良性中心气道狭窄病因与形态学分类的关系及预后分析

Relationship between etiology and morphological classification of benign central airway stenosis and its prognosis

目的对良性中心气道狭窄病因与形态学分类的关系及预后进行分析。方法回顾性分析2003年1月至2019年10月首都医科大学附属北京天坛医院呼吸与危重症医学科首诊为良性中心气道狭窄453例患者的病历资料,其中男260例,女193例,年龄12~86(44.0±25.5)岁。采用SPSS 25.0软件进行统计学处理。结果453例良性中心气道狭窄主要病因构成为:医源性狭窄161例(35.5%,气管切开术后狭窄113例,气管插管后狭窄48例),良性肿瘤88例(19.4%),气管、支气管结核77例(17.0%),气管异物71例(15.7%)。病因构成在不同性别、年龄中有差异。狭窄类型主要为结构性狭窄,其中管内生长型241例(53.2%),瘢痕挛缩型183例(40.4%)。狭窄部位与狭窄病因有一定关系。狭窄程度主要在2~4级(76.4%),长度主要在3 cm以内(84.8%)。单因素分析病因及形态分类对预后的影响显示良性肿瘤、气道异物、腔内型狭窄、狭窄程度3~4级、长度为1~2级的良性中心气道狭窄患者预后更好,差异均有统计学意义。结论医源性气道狭窄、良性肿瘤、气管支气管结核及气管异物是常见良性中心气道狭窄原因。良性中心气道狭窄的不同病因及形态学分类经气管镜介入治疗后的预后有所不同。临床医师应了解良性中心气道狭窄病因、形态特点以及危险因素,以期达到早发现、早治疗甚至早预防气道狭窄的目的。

Objectives To analyze the relationship between etiology and morphological classification of benign central airway stenosis and its prognosis.Methods We performed a retrospective study of the medical records of 453 patients initially diagnosed with benign airway stenosis at Department of Respiratory Diseases in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2003 to October 2019.Of 453 patients,260 were male.The age of the study population was 12-86(44.0±24.5)years.Results Among the 453 patients diagnosed with benign central airway stenosis,161 case(35.5%,including 113 post-tracheostomy tracheal stenosis and 48 post-intubation tracheal stenosis)were iatrogenic;88 cases were from benign tumors(19.4%),77 cases from tracheal or bronchial tuberculosis(17.0%),71 case from tracheal foreign bodies(15.7%).Disease causes varied among different gender or age groups.The main type of stenosis was structural stenosis,of which 241 cases(53.2%)were intra-luminal and 183 cases(40.4%)were scar contracture type.The site of stenosis showed a certain relationship with the causes of stenosis.The stenosis degree was mainly from grade 2 to grade 4(76.4%),and the length was mainly within 3 cm(84.8%).Single factor analysis on the relationship between disease cause,morphological classification and prognosis of benign central airway stenosis showed statistically better prognosis in groups that were caused by benign tumor,intraductal stenosis or stenosis that were 3-4 in degree and 1-2 degree in length.Conclusion The common causes of central airway stenosis included iatrogenic stenosis,benign tumor,tracheal or bronchial tuberculosis and tracheal foreign bodies.Benign airway stenosis with different disease causes and morphological classification had different prognosis after bronchoscopic interventional treatment.Clinicians should know the disease causes,morphological characterization and risk factors for benign airway stenosis for earlier diagnosis,treatment or prevention.