支气管镜介入冷冻治疗支气管结核

目的　探讨支气管镜下冷冻治疗支气管结核的疗效。方法 21例支气管结核患者常规抗结核化疗基础上,在支气管镜下行冷冻和镜下注药治疗并追踪观察。结果 21例支气管结核患者行支气管镜下冷冻和镜下注药治疗,平均治疗5±2次/例。18例溃疡坏死型和/或肉芽增殖型患者经治疗后,支气管黏膜光滑、管腔通畅,原有阻塞性肺炎、肺不张消退,症状消退或明显改善,仅3例患者支气管腔内遗留少量瘢痕组织,不影响通气功能。显效83.3%(15/18)、有效16.7%(3/18),总有效率100%(18/18)。而3例瘢痕型经多次冷冻治疗后,病变无变化,症状无改善。结论 肉芽增殖型和/或溃疡坏死型支气管结核采用支气管镜下介入冷冻治疗不仅能迅速缓解病人临床症状、促进病灶吸收,通畅呼吸道,还可有效地控制肉芽增生,避免瘢痕纤维组织形成的气道狭窄或闭锁等不良后果。但对于肉芽增生进入瘢痕纤维组织形成后,冷冻治疗则难以奏效。故对于支气管结核患者应争取尽早诊断、尽早治疗,纤支镜介入冷冻治疗支气管结核是一种无明显并发症和不良反应,安全有效的方法。

Bronchoscpic cryotherapy for endobronchial tuberculosis

ObjectiveTo evaluate the effects of bronchoscpic cryotherapy on endobronchial tuberculosis(EBTB).MethodsTwenty-one EBTB patients, cryotherapy and cather intervention compined with chemotherapy were performed through bronchofibroscope. Efficacy was assessed and followed up after treatment. ResultsTwenty-one patients with EBTB were treated 52 times by bronchoscpic cryotherapy. In 18 patients with granulomatous and ulcerative EBTB, intraluminal lesions disappeared thoroughly and the chinical symptoms improved completely and atelectasis or obstructive pneumonia disappeared.Only 3 patients leaved some intraluminal cicatrices. The significant improvement rate was 83.3%(15/18 patients), clinical effective rate was 16.7%(3/18 patients).The overall effective rate was 100%(18/18 patients).But,there were not significantly efficacy in 3 patients with cicatricial EBTB by bronchoscpic cryotherapy. ConclusionsBronchoscpic cryotherapy for granulomatous and ulcerative EBTB, could disappeared thoroughly the intraluminal lesions,and rapidly relieve chinical symptoms.Bronchoscpic cryotherapy is an effective and safe method of treatment in patients with EBTB.