支气管镜下氩等离子体凝固在气道疾病中的应用

目的探讨局部麻醉下氩等离子体凝固在气道疾病中应用的有效性及安全性。方法局部麻醉下经电子支气管镜应用氩等离子体凝固（APC）300型氩气刀治疗77例患者的气道阻塞性疾病。结果77例伴有92处中心气道阻塞的患者接受APC300型氩气刀治疗167次,24例恶性肿瘤有效率为84．0％,53例良性肿瘤及支气管结核有效率为94．3％;疗效还与病变位置有关,位于气管的病变有效率为100％,主支气管及右中间段支气管的病变疗效为95．3％,而叶支气管的病变疗效为82．4％。结论在局部麻醉下采用APC300型氩气刀可以有效、安全地治疗气道疾病,特别是大气道的良性病变。     

氩等离子体凝固切除中心气道内阻塞性病变的疗效

目的了解氩等离子体凝固切除中心气道内阻塞性病变的疗效。方法2003年11月至2006年12月收治的53例伴有中心气道阻塞性病变患者，男37例，女16例，平均年龄55（14～82）岁，其中恶性肿瘤28例，良性肿瘤13例，其他疾病12例。使用局部麻醉或全身麻醉，支气管镜下应用德国ERBE公司氩等离子体凝固300型机切除病变。根据病变切除程度、狭窄再通和临床资料判断疗效。结果53例患者的病变分布于86处，有效切除病变的成功率分别为：气管内病变97％（35／36），主支气管79％（22／28），叶支气管和中间段支气管64％（14／22）；良性病变的成功率（92％，34／37）高于恶性病变（76％，37／49）。中心气道严重阻塞致呼吸衰竭的患者18例，全身麻醉下经氩等离子体凝固治疗即刻缓解。结论氩等离子体凝固适用于切除中心大气道的腔内增生性病变；治疗后即刻起效，可以用于抢救急诊重症病例。重症患者应该给予全身麻醉和机械通气，以提高介入治疗的成功率和安全性。     

APC在治疗恶性气道阻塞性病变的疗效观察

目的评估经支气管镜氩等离子体凝固术(APC)治疗气道阻塞性病变的疗效。方法分析我院经支气管镜氩等离子体凝固治疗联合化疗的肺癌患者30例(A组:APC治疗联合化疗组)和单纯化疗的肺癌患者32例(B组:单纯化疗组)。收集患者治疗前后临床症状改善情况、肺功能、血气分析、气促等级以及生活质量评分等资料。结果 A组患者经治疗后,气道再通有效率为80%,患者临床症状显著改善; B组患者经治疗后,气道再通有效率仅为18. 8%。A组患者经治疗后肺功能、气促等级和生活质量评分改善显著高于B组(P 0. 05),且患者未出现严重并发症。结论 APC治疗恶性气道阻塞性病变的近期疗效较好,可很快缓解症状,改善患者生活质量。     

气管镜介入治疗对120例良性气道狭窄的疗效分析

目的探讨多种气管镜介入治疗方法对不同病变类型气道内良性狭窄的疗效。方法经气管镜治疗的良性气道狭窄患者120例,其中气道内瘢痕组55例,肉芽肿组53例,气道良性肿瘤12例。采用支气管镜下氩等离子体凝固（argon plasmacoagulation,APC）、冷冻、内支架等方法进行治疗,并从狭窄程度及气促评分等方面进行疗效分析。结果经支气管镜APC结合冷冻对气道内瘢痕、肉芽肿、良性肿瘤的处理效果相似。治疗后三组狭窄程度和气促评分较术前均有明显改善,表明APC结合冷冻对良性狭窄的治疗效果立竿见影。结论 APC可一次性大部分清除气道内良性肿瘤和肉芽组织,快速缓解气道梗阻症状。同时配合冷冻治疗,延缓复发时间,后期单用冷冻治疗,可达治愈效果。治疗过程中慎用金属支架。     

喉罩通气全麻下经支气管镜高频电刀治疗主支气管肿瘤的临床观察

目的探讨喉罩通气全麻下经支气管镜应用高频电刀治疗主支气管肿瘤导致的气道阻塞的疗效、方法、安全性。方法选择主支气管腔内恶性肿瘤阻塞大气道导致呼吸困难的患者12例,在用异丙酚、芬太尼和维库溴铵行静脉全身麻醉后,再在喉罩通气下经支气管镜应用高频电刀对病变进行治疗。结果 12例患者经支气管镜下高频电治疗后呼吸困难得到明显改善。12例患者肺功能FEV1,气促评分在术前、后均有明显改变,差异有统计学意义（P〈0.01）。结论喉罩通气全麻下经支气管镜高频电刀治疗主支气管肿瘤导致的气道阻塞,可以明显解除患者的气道阻塞,从而改善呼吸困难,提高生活质量,喉罩通气下经支气管镜高频电刀治疗大气道肿瘤安全、可行、治疗效果明显。     

支气管镜下介入治疗支气管结核气道阻塞82例临床疗效分析

目的 探讨经支气管镜下介入治疗支气管结核气道阻塞的临床疗效。方法 对82例支气管结核气道阻塞的患者在全身常规抗结核治疗的同时,联用支气管镜下介入治疗,根据气道阻塞狭窄程度选择冲洗、钳夹清除、高频电凝治疗及球囊扩张术治疗,后再局部管腔内注入抗结核药物INH。结果 82例患者管腔完全通畅54例、管腔轻度狭窄26例,气道阻塞未改变2例。结论 经支气管镜下介入治疗支气管结核气道阻塞的疗效确切,能有效解除气道阻塞。     

经电子支气管镜氩等离子体凝固治疗支气管结核

目的探讨经电子支气管镜氩等离子体凝固（argon plasma coagulation,APC又称氩气刀）治疗支气管结核临床应用价值。方法应用ERBEAPC-300型治疗仪经电子支气管镜对25例支气管结核进行治疗,其中包括10例炎性浸润型,9例黏膜溃疡及干酪坏死型,3例肉芽增殖型,2例疤痕狭窄型,1例管壁软化型,其中2例疤痕狭窄型需结合高压球囊扩张气道成形术。从病灶狭窄处治疗后再通及临床症状改善进行疗效评价。结果 25例患者进行了61次APC治疗（2例1次,10例2次,13例3次）。完全有效20例（80%）,部分有效2例（8%）,轻度有效2例（8%）,无效1例（4%）。结论经电子支气管镜APC治疗支气管结核是一种安全有效的方法。     

可弯曲电子支气管镜高频电刀烧灼与切割治疗的护理

气管及支气管结核、良性肿瘤、恶性肿瘤引起气道阻塞呼吸困难，经应用支气管镜介入高频电刀烧灼与切割治疗，解除了患者气道阻塞，呼吸困难、咳嗽得到了控制与缓解，良性病变得到治愈，恶性肿瘤得到控制及延长生命。我院自2003年11月至2007年3月，应用日产OLYMPUS—CV240型可弯曲电子支气管镜介入高频电刀烧灼与切割技术治疗气管、支气管阻塞的病变共902例次，取得了良好的效果，现将术前、术中、术后护理体会总结如下。     

支气管灌洗在AECOPD治疗中的疗效

目的探讨纤维支气管镜（纤支镜）在慢性阻塞性肺疾病急性加重期（AECOPD）治疗中的应用价值。方法选择80例AECOPD患者进行纤支镜吸痰、支气管灌洗及局部抗感染治疗。结果显效55例（68.75%）,有效19例（23.75%）,总有效率为92.5%,无效6例（7.5%）。结论对于分泌物较多难以排出气道的AECOPD患者,及时给予纤支镜吸引和灌洗,有利于迅速解除气道阻塞,改善血气交换,支气管吸引灌洗技术是一种安全有效、简便经济,易被患者接受的治疗方法。     

纤维支气管镜在气道狭窄和阻塞病因诊断中的应用

目的 探讨纤维支气管镜在气道狭窄和阻塞病因鉴别中的应用价值。方法 对216例有气道狭窄和阻塞改变患者的镜检结果进行分析。结果 216例患者,肺癌143例（66．2％）,非癌性病变69例（31．9％）,食道癌、甲状腺癌侵犯气道4例（1．9％）。非癌性病变中结核、炎症分别为44．9％（31例）和40．6％（28例）。肺癌和非癌性病变的检出率分别为87．4％和69．6％,总检出率81．9％。结论 肺癌是造成气道狭窄和阻塞的主要原因,其次是结核和炎症,支气管镜检在病因鉴别中有重要作用。     

中央气道阻塞性病变的病因诊断及疗效分析

目的 探讨中央气道阻塞的病因、临床特点及诊治手段.方法 回顾性分析2007年4月至2009年6月就诊于解放军总医院呼吸科的中央气道阻塞性病变患者40例,归纳其临床特点.结果 40例中央气道阻塞病变患者中,男29例,女11例,年龄30～82岁,中位年龄为54岁;其中气管鳞癌患者13例(13/40),各种良性肿瘤6例(6/40),腺样囊性癌5例(5/40),食管鳞癌4例(4/40),3例为气管内异物(3/40),慢性炎症3例(3/40),气管结核各2例,纵隔恶性畸胎瘤、M浆细胞瘤、淋巴瘤及气管骨形成症各1例.40例中咳嗽36例,气短或呼吸困难21例,气管鳞癌患者咳血或痰中带血症状多见(11/13).所有患者均行胸部CT检查,21例行气道三维重建,均发现病变.6例行肺功能检查,均可见通气功能障碍及流速-容量环平台.除1例患者不耐受检查,39例患者行气管镜检查均发现病变,32例气道内器质性病变在气管镜检查中经活检钳取得组织标本,初次病理阳性率100%.40例中11例行气管镜下肿瘤圈套术及氩等离子电凝(APC),全部耐受,2 d后临床症状均缓解.结论 中央气道阻塞病因复杂,以恶性病变为主,常见症状为咳嗽及呼吸困难,无特异性表现,胸部CT联合气道重建、气管镜及病理检查可为诊断提供准确信息,根据不同病因及不同病变部位选择治疗方法,尤其APC、电切等介入治疗手段对恶性病变短期疗效明显,安全性好.

Abstract：

Objective To explore the etiology, clinical features, diagnosis and treatment of central airway obstruction (CAO), and therefore to raise awareness of this disease.Methods Forty patients with central airway obstruction were analyzed retrospectively and their clinical characteristics were described.Results Among these 40 cases of CAO, the diagnoses included squamous cell carcinoma (n = 13 ),adenoid cysts ( n = 5 ) , esophageal squamous cell carcinoma ( n = 4 ) , and benign tumor ( n = 6 ).The presenting symptoms included cough(n = 36), shortness of breath or difficulty breathing(n = 21 ), and bemoptysis or bloody sputum which was more common in cases with airway squamous cell carcinoma ( n =11 ).All the patients underwent chest CT examination, and the lesions were evident in all the cases.Twenty-one cases underwent three-dimensional reconstruction of the airway.Six patients underwent pulmonary function test, and ventilatory abnormalities were revealed, and showed the characteristic blunting of the flow-volume loop.Thirty-nine cases underwent bronchoscopy and correct clinical diagnosis was made.Eleven patients received interventional therapy with argon plasma coagulation ( APC ), and their symptoms were all relieved within 2 days.Conclusions CAO may be caused by variety of diseases, but the most common cause is malignancy.The common symptoms of CAO are cough and dyspnea.Chest CT with airway reconstruction, bronchoscopy and pathological examination can provide accurate information for diagnosis.The choice of treatment modalities depends on the size, location and the pathology of the lesions.APC is a safe and effective therapy for short-term management of malignant lesions.     

Argon plasma coagulation in bronchology: a new method--alternative or complementary?

Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998, 364 patients (80 women, 284 men), 88% with a confirmed malignant tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway stenoses (186 patients). The defined therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with Nd:YAG laser, extensive bronchial tumors were treatable, in which coagulated tumor fractions were removed either with forceps or bronchoscope tip. The second indication was bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under local anesthesia was used. In 34 patients, APC was successfully used to recanalize occluded stents. Rare indications included benign endobronchial tumor, fistula conditioning before fibrin adhesion, and the treatment of scar tissue stenosis. Summarizing all complications, a rate of 3.7% "per treatment" was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic tumor ablation and hemostasis and can be used with local anaesthetic with flexible bronchoscopy or rigid bronchoscopy with general anesthesia. Compared with Nd:YAG laser, APC is an economic alternative technique offering more effective hemostasis. Furthermore, APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy.     

经人工气道冷冻联合氩等离子电凝治疗晚期中央型肺癌的疗效分析

目的探讨经人工气道支气管镜下冷冻联合氩等离子电凝（APC）治疗晚期中央型肺癌的可行性、安全性。方法回顾分析我院2011年2月至2012年12月经人工气道在支气管镜下对41例晚期中央型肺癌,行冷冻,并联合APC治疗的临床资料进行分析,术后一周评价疗效。评价指标包括术前、术后咳嗽、咯血、发热症状,呼吸困难指数、影像学检查、支气管镜复查气道狭窄情况等。结果患者咳嗽减轻13例（31．7％）,咯血缓解14例（34．1％）,发热缓解9例（22．0％）,术前呼吸困难指数3．5±0．42,术后1．8±0．33;影像学提示阻塞性肺炎、肺不张消退12例（29．3％）,好转27例（65．9％）,无变化者2例;气管镜复查完全有效17例（41．5％）,部分有效21例（51．2％）,无效3例（7．3％）。结论经人工气道支气管镜下冷冻联合APC治疗中央气道肿瘤可以缓解咳嗽、咯血、发热、呼吸困难等症状,并发症少,安全性高,值得临床推广。     

Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction

STUDY OBJECTIVE: To evaluate the usefulness of endobronchial argon plasma coagulation (APC) for the treatment of hemoptysis and neoplastic airway obstruction. DESIGN: Retrospective study. SETTING: Bronchoscopy unit of a university hospital. PATIENTS: A total of 60 patients with bronchogenic carcinoma (n = 43), metastatic tumors affecting the bronchi (n = 14), or benign bronchial disease (n = 3). Indications for intervention were hemoptysis (n = 31), symptomatic airway obstruction (n = 14), and both obstruction and hemoptysis (n = 25). Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50 to 200 mL/d (n = 23), or < or = 50 mL/d but persistence for > 1 week (n = 27). The mean (+/- SD) duration of hemoptysis was 16.5 +/- 16.1 days before intervention. Obstruction sites were the trachea (n = 8), mainstem bronchi (n = 21), and lobar bronchi (n = 30). In 24 cases, the patient had obstructions at multiple sites. The mean size of the pretreatment obstruction was 76 +/- 24.9%. INTERVENTIONS: APC, a noncontact form of electrocoagulation, was performed via flexible bronchoscopy. Sixty patients underwent 70 procedures. Conscious sedation without endotracheal intubation was used in all patients except four, who were mechanically ventilated because of underlying respiratory failure. MEASUREMENTS AND RESULTS: All patients with hemoptysis experienced a resolution of bleeding immediately after APC. Hemoptysis from treated sites did not recur during a mean follow-up duration of 97 +/- 91.9 days. Patients with endoluminal airway lesions had an overall decrease in mean obstruction size to 18.4 +/- 22.1%. All patients with obstructive lesions, except one who died of sepsis, experienced symptom improvement. In these patients, symptom control was maintained during a median follow-up period of 53 days (range, 18 to 321 days). There were no complications related to the procedure. CONCLUSIONS: APC is effective for the treatment of endoluminal hemoptysis and airway obstruction. The procedure can be performed in an outpatient setting or at the bedside in the ICUs. APC provides a simpler, lower-risk alternative to other interventional endobronchial techniques.     

纤维支气管镜检查对肺弥漫性疾病的诊断价值

目的　了解纤维支气管镜(FB)检查对肺弥漫性病变的临床诊断价值。方法 总结1993～1999年间,经痰细胞学及细菌学检查均为阴性的肺部弥漫性病变86例行FB,并做活检、灌洗及刷片检查。结果 FB总的阳性率87.2%,镜下直视有病变51例,占59.4%。活检、灌洗液及刷检阳性率分别为69.2%、55.6%和30.8%。确诊肺癌38例中,支气管内新生物及肺活检阳性率分别为100%和84.2%,支气管肺泡灌洗液阳性率仅27.3%。在25例肺结核中,FB总的活检阳性率85.7%,而FB刷检和培养阳性率低16.2%。支气管镜肺活检的阳性率不因取活检次数的增加而增加。结论 FB,特别是活检是一种安全有效简便的方法,对肺弥漫性病变诊断率高,副作用小。     

难治性中心气道狭窄的综合介入治疗

目的 评价5种介入技术联合应用在难治性中心气道狭窄治疗中的价值.方法 2001年1月至2008年6月第四军医大学唐都医院呼吸科收住的138例难治性中心气道狭窄患者,经临床、肺功能评价后,根据狭窄的病因、类型、部位、程度、长度以及狭窄远端肺组织和气道功能的不同,选择高频电力、氩等离子体凝固(APC)、冷冻、支架置入和高压球囊扩张等5种技术中的2种(包括2种)以上方法.138例中高频电刀+APC治疗42例,高频电刀+冷冻+APC治疗54例,高频电刀+冷冻+APC+支架置入治疗29例,冷冻+APC+高压球囊扩张治疗13例.达到理想效果1个月后评价气道开放、近期疗效和肺功能改善情况.结果 138例患者近期总有效率为100%,气道直径术前为(2.6±1.5)mm,术后为(6.2±1.7)mm;气促评分由术前的(2.4±0.8)减少到术后的(0.7 4±0.6).FEV_1由术前的(1.8±0.6)%上升到术后的(3.1±0.7)%.23例良性病变(包括4例良性肿瘤,15例结核性狭窄和4例其他肉芽肿狭窄)的患者,3个月随访有5例发生再狭窄需要介入治疗,有效率为78.3%(18/23),6个月随访有3例再狭窄需要介入治疗,有效率为86.9%(20/23),12个月随访23例患者均未见明显狭窄.恶性肿瘤狭窄患者未进行远期随访.结论 高频电刀、APC、冷冻、支架置入和高压球囊扩张等5种介入技术联合应用,对难治性中心气道狭窄有较好的效果,该方法并发症少,安令可行,值得临床推广应用.     

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

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。