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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2023年05期

页码:

645-649

栏目:

论著

出版日期:

2023-10-20

文章信息/Info

Title:

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

作者:

熊 震; 阳光辉; 郑小春; 王 娜

541002 桂林,联勤保障部队第九二四医院呼吸与危重症医学科

Author(s):

Xiong Zhen;  Yang Guanghui;  Zheng Xiaochun;  Wang Na.

Department of Respiratory and Critical Care Medicine, Unit 924th Hospital, Joint Logistic Support Force, Guilin 541002, China

关键词:

良性气道狭窄;  联合介入治疗;  疗效分析

Keywords:

Benign airway stenosis;  Combined interventional therapy;  Efficacy analysis

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2023.05.008

摘要:

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。

Abstract:

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.

参考文献/References:

1 余丽丽, 贾晋伟, 肖 洋. 良性气道狭窄病因分析[J]. 临床肺科杂志, 2019, 24(8): 1394-1398.
2 方晓玉, 张 杰, 王 婷, 等. 良性中心气道狭窄病因与形态学分类的关系及预后分析[J]. 中华结核和呼吸杂志, 2022, 45(8): 768-774.
3 中华医学会呼吸病学分会. 良性中心气道狭窄经支气管镜介入诊治专家共识[J]. 中华结核和呼吸杂, 2017, 40(6): 408-418.
4 金发光. 支气管结核介入的诊治方案[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(1): 1-4.
5 WangT, Zhang J, Qiu XJ, et al. Scarring airway stenosis in Chinese adults: Characteristics and interventional bronchoscopy treatment[J]. Chin Med J(Engl), 2018, 131(3): 276-281.
6 王洪武, 张 楠, 周云芝, 等. 207例气管切开/气管插管后良性气道狭窄的疗效分析[J]. 国际呼吸杂志, 2017, 37(8): 595-599.
7 江贤亮, 柯 立, 徐美青, 等. 肺移植8例临床经验总结[J]. 临床肺科杂志, 2019, 24(1): 1-4.
8 张 杰. 良性气道疾病呼吸介入操作的规范性要求[J]. 中华结核和呼吸杂志, 2023, 46(10): 1038-1043.
9 Liang W, Hu P, Guo W, et al. Appropriate treatment sessions of flexible bronchoscopic balloon dilation for patients with nonmalignant central airway stenosis^{[ J]}. Ther Adv Respir Dis, 2019, 13: 1753466619831966.
10 吴 旋, 苏振忠, 胡丽茎, 等. 560 例气管切开行机械通气患者并发气管狭窄的危险因素分析^{[ J]}. 中华耳鼻咽喉头颈外科杂志, 2007, 42(11): 839-842.
11 田良东, 李 俊, 陆光兵, 等. 不同时机行球囊扩张术对结核性气道狭窄患者肺功能及阻塞性肺炎的影响[J]. 临床肺科杂志, 2021, 26(10): 1463-1466,1480.
12 李梦怡, 宫蓓蕾, 李 伟, 等. 内镜下激光治疗重度良性中心气道狭窄疗效分析[J]. 中华全科医学, 2022, 20(6): 923-926.
13 Zhang J, Wang T, Wang J, et al. Effect of three interventional bronchoscopic methods on tracheal stenosis and the formation of granulation tissues in dogs[J]. Chin Med J(Engl), 2010, 123(5): 621-627.
14 张 杰, 王 娟, 王 婷, 等. 经支气管镜治疗良性瘢痕增生性气道狭窄方法的比较[J]. 中华结核和呼吸杂志, 2011, 34(5): 334-338.
15 Ashish D, Sunil J, Virendra W, et al. Airway management and bronchoscopic treatment of subglottic and tracheal stenosis using holmium laser with balloon dilatation[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(Suppl 1): 453-458.
16 王 辉, 陈伟庄, 葛 挺, 等. 硅酮支架在良性气道狭窄中的临床应用[J]. 中国内镜杂志, 2020, 26(7): 63-67.
17 中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.气管支气管结核诊断和治疗指南(试行)[S]. 中华结核和呼吸杂志, 2012, 35(8): 581-587.
18 Um SW, Yoon YS, Lee SM, et al. Predictors of persistent airway stenosis in patients with endobronchial tuberculosis[J]. Int JTuberc Lung Dis, 2008, 12(1): 57-62.
19 马 芸, 杨会珍, 黄泰博, 等. 经支气管镜介入治疗在非中心性气道狭窄合并肺不张中的疗效与安全性研究[J]. 中华结核和呼吸杂志, 2022, 45(5): 480-482.
20 王洪武. 气管支气管内支架的种类、性能及置入技术[J]. 中国组织工程研究与临床康复, 2008, 12(9): 1738-1744.
21 Byeong-Ho J, Jeffrey N, Suk HJ, et al. Clinical outcomes of complications following self-expandable metallic stent insertion for benign tracheobronchial Stenosis[J]. Medicina(Kaunas), 2020, 56(8): 367.
22 Cheng LP, Gu Y, Gui XW, et al. Diagnostic value of virtual bronchoscopic navigation in the bronchial tuberculosis induced central airway stenosis[J]. Infect Dis Ther, 2020, 9(1): 165-174.
23 李时悦. 良性中央气道狭窄的介入治疗方法选择[J]. 中华结核和呼吸杂志, 2011, 34(5): 329-332.
24 冯致余, 张忠晓, 徐惠惠, 等. 先天性气管狭窄介入治疗后再狭窄的外科手术治疗9例临床分析[J]. 中华外科杂志, 2022, 60(1): 84-89.
25 Kleiss IJ, Verhagen AF, Honings J, et al. Tracheal surgeryfor benign tracheal stenosis:our experience in sixty three patients[J]. Clin Otolaryngol, 2013, 38(4): 343-347.

备注/Memo

备注/Memo:

基金项目: 桂林市科学研究与技术开发计划资助项目(20180106-4-6)
通信作者: 阳光辉, Email: xiongzhen007@163.com

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更新日期/Last Update: 2023-10-20