良性气道狭窄的处理方法

良性气道狭窄种类繁多,当病变累及范围过大或患者心肺功能差时,不能通过外科手术方式解除梗阻.内镜技术的进展为气道阻塞性疾病患者提供了大量的姑息性甚至治愈的方法,包括球囊扩张、电灼烧、激光消融、氩等离子体凝固技术、冷冻、腔内放疗、光动力治疗、支架植入等.但是没有随机试验比较不同治疗方法的效果,本文主要介绍几种良性气道狭窄性疾病及其处理方法.     

球囊扩张疗法治疗良性气道狭窄临床应用

临床研究显示,电凝治疗气道瘢痕病变时可导致对气道更严重、更大范围的损伤,从而引起再狭窄并最终导致治疗失败。根据良性气道瘢痕狭窄的不同情况,采用单纯球囊扩张治疗,或采用针形电刀和(或)冷冻对瘢痕组织进行先期松解,然后在辅以球囊扩张,是目前治疗良性瘢痕增生性气道狭窄疗效相对可靠且并发症相对较少的方法。经合理恰当的球囊扩张治疗,其疗效在80%以上,值得在临床中加以推广。     

高压球囊气道成形治疗良性近端气道狭窄

目的　对纤维支气管镜 (纤支镜 )介导下高压球囊扩张气道成形治疗良性近端气道狭窄的疗效和安全性进行评价。方法　对 37例不同原因造成的不同部位近端气道的良性狭窄患者 ,实施纤支镜介导下高压球囊扩张气道成形术 ,分别于术前和最后一次球囊扩张术后的当天 ,对患者狭窄段的气道直径、气促评分和一秒钟用力呼吸容积 (FEV1 )进行测定并对其并发症的发生情况进行评价。对所有患者均进行了 4～ 2 8个月 (平均 1 4 6个月 )的随访。结果　 37例良性近端气道狭窄的患者分别接受高压球囊扩张 1～ 6次 ,平均接受球囊扩张 (2 4± 1 1 )次。经过高压球囊扩张气道成形术后 ,狭窄段气管、支气管管径明显增大 ,即刻疗效达 1 0 0 %。狭窄段气道直径由扩张前的 (2 6± 1 2 )mm增加到 (6 9± 1 8)mm(P <0 0 1 )。气促评分亦由术前的 2 0± 0 8减少到 0 7± 0 6(P <0 0 1 )。 37例患者中有 2 6例分别于术前及术后进行了FEV1 的测定 ,2 6例患者的术前平均FEV1 为 (1 3± 0 6)L ,经球囊扩张治疗后升至 (1 8± 1 0 )L(P <0 0 1 )。经过 4～ 2 8个月的随访 ,远期疗效达 89% (33/ 37)。其中有 4例患者因肉芽组织过度增生或气管支气管软化而接受了微波、氩气刀或支架植入等联合治疗。37例接受此方法治疗的患     

良性气道狭窄的治疗方法综述

良性气道狭窄病因多种多样,患者个体情况也存在很大差异,不同患者究竟选择何种治疗方法来解除气道狭窄,需结合病因与患者的个体情况等综合分析.目前常用的气道狭窄治疗方法包括传统的手术治疗,药物治疗和近十年迅速发展起来的介入治疗.本文主要介绍常用的几种气道狭窄处理方法及该领域的研究新进展.     

支气管镜介入冷冻治疗气管良性狭窄1例并文献复习

<正>引起气管狭窄的病因有多种,其中气管切开术后肉芽形成是导致气管良性狭窄的主要原因之一。通过外科手术切除肉芽组织是传统的治疗方法,风险高,创伤相对较大。近年来,随着支气管镜介入治疗技术水平的不断提高和成熟,通过支气管镜介入治疗,使得很多以往需要手术或根本无法手术的气道良性狭窄病变获得治愈[1]。本文通过分析江苏省人民医院呼吸内科收治的1例气管切开术后气管腔内肉芽组织生成导致的气管良性狭窄,经可弯曲     

联合介入技术治疗良性气道狭窄临床分析

目的研究经支气管镜联合介入技术治疗良性气道狭窄中的价值。方法 13例良性气道狭窄单独介入治疗不能有效的患者接受联合介入治疗,根据狭窄情况选择电刀消融、高压球囊扩张及支架置入等方法。结果经联合介入治疗后,13例患者,共19支气道狭窄,经3月治疗随诊,气道再通完全有效6支（31.57%）,部分有效9支（47.37%）,轻度有效2支（10.53%）,无效2支（10.53%）。气促由治疗前的（3.15±0.69）级改善为（1.08±0.86）级（P〈0.001）。治疗过程中6例患者出现鼻出血,2例患者出现气胸。结论对于单独介入治疗不能有效的良性气道狭窄的患者给予联合介入治疗可以起到好的临床疗效,且安全性高,并发症少。     

良性气道狭窄病因分析

目的分析良性气道狭窄的病因构成。方法对重庆医科大学附属第一医院呼吸与危重症医学科2013年1月至2018年1月的237例确诊为良性气道狭窄的病例资料进行回顾性总结,分析其病因构成及狭窄部位。结果 237例良性气道狭窄病例中病因前三位为气管支气管结核166例(70. 04%),气管插管术20例(8. 44%),气管切开术后18例(7. 59%),其他病因有支气管异物、气管支气管肉芽肿、气管支气管良性肿瘤、全喉切除术、支气管吻合术后、原发性支气管淀粉样变、气管化学性损伤。在不同年龄、性别中,其病因构成有差异。气道狭窄部位大多发生于中心性气道,狭窄部位与病因存在一定的关联。结论本组病例中良性气道狭窄最常见的病因为气管支气管结核,其次为气管插管及气管切开术后所致的气道狭窄,常见狭窄部位为中心性气道。     

经支气管镜球囊扩张术治疗良性中心气道狭窄临床分析

目的探讨经支气管镜球囊扩张技术治疗良性中心气道狭窄的操作方法、安全性及有效性。 方法选择2014年6月至2018年6月达州市中心医院呼吸内科收治的良性中心气道狭窄患者67例,其中结核性狭窄61例,气管损伤性狭窄6例,对不同原因导致的气道良性狭窄患者进行球囊扩张治疗,并必要时联合其他介入治疗措施如冷冻治疗等。治疗结束后对气促评分、KPS评分、肺功能(FEV₁)、气管狭窄程度和并发症发生情况进行评价。 结果所有患者均在气管镜直视下进行球囊扩张治疗,同时进行冷冻治疗。67例患者中,共进行球囊扩张治疗324次。经过球囊扩张治疗后,短期观察狭窄段支气管均有内径增大,气促评分增加,症状缓解。对球囊扩张后气道扩宽的瘢痕狭窄患者随访观察,有18例气道扩宽后再次发生瘢痕挛缩,发生再次狭窄。所有患者中,扩张治疗出现胸痛12例,黏膜少许撕裂2例,无严重不良反应发生。 结论良性中心气道狭窄支气管球囊扩张治疗,近期疗效良好,远期疗效有待进一步评估。     

良性气道狭窄治疗存在的问题及对策

良性气道狭窄是指气管支气管结核、外伤、手术、气管切开、气管插管、异物、良性肿瘤、淀粉样变等引起的气道占位性或瘢痕挛缩性狭窄,以及复发性多软骨炎和甲状腺囊肿对气道壁的破坏引起的气道塌陷性狭窄。我国结核病疫情严重,10％～40％的肺结核合并气道结核,良性气道狭窄实际上是常见病。     

丝裂霉素C对良性气道狭窄干预效果的荟萃分析

目的系统评价丝裂霉素C治疗良性气道狭窄疗效及安全性。方法计算机检索PubMed、EMbase、Webofscience、万方、中国学术期刊全文数据库,检索时限设置为建库至2019年9月,检索关于丝裂霉素C治疗良性气道狭窄的临床随机对照试验。由2位研究者按照纳入和排除标准独立对文献进行筛选,并加以资料提取及方法学质量评价,采用Stata10.0软件进行数据分析。结果共纳入13篇随机对照研究文献,包括440例气道良性狭窄患者。meta分析结果显示:治疗组总体客观有效率高于对照组(RR=1.23,95%CI:1.08~139,P<0.05)。根据人种的不同,对该研究进行亚组分析,结果显示:在亚洲人群中,治疗组客观有效率高于对照组(RR=1.22,95%CI:1.04~144,P<0.05);在高加索人群中,治疗组客观有效率也高于对照组(RR=1.24,95%CI:101~1.51,P<005)。同时,治疗组经丝裂霉素治疗后气道直径(SMD=047,95%CI:0.20~0.75,P<0.05)及气促评分(SMD=0.47,95%CI:0.13~082,P<0.05)均优于对照组;治疗组6个月内介入治疗次数也低于对照组(SMD=-2.30,95%CI:-2.88^-1.72,P<0.05)。2组不良反应发生率差异无统计学意义(RR=1.21,95%CI:0.58~250,P>0.05),可对症缓解。结论在单纯气道介入治疗基础上加以丝裂霉素C可改善患者气促症状,减少气道介入治疗的频次,且不良反应少,患者总体耐受较好,具有一定的临床应用价值。     

复发性多软骨炎致气道严重狭窄一例并文献复习

目的 总结复发性多软骨炎(RP)的临床表现以及气道受累的特点和治疗策略,提高对该病的认识.方法 报道1例RP合并严重气管狭窄的临床特点、诊治经过,并对该病进行文献复习.结果 患者为33岁女性,以咳嗽、声嘶、气短起病,3个月后确诊RP,此时已经出现严重的气管狭窄.糖皮质激素和免疫抑制剂治疗有效.结论 RP出现呼吸道受累并不少见,部分患者为首发症状.临床上应高度重视RP气道受累的早期诊治.否则预后不良.     

累及气道的窦组织细胞增生症伴巨大淋巴结病一例并文献复习

目的 提高对累及气道的窦组织细胞增生症伴巨大淋巴结病(Rosai-Dorfman病)的认识.方法 分析1例确诊为气道受累的Rosai-Dorfman病患者的临床表现、支气管镜下表现、病理特征、诊断和治疗并结合文献进行讨论.结果 患者女,60岁.因"反复发作性喘息18个月,加重1个月"于2007年3月6日收入福建省立医院.曾诊断为"支气管哮喘",口服强的松、吸入布地奈德等治疗,症状好转.1个月前喘息再次发作,且出现吸气性呼吸困难,平卧位时明显,再次就诊,以"呼吸困难原因待查"收入院.23年前发现"高血压、左肾上腺腺瘤",诊断为"原发性醛固酮增多症",未行手术.1999年发现左腮腺肿物、左颌下淋巴结肿大,行手术切除.2000年行双眼泪腺肿物切除.2001年发现全身皮下多发性结节,且逐年增多,结节可自行增大和缩小.入院检查左颌下可触及大小约3.0 cm×2.0 cm结节,双上臂、胸背部、腹部、臀部及双大腿外侧可扪及黄豆至蚕豆大小结节,边界清楚,质偏硬,表面尚光滑,稍活动,轻压痛,部分皮肤见色素沉着.胸部CT平扫+气管重建显示气管壁多发性结节状突起,相应区域管腔狭窄,左肺舌叶炎症,纵隔内未见明显肿大的淋巴结,胸背部皮下多发性结节影.淋巴结病理切片可见组织细胞形成的浅染区与浆细胞和淋巴细胞形成的深染区相间排列,呈一种窦样结构,组织细胞胞质内可见吞噬的浆细胞和淋巴细胞,确诊为Rosai-Dorfman病.结论 Rosai-Dorfman病累及气道是罕见的淋巴结外病变,易发生误诊和漏诊.支气管镜检查是发现Rosai-Dorfman病气道受累的重要手段,组织细胞增生并吞噬完整的浆细胞和淋巴细胞是其病理特征,免疫组织化学染色S100蛋白及CD_(68)阳性有助于诊断和鉴别诊断.手术切除联合应用糖皮质激素或放疗是治疗气道病变较为有效的方法之一.     

自膨胀式金属支架在良性气道狭窄中的应用

近年来,自膨胀式金属支架由于其仅需在局麻下通过纤维性支气管镜就能有效、安全地治疗中央气道阻塞性病变而被广泛地应用于临床.由于金属支架一旦放置就难以取出及某些较难处理的并发症使其在良性气道狭窄的临床应用仍存在争议.本文就自膨胀式金属支架的特点及其在治疗良性气道狭窄中的优缺点、并发症、应用现状作一综述.     

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.     

Stent placement for benign colonic stenosis: case report,review of the literature,and animal pilot data

BACKGROUND: Permanent metal stent placement for malignant intestinal obstruction has been proven to be efficient. Temporary stents for benign conditions of the colon and rectum are less studied. This is a case study, review of the literature, and observation from an animal model on placement of stents in the colorectum for benign disease. MATERIALS AND METHODS: A 55-year-old man presented with recurrent obstructions from a benign stricture of the distal sigmoid colon. After failed balloon dilations, a polyester coated stent was placed. The purpose of the stent was to improve symptoms and avoid surgery. The stent was expelled after 5 days. We conducted a literature review of stents placed for benign colorectal strictures and an animal study to evaluate stent migration. RESULTS: In the literature, there were 53 reports of uncovered metal stents, four covered metal stents, and six polyester stents. Patency rates were 71%, and migration rate was 43%. Migration occurred earlier with polyester stents (mean = 8 days) versus covered (32 days) or uncovered metal stents (112 days). Severe complications were seen in 23% of patients. Four 45-kg pigs underwent rectosigmoid transection with a 21-mm anastomosis and endoscopic placement of a Polyflex stent. Two stents were secured with suture. Stents without fixation were expelled within 24 h of surgery. Stents with fixation were expelled between postoperative days 2 and 14. CONCLUSION: Stents for the treatment of benign colorectal strictures are safe, with comparable patency rates between stent types. Metal stents can cause severe complications. In a pig model, covered polyester stents tend to migrate early even with fixation. Further investigation needs to focus on new stent designs and/or better fixation.     

良性气道狭窄的药物治疗

气道损伤时,伤口愈合过程异常是导致肥厚性瘢痕形成和气道管腔狭窄的原因,愈合过程可分为3个阶段：炎症期、增生期及成熟期.针对不同愈合阶段,所应用的预防和治疗瘢痕形成及气道狭窄的药物是不同的.具体包括：抗生素和类固醇、丝裂霉素、紫杉醇、5-氟尿嘧啶/氟羟强的松龙结合物、卤夫酮、抗反流药物、免疫抑制剂、生长因子等.本文综述了上述药物在细胞、动物及临床试验中治疗气道狭窄的作用、安全性及应用前景.     

Post-intubation pulmonary embolism and tracheal stenosis: a case report and review of the literature

Tracheal stenosis may be attributed to several conditions including trauma, infection, tumour or congenital and collagen vascular diseases. Despite improvement in the design of tracheal tubes, however, tracheal stenosis following intubation still remains an important cause for tracheal obstruction, which may be life threatening and often misdiagnosed. On the other hand, studies have exerted the impact of mechanical ventilation as a risk factor for pulmonary embolism. Here, we describe for the first time, an otherwise healthy patient who was mechanically ventilated due to a labor accident and developed acute pulmonary embolism that was further complicated with post-intubation tracheal stenosis. The patient was treated with anticoagulant therapy and oral corticosteroids and was further referred to a specialist centre for consideration for non-surgical endoscopic treatment.     

Pulmonary benign metastasizing leiomyoma: a case report and literature review

Benign metastasizing leiomyoma (BML) is a rare condition that occurs in all age groups and that is particularly prevalent among women of late childbearing age. All patients have a history of uterine leiomyoma and/or myomectomy, often associated with distant metastases from the uterus, which commonly occurs in the lung. We report the case of a 32-year-old young woman suffering from chest stuffiness, labored respiration and weakness after a myomectomy performed one month earlier. The chest CT showed a diffuse miliary shadow in both sides of her lungs, but serum tumor markers such as CA125, CA199, carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and CYFRA21-1 were normal. The patient underwent a lung biopsy by thoracoscopic surgery after four weeks of anti-TB treatment; there were no significant changes in the chest CT. H&E staining showed that the tumor cells had characteristics of smooth muscle cell differentiation. Immunohistochemical staining showed a low tumor cell proliferation index, which indicated that the likelihood of a malignancy was not high. There was no expression of CD10, indicating a diagnosis of pulmonary benign metastasizing leiomyoma (PBML). Smooth muscle actin (SMA) and desmin as specific markers of smooth muscle and the estrogen receptor (ER) and progesterone receptor (PR) were all strongly positive, which is characteristic of PBML. The patient was given the anti-estrogen tamoxifen for 3 months. With no radiological evidence of disease development and further distant metastasis, the patient will continue to be followed.