气管镜高频电刀热消融联合冷冻术治疗气管支气管结核的有效性和安全性。方法回顾性分析2018年8月至2019年9月于哈尔滨市胸科医院结核科住院治疗的79例气管支气管结核患者,根据治疗方法分为观察组(n=31)和对照组(n=48),观察组经支气管镜高频电刀热消融联合冷冻术治疗,对照组经单纯冷冻术治疗,两组均经局部灌注抗结核药物治疗,比较分析两组患者治疗2个月后的治疗次数、痰菌阴转情况、支气管镜下病灶吸收情况、胸部CT病灶吸收情况及临床疗效。结果观察组患者接受经支气管镜高频电刀热消融联合冷冻术治疗共77次,平均(2.48±1.21)次/例,对照组患者接受经支气管镜冷冻治疗共178次,平均(3.71±1.24)次/例,两组比较差异有统计学意义(t=4.34,P<0.05)。观察组患者的痰菌阴转率86.36%(19/22),高于对照组的痰菌阴转率[60.00%(21/35)],差异有统计学意(χ^(2)=4.49,P<0.05)。观察组患者解除和缓解气道阻塞,症状消失,肺部病灶明显好转。两组治疗2个月后支气管镜下病灶吸收情况总有效率[93.55%(29/31),93.75%(45/48)],治疗前后病灶吸收情况总有效率[90.32%(28/31),87.50%(42/48)]及临床疗效总有效率[93.55%(29/31),89.58%(43/48)]比较,均差异无统计学意义(Z=-0.84,-0.86,-0.47;均P>0.05)。2组患者治疗期间均无严重不良反应发生。结论经支气管镜热消融术治疗不同类型的气管支气管结核可取得满意的疗效,且冷热技术结合更具优势。

ObjectiveTo investigate the efficacy and safety of transbronchoscopic high-frequency electrosurgical thermal ablation combined with cryotherapy in the treatment of tracheobronchial tuberculosis(TBTB).MethodsFrom August 2018 to September 2019,79 patients with TBTB hospitalized in Tuberculosis Department of Harbin Chest Hospital were retrospectively analyzed.The patients who were treated by high-frequency electrosurgical thermal ablation combined with cryotherapy by bronchoscopy and injection of antituberculosis drugs were classified into observation group(n=31),and the patients who were treated by cryotherapy and injection of antituberculosis drugs by bronchoscopy were classified into control group(n=48).After 2 months of treatment,the treatment frequency,negative sputum conversion,bronchoscopy performance,imaging performance and clinical symptoms of the two groups of patients were compared and analyzed.ResultsIn the observation group,31 patients received 77 times of bronchoscopic cryotherapy combined with high-frequency electrosurgical thermal ablation,with an average of(2.48±1.21)times per patient.Patients in the control group received bronchoscopic cryotherapy for 178 times,with an average of(3.71±1.24)times per case.The average number of interventional therapy in the observation group was smaller than that in the control group,and the difference was statistically significant(t=4.34,P<0.05).The sputum negative rate in the observation group was 86.36%(19/22),which was higher than that in the control group[60.00%(21/35)],and the difference was statistically significant(χ^(2)=4.49,P<0.05).In the observation group,the airway obstructions of patients were relieved,symptoms disappeared and the pulmonary lesions improved significantly.After 2 months of treatment,the total effective rates of the two groups compared in bronchoscopy,imaging and clinical efficacy were[93.55%(29/31),93.75%(45/48),90.32%(28/31),87.50%(42/48),93.55%(29/31),89.58%(43/48)],with no significant differences(Z=-0.84,-0.86,-0.47,all P>0.05).No serious adverse reactions occurred in the two groups of patients.ConclusionDifferent types of TBTB treated by bronchoscopy of thermal ablation can achieve satisfactory results,and the combination of thermal ablation and cryotherapy by bronchoscopy has more advantages.