激光治疗过度动态气道塌陷的疗效分析(附13例报告)

Therapeutic effect analysis of excessive dynamic airway collapse treated by laser(13 cases)

目的评估激光治疗过度动态气道塌陷(EDAC)的安全性和有效性。方法选取2018年1月-2022年8月该院13例经支气管镜证实的EDAC患者,根据是否合并气管支气管软化症(TBM),分为单纯EDAC组(6例)和EDAC+TBM组(7例)。所有患者均进行支气管镜下气管支气管激光成形术治疗,比较两组患者治疗前后患者症状、气道塌陷导致气道管腔狭窄情况、氧合指数、改良英国医学研究学会呼吸困难指数(mMRC)和6 min步行试验结果。结果13例患者共进行了17次气管支气管激光成形术治疗,所用激光功率为8~15 W。其中,4例患者进行了2次气管支气管激光成形术治疗。治疗后,所有患者咳嗽、咳痰、气短和呼吸困难等临床症状均得到改善。单纯EDAC组治疗后1周,气道管腔狭窄程度与治疗前比较,明显好转,差异有统计学意义(P<0.05),治疗后1个月,气道管腔狭窄程度、氧合指数、FEV_(1)%、6 min步行试验和mMRC等指标均较治疗前改善,并在6个月的随访中维持稳定。EDAC+TBM组治疗后1周,气道管腔狭窄程度、氧合指数和mMRC较治疗前明显好转,差异均有统计学意义(P<0.05),部分患者8 d~6个月内再次出现气道管腔狭窄,需要接受球囊扩张、冷冻和支架置入等综合治疗。激光治疗后,部分患者会出现局部坏死和肉芽增生,所有患者均未发现与激光介入操作相关的严重并发症。结论气管支气管激光成形术治疗EDAC,安全、有效。对于单纯EDAC患者治疗效果好,对于EDAC合并TBM的患者,长期疗效欠佳。

Objective To evaluate the safety and effectiveness of excessive dynamic airway collapse(EDAC)treated by laser.Methods 13 patients with EDAC confirmed by bronchoscopy from January 2018 to August 2022 were selected and divided into a simple EDAC group(6 cases)and an EDAC combined with tracheobronchomalacia(TBM)group(7 cases)based on whether they were combined with TBM.All patients underwent laser tracheobronchoplasty under bronchoscope.Symptoms,airway collapse,oxygenation index,modified version of British Medical Research Council dyspnoea scale(mMRC)and 6 min walking test before and after treatment were compared to evaluate the therapeutic effect.Results 13 patients underwent 17 times of laser tracheobronchoplasty with laser power of 8~15 W,and 4 patients underwent 2 times of laser tracheobronchoplasty.After treatment,the clinical symptoms of cough,sputum,shortness of breath and dyspnea were improved in all patients.1 week post treatment,the EDAC group showed a significant improvement in airway lumen stenosis,with a significant statistical difference(P<0.05),1 month post-treatment,enhancements were observed in airway stenosis,oxygenation index,FEV1%,6-minute walk test,and mMRC,which remained stable over a 6 month follow-up.In the EDAC+TBM group,significant enhancements in airway stenosis,oxygenation index,and mMRC were noted 1 week post treatment,with statistical significance(P<0.05).Between 8 d~6 months post-treatment,some patients exhibited a recurrence of airway stenosis,necessitating comprehensive interventions like balloon dilation,cryotherapy,and stent insertion.Local necrosis and granuloma occurred in some patients after laser therapy,and no serious complications associated with laser intervention were found in all patients.Conclusion Laser tracheobronchoplasty is a safe and effective technique for the treatment of EDAC.For patients with EDAC alone,the therapeutic effect is good,but for patients with EDAC combined with TBM,the long-term effect is not good.