电视硬质气管镜治疗大气道良性肿瘤

目的探讨电视硬质气管镜在大气道良性肿瘤治疗中的价值.方法2002年9月～2005年4月,我院应用电视硬质气管镜治疗大气道良性肿瘤7例,其中气管1例,隆突1例,左主支气管3例,右主支气管2例.手术采用静脉全身麻醉,喷射通气供氧,探查评估气道后,首先冷冻或电凝肿瘤,破坏肿瘤血供,再以活检钳分块取出,蒂部采用冷冻或氩气凝固处理;对于宽蒂肿瘤,内镜下将肿瘤主体清除后中转开胸行气管局部切除吻合术.结果7例手术均顺利,无一例死亡和严重并发症发生.6例气管窄蒂良性肿瘤镜下完整摘除,1例气管膜部宽蒂平滑肌瘤先内镜清除肿瘤主体后中转开胸行气管局部切除.术后病理为错构瘤2例,平滑肌瘤3例,嗜酸性肉芽肿性腺瘤1例,炎症组织1例.7例随访3～36个月,平均17.3月,无肿瘤复发.结论电视硬质气管镜治疗大气道良性肿瘤安全可靠.

Application of video - assisted rigid bronchoscopy in the treatment of benign tumors of tracheobronchus

Objective To evaluate the feasibility and safety of video-assisted rigid bronchoscopy in the treatment of benign tumors of tracheobronchus.Methods Seven patients with benign tumors of tracheobronchus were managed with video-assisted rigid bronchoscopic surgery in this hospital from September 2002 to April 2005.The endoscopic procedure was performed under general transvenous anesthesia and jet ventilation.The tumor was firstly frozen or electocoagulated for better bleeding control,and then was removed with a biopsy clamp by parts,with the pedicle treated with freezing,coagulation or argon plasma coagulation(APC).For tumors with a broad pedicle,after the bulk of tumor was ablated under bronchoscope,a conversion to open local resection was carried out.Results All the 7 operations was accomplished smoothly without mortality or severe morbidity.Except one patient with broad pedicle leiomyoma which was resected through thoracotomy after airway clean-up and intubation,all 6 patients with narrow pedicle tumors underwent a complete tumor removal endoscopically.Postoperative pathological reports confirmed the benign diagnosis as 2 cases of hamartoma,3 cases of leiomyoma,1 case of acidophilus granuloma,and 1 case of inflammation.Follow-up observations in the 7 patients for 3~36 months(mean,17.3 months) showed no recurrence.Conclusions Video-assisted rigid bronchoscopy in the treatment of benign tumors of tracheobronchus is safe and reliable.