中心气道占位性病变的呼吸内镜介入治疗策略与疗效分析

doi:10.3877/cma.j.issn.1674-6902.2021.05.007

目的

分析经支气管镜介入治疗中心支气管狭窄的有效性及安全性。

方法

回顾分析了2018年9月至2019年8月在上海市肺科医院内镜中心接收腔内治理的患者136例，均为中心支气管重度以上狭窄经支气管介入治疗患者。收集患者临床病历资料，观察患者病变位置、占位引起管腔狭窄类型及程度、治疗手段、病理类型、术后1周内症状缓解情况，以评估气管镜介入治疗的短期疗效。

结果

在136位接受支气管镜介入治疗患者里，男性有109例(80%)、女性27位(20%)，中位年龄(57.66±7.35)岁。术前或术后病理结果为恶性：111例、良性：25例。主要采取电凝、圈套、球囊扩张、APC、激光、支架植入等治疗方案。术后所有患者的占位处气管狭窄得到明显改善，狭窄程度、呼吸困难程度均较术前明显改善(P<0.01，P<0.05)。术中或术后主要并发少量出血113例(83.09%)。

结论

呼吸内镜介入治疗可以高效、安全、微创地改善症状，为后续治疗创造条件，并能作为气管外科手术的评估手段。

关键词: 中心气道占位, 支气管镜介入治疗, 电凝治疗, 圈套治疗, 支架置入

Objective

To investigate the efficacy and safety of interventional bronchoscopy in the treatment of central bronchial stenosis.

Methods

A total of 136 patients with severe central bronchial stenosis or above were collected from endoscopy center of Shanghai pulmonary hospital from September 2018 to August 2019. Detailed medical records of patients were collected to observe the location of lesions, type and degree of lumen stenosis caused by space occupation, treatment methods, pathological types, and symptom relief within 1 week after surgery, so as to evaluate the short-term efficacy of tracheal bronchoscopic interventional therapy.

Results

Among the 136 patients who received bronchoscopy intervention, 109 (80%) were males and 27 (20%) were females, with a median age of 57.66±7.35 years. Preoperative or postoperative pathological results were: malignant: 111 cases, benign: 25 cases. It mainly adopts electro-coagulation, APC, snare, balloon dilatation, laser stentimplantation treatment schemes. Postoperative tracheal stenosis was significantly improved in all patients, and the degree of stenosis and dyspnea were significantly improved compared with those before surgery (P<0.05). There were 113 cases (83.09%) with minor bleeding during or after operation.

Conclusion

Bronchoscopic interventional therapy can improve symptoms efficiently, safely and minimally invasively, and can be used as an evaluation method for tracheal surgery.

Key words: Central airway occupation, Bronchoscopic interventional therapy, Electrocoagulation therapy, Snare therapy, Stent implantation

图1： 治疗前后对比典型病例影像学表现；注：A：气道中下段占位CT表现；B：气管镜介入治疗前表现；C：气管镜下电凝联合圈套治疗后表现；D：右主气管处占位CT表现；E：气管镜介入治疗前表现；F：气管镜电凝联合支架治疗后表现；G：气道中下段占位CT表现；H：气管镜介入治疗前表现；I：气管镜下电凝治疗后表现

表1 内镜治疗前后中心气道狭窄、呼吸困难情况对比

分　级	术前	术后	P值
轻	0	41	0.000
中	0	64
重	62	31
极重	71	0
完全堵塞	17	0
1级	0	0	0.005
2级	14	26
3级	66	57
4级	56	51

表1 内镜治疗前后中心气道狭窄、呼吸困难情况对比

分　级	术前	术后	P值
轻	0	41	0.000
中	0	64
重	62	31
极重	71	0
完全堵塞	17	0
1级	0	0	0.005
2级	14	26
3级	66	57
4级	56	51

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Analysis of interventional therapy strategy and therapeutic effect of respiratory endoscopy for central airway space-occupying lesions

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Analysis of interventional therapy strategy and therapeutic effect of respiratory endoscopy for central airway space-occupying lesions