经纤维支气管镜局部化疗治疗气管支气管结核的疗效及方案研究

目的 探讨合理的经纤维支气管镜局部化疗治疗气管支气管结核的方案.方法 对255例予全身化疗联合经纤维支气管镜局部化疗的气管支气管结核患者的疗效等进行回顾性分析.其中局部注入异烟肼+丁胺卡那霉素+利福平者(多药组)49例,局部注入异烟肼+利福平者(双药组)152例,局部单用利福平者(单药组)54例.结果 ①多药组和双药组平均治疗次数[(4.3±3.9)次,(5.0±4.0)次]少于单药组[(9.9±5.2)次](P<0.01).②经纤维支气管镜局部化疗4周后,50%以上的患者镜下病变缩小或消失,三组的好转率差异无统计学意义.③经纤维支气管镜局部化疗4周后,三组患者胸片或胸CT病变均有不同程度的吸收,但差异无统计学意义.④局部化疗治疗终止时,三组胸片或胸CT病变吸收总有效率依次为82%、80%、44%,多药组和双药组优于单药组(P<0.05).⑤局部化疗治疗终止时,多药组支气管狭窄的发生率(16.3%)高于双药组(4.6%)和单药组(5.6%)(P<0.05).结论 经纤维支气管镜局部注人异烟肼+利福平,给药次数较少,疗效较好,不良反应小,是气管支气管结核局部治疗的最佳方案.

Therapeutic effect and program research of local chemotherapy using bronchofibroscope in treatment of tracheobronchial tuberculosis

ObjectiveTo investigate a reasonable plan of local chemotherapy using bronchofibroscope in the treatment of tracheobronchial tuberculosis.Methods The efficacy of systemic chemotherapy combined with local chemotherapy using bronchofibroscope in 255 patients with tracheobronchial tuberculosis were retrospectively analyzed.49 patients were locally injected with isoniazid,amikacin and rifampin (multi-drug group),152 patients were locally injected with isoniazid and rifampicin (two-drug group),54 patients were partially treated with rifampicin alone (single drug group).Results ①The treatment time in multi-drug group and two-drug group[ (4.3±3.9) times,(5.0 ±4.0) times] was lower than that in single drug group[(9.9 ± 5.2)times]( P <0.01 ).②After local chemotherapy using bronchofibroscope for four weeks,the endoscopic lesions in more than 50 ％ patients were reduced or disappeared,there was no statistical significance on improvement rate among three groups.③After local chemotherapy using bronchofihroscope for four weeks,lesions by chest radiograph or chest CT had different levels of absorption in three groups,but there was no statistical significance among three groups.④At the end of local chemotherapy,the total effective rates of lesion absorption by chest radiograph or chest CT were respectively 82 ％,80 ％,44 ％ in three groups.The total effective rate of lesion absorption in multi-drug group and two-drug group was higher than that in single drug group ( P <0.05).⑤At the end of local chemotherapy,the incidence of bronchial stenosis (16.3 ％) in multi-drug group was higher than that in two-drug group (4.6 ％) and single drug group (5.6 ％ )( P <0.05).Conclusions Because of less administered frequency,better efficacy,and less adverse effect,local injection of isoniazid and rifampicin by bronchofibroscope is the best local treatment of tuberculosis tracheobronchial.