气管支气管结核的局部药物治疗进展

Progress of local drug therapy in tracheobronchial tuberculosis

气管支气管结核(tracheobronchial tuberculosis,TBTB)临床表现缺乏特异性,检查手段受限,极易漏诊误诊。近年来,随着支气管镜和支气管介入技术的普及和发展,TBTB的检出率大幅提高,治疗手段也日益丰富,除全身抗结核药物治疗外,也发展出了气道内局部给药、球囊扩张、冷冻、热消融及支架置入等治疗技术,但目前尚缺乏统一的操作规范及指导方案。笔者通过总结TBTB局部抗结核治疗、防止气道狭窄的常用方法及耐多药TBTB的局部用药策略,以及近年来新的局部用药方式和新型吸入制剂的研究进展,对TBTB的气道内局部用药策略进行综述,以期为TBTB的局部治疗提供快速有效的组合方案。

The tracheobronchial tuberculosis(TBTB)lacks typical and clinical presentation,and misdiagnosis is common.In recent years,with the development of bronchoscopy and bronchial intervention technology,the detection rate of TBTB has increased significantly.Besides systemic antituberculosis therapy,there are more and more treatment methods,such as local drug therapy in airway,balloon dilatation,cryotherapy,thermal ablation and stent placement.However,there is no uniform and normative guideline at present.In order to provide a rapid and effective combination scheme for the local treatment of TBTB,the author summarizes the local antituberculosis treatment of TBTB,the common methods to prevent airway stenosis and the local medication strategies of multidrug-resistant TBTB,as well as the research progress of new local medication methods and new inhalation drugs.