经纤维支气管镜冷冻治疗中、晚期中心型肺癌致气道梗阻的疗效

目的探讨经纤维支气管镜冷冻治疗中、晚期中心型肺癌的疗效。方法经纤维支气管镜用液态CO2对31例不适合常规开胸手术的中、晚期中心型肺癌患者进行冷冻治疗,并与治疗前比较,以观察其疗效。操作方法：将冷冻探针经支气管镜活检孔插入,置于肿瘤中心或边缘,冷冻约30～120s,冷冻温度-50～-70℃,在其探针顶端形成的冰球未完全溶解前“撕脱”切除肿瘤,反复多次操作直至管腔再通。结果经1～6次（平均2.5次）治疗,症状缓解率：咳嗽74%（23/31）、咯血87%（27/31）、呼吸困难87%（27/31）,胸痛58%（18/31）。显效61%（19/31）,有效39%（12/31）。肺功能改善：第一秒用力呼气容积（FEV1）从（1.21±0.22）L提高到（1.72±0.35）L（t=21.843,P=0.001）,用力肺活量（FVC）从（1.86±0.31）L提高到（2.26±0.43）L（t=33.703,P=0.001）。结论经纤维支气管镜冷冻治疗能使管腔得以重新疏通,使阻塞性肺炎得到控制,呼吸困难和咯血得到改善,生活质量明显提高,是一种简便有效的微创治疗方法。

Cryosurgery for Middle and Late Stage Central Lung Cancer with Fiber Optic Bronchoscopy

Objective To evaluate the effectiveness of cryosurgery by using fiber optic bronchoscope for the treatment of middle or late stage central lung cancer. Methods Cryosurgery was performed on 31 patients with middle or late stage central lung cancer, who could not received open surgery, with liquid CO2 by using fiber optic bronchoscope. The effectiveness was monitored. Via the bronchoscope, a cryo-probe was inserted to the center or margin of the tumor. The cryotherapy was persisted for 30 to 120 seconds at -50 to -70℃. And then, the tumor was removed before the ice-ball on the point of the probe thawed. The procedure was repeated for several times till the airway was reopened. Results After 1 to 6 times therapies （2.5 times on average） , the improve rates of cough, hemoptysis, dyspnea, and chest pain were 74% （23/31）, 87% （27/31）, 87% （27/31）, and 58% （18/31）, respectively. The rates of ＂markedly effective＂ and ＂effective＂ were 61% （ 19/31 ） and 39% （ 12/31 ） respectively. The pulmonary function of the patients was also improved ： the FEV1 rose from （ 1.21 ± 0. 22） L to （ 1.72± 0.35 ） L （ t = 21. 843, P = 0. 001 ）, and the FVC was increased from （ 1.86 ± 0. 31 ） L to （2.26 ± 0. 43 ） L （ t = 33. 703, P = 0. 001 ）. Conclusions Cryosurgery by using a fiber optic bronchoscope is an effective and minimally invasive method to reopen the airway, control the obstructive pneumonia, and improve dyspnea and hemoptysis.