支气管镜下联合介入治疗75例良性中央气道狭窄效果分析

Effect analysis of 75 cases of benign central airway stenosis treated by bronchoscopy combined with interventional therapy

目的通过对支气管镜下联合介入诊疗方法治疗良性中央气道狭窄疗效及预后评估,分析优化中央气道狭窄支气管下介入诊疗方法的选择。方法收集我院呼吸与危重症医学科2016年8月至2021年12月中央气道良性狭窄患者75例,共计行232例次支气管镜下介入诊疗,主要方法有高频电刀、氩气刀、冷冻治疗、激光消融、球囊扩张、气管支架置入等。术前对患者进行狭窄气道内径测量,评估狭窄程度及分级、Borg呼吸困难评分、术前风险评估,针对每名患者狭窄病因和部位不同制定对应支气管镜下治疗策略。结果对于支气管结核引起的狭窄,80%以上患者可在支气管镜下介入联合治疗后得到有效治疗,能缩短抗结核治疗疗程。对于气管上段插管或气切后狭窄的患者行内镜下介入诊疗能快速缓解临床症状,但是对于气管结构性损坏或反复多种方法治疗后仍有疤痕挛缩的患者置入硅酮支架是理想选择,经过随访,1~2年后取出硅酮支架患者气道狭窄段结构稳定,黏膜完整光滑。对于气道良性肿瘤及异物引起的各段气管、支气管狭窄,支气管镜下介入诊疗能达到根治的目的。而因结构性肺病引起的气道牵拉变形狭窄治疗方法不理想。结论中央气道良性狭窄病因多样,针对不同病因采取不同的支气管镜下联合介入治疗,特别是支气管结核、气管插管、气管切开、气道良性肿瘤、气道异物等引起的狭窄患者能取得理想的临床效果。

Objective To evaluate the efficacy and prognosis of bronchoscopy combined with interventional diagnosis and treatment in the treatment of benign central airway stenosis,and to explore the choice of optimal subbronchial interventional diagnosis and treatment of central airway stenosis.Methods From August 2016 to December 2021,75 patients with benign stenosis of central airway in the department of respiratory and critical care medicine of our hospital were collected.A total of 232 cases underwent interventional diagnosis and treatment under bronchoscope.The main methods include high-frequency electric knife,argon knife,cryotherapy,laser ablation,balloon dilatation,tracheal stent implantation,etc.Before operation,measure the inner diameter of narrow airway,evaluate the degree and grade of stenosis,Borg dyspnea score and preoperative risk assessment,and formulate corresponding bronchoscopic treatment strategies according to the different causes and locations of stenosis in each patient.Results For the stenosis caused by bronchial tuberculosis,more than 80%of patients can get effective treatment after interventional combined treatment under bronchoscope,and can shorten the course of anti tuberculosis treatment.For patients with stenosis after upper tracheal intubation or tracheotomy,endoscopic interventional diagnosis and treatment can quickly alleviate clinical symptoms,but for patients with structural damage of trachea or scar contracture after repeated treatment with multiple methods,silicone stent is an ideal choice.After follow-up 1-2 years,the structure of airway stenosis is stable,and the mucosa is complete and smooth.Interventional diagnosis and treatment under bronchoscope can achieve the purpose of radical cure for all segments of tracheal and bronchial stenosis caused by benign airway tumors and foreign bodies.All kinds of treatment methods for airway stretch deformation stenosis caused by structural lung disease are not ideal.Conclusion There are multiple causes of benign central airway stenosis.Different combined interventional therapy under bronchoscope can achieve ideal clinical results,especially in patients with stenosis caused by bronchial tuberculosis,endotracheal intubation,tracheotomy,benign airway tumor and airway foreign body.