摘要
目的观察支气管镜介入治疗对结核性主支气管重度狭窄或闭锁并一侧全肺不张的疗效。方法1999年7月至2009年9月第二军医大学长海医院收治的90例结核性主支气管重度狭窄或闭锁并一侧全肺不张患者，其中男13例，女77例，年龄13～71岁，平均（31±10）岁。根据是否放置支架分为介入治疗组（53例）和支架置人组（37例），介入治疗组采用高频电凝、球囊扩张及冷冻等治疗方法，支架置入组在介入治疗的基础上置人金属支架。比较2组患者治疗前和病情稳定后影像学、支气管镜下表现及气促指数，观察治疗有效率、起效时间及再狭窄率，比较不同病程患者之间的疗效差异。2组资料比较显著性检验采用x。检验。气促指数、病程的显著性检验采用Wileoxon秩和检验。结果治疗3个月后支架置入组显效率（36／37）和总有效率（37／37）均优于介入治疗组（22／53，43／53，X＾2=29．595、6．060，均P〈0．05），支架置入组的起效时间（0．25个月）较介入治疗组（1．60个月）明显缩短。所有患者治疗后气促指数均较前明显改善，支架置入组与介入治疗组比较差异有统计学意义（u=－2．478，P〈0．05）。治疗有效者中位病程为2．0个月，好转者为3．5个月，无效者为5．0个月，有效与无效者相比，差异有统计学意义（u=－3．079，P〈0．01）。对治疗有效者随访结果显示，再狭窄发生率达72％（26／36），显著高于介入治疗组的32％（7／22，X＾2=9．090，P〈0．01）。发生再狭窄的中位时间介入治疗组为4个月，支架置人组为6个月。治疗有效后第12个月复查支气管镜，支架置人组的显效率（15／25，60％）及总有效率（22／25，88％）均优于介入治疗组（7／24，29％，14／24，60％，x。=10．559，10．261，均P〈0．01）。支架置入组中主支气管闭锁患者的总有效率（10／11，91％）明显高于介入治疗组（7／14，50％，Fisher检验，P〈0．05）。组内比较主支气管重度狭窄与闭锁者的有效率无明显差异。结论支气管镜下高频电凝、球囊扩张及冷冻等常规介入治疗及支架置入均是治疗导致肺不张的结核性主支气管重度狭窄或闭锁的有效方法。其中支架置入的疗效更好，症状改善更快。支架置入的疗效较好，但再狭窄发生率高，易发生在支架置人后6个月，应加强随访。病程对疗效有显著影响，病程长者疗效较差。因此对于出现呼吸困难，特别是肺不张的支气管结核患者，应尽早治疗。
Objective To observe the therapeutic efficacy of bronchoscopic interventional therapy on severe tuberculous main bronchial stenosis or atresia complicated with unilateral ateleetasis. Methods Ninety patients with severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis, who had received bronchoscopic interventional therapy, were divided into group A and B according to whether stents had been implanted or not. Patients in group A had been treated with electrocautery, balloon dilatation and cryotherapy. Group B had been treated with metallic stent implantation on the basis of the above interventional management. In order to observe the effectiveness, the time needed for taking effect and restenosis rate were noted. The efficacy between patients with different disease courses, radiology, bronchoscopy and dyspnea index were evaluated before treatment and after the patients＇ conditions were stable. Results Three months after treatment, the good response rate and the total effective rate of group B were higher than those of group A, 97% vs 42% （X2 =29. 595, P 〈0.05）, 100% vs 81% （ X^2 = 6. 060, P 〈 0.05 ） , respectively. The time needed for taking effect in group B was significantly shorter than that in group A, 0. 25 month vs 1.6 month. The dyspnea indexes of both groups were significantly improved after treatment, but the improvement of group B was more significant than that of group A （ u = -2. 478,P 〈0. 05）. The disease course of patients with different therapeutic efficacy was evaluated, and the median disease course was 2 months in good response efficacy patients, 3. 5 months in improved patients, and 5 months in ineffective patients; the difference being significant between ineffective and good response efficacy patients （ u = - 3. 079, P 〈 0. 01 ）. The restenosis rate of gToup B was significantly higher than that of group A, 72% vs 32% （ X^2 =9. 090,P 〈0. 01 ）. The median restenosis time was 4 months in group A, and 6 months in group B. Bronchoscopy follow-up 12 months after the initial effective treatment showed that the good response rate and the total effective rate of group B were better than those of group A, 60% vs 29% （X^2= 10. 559, P 〈0. 01）, 88% vs 60% （X^22= 10. 261, P 〈0. 01, respectively）, and the total effective rate of main bronchial atresia patients in group B was significantly higher than that in group A, 90% vs 50% （Fisher＇ s exact test, P 〈 0. 05）. There was no significant difference in effectiveness between severe stenosis and atresia patients in group A and B. Conclusion Eiectrocantery, balloon dilatation, cryotherapy and stent implantation were effective methods to treat severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis. Among them, the therapeutic efficacy was better and the symptoms improved more quickly in patients with stent implantation. The efficacy of stent implantation was better than that of conventional interventional therapy, but the incidence of restenosis was also higher. Following-up should be emphasized in this group of patients. Disease courses were associated with the therapeutic efficacy; longer disease course was related to worse therapeutic efficacy, and restenosis occurred earlier. So interventional therapy should be initiated earlier for bronchial tuberculosis with dyspnea, especially for that complicated by atelectasis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2011年第6期454-458,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
结核
气管狭窄
支气管镜
肺不张
Tuberculosis
Tracheal stenosis
Bronchoscope
Ateleetasis
