经支气管镜治疗良性瘢痕增生性气道狭窄方法的比较

目的 通过临床病例资料的分析,对厅前常用的治疗良性瘢痕性气道狭窄的介入技术进行评价,并对影响疗效的相关因素进行讨论.以期寻找最佳的治疗方法.方法 研究选择2004年12月至2009年12月收入北京天坛医院呼吸科的良性瘢痕增生性气道狭窄患者36例,其中男15例、女21例,年龄13～82岁,平均(40±21)岁.根据采用的介入治疗方法不同将患者分为3组,A组使用电凝治疗;B组经电凝治疗后改为针形电刀、球囊扩张和(或冷冻治疗);C组不使用电凝治疗,采用球囊扩张、冷冻和(或)针形电刀治疗.评价不同介入处理方法的疗效及并发症情况,各组间病例资料的比较采用四格表卡方检验.结果 36例患者中治愈9例,治愈率为25%(9/36),有效10例,总体有效率为53%(19/36);无效12例,失败5例,总体无效率47%(17/36).其中电凝治疗有效者1例(1/12,8%),治疗后狭窄段延长8例(8/12,67%);球囊扩张及冷冻和(或)针形电刀治疗有效者14例(14/17,82%),治疗后狭窄段延长2例(2/17,12%).与电凝治疗相比,球囊扩张及冷冻和(或)针形电刀治疗的有效率明显提高,再狭窄率明显减少.结论 急性期气道复张治疗中,目前常用的电凝方法可加重气道再狭窄并最终导致治疗失败,而急性期应用球囊扩张联合针形电刀及冷冻是较为合理且有效的气道复张治疗方法.

Abstract：

Objective To evaluate the efficacy of different interventional bronchoscopic techniques for the management of benign cicatricial hyperplasia airway stenosis,and to study the factors associated with the treatment effects.Methotis From December 2004 to December 2009,36 patients with cicatricial airway stenosis were admitted to our department.An investigation was made to analyze the effects by different interventional bronchoscopie treatments.The most suitable treatment modality for cicatricial airway stenosis was explored and described.Results For the 36 patients,the disease was cured in 9,improved in 10,not improved in 12,and failure in 5.The care rate,effective rate and ineffective rate were 25%,53%and 47%,respectively.Further analysis showed that the effective rate was 8%and 82%respectively for the electrical coagulation therapy and the balloon dilation eombined with needle electrical knife and/or cryotherapy.Restenosis extension after operation occurred in 67%of the cases by electrical coagulation therapy,but only 12% of casesby the balloon dilation combined with needle electrical knife and/or cryotherapy.Conclusions Our experience demonstrated that for the treatment of airway cicatricial stenosis,electrical coagulation might induce and worsen serious airway restenosis resulting in failure of treatment.On the other hand,balloon dilation combined with needle dectrical knife and/or cryotherapy might be a relative safe and effective therapy for airway cicatricial stenosis.

A pilot study on interventional bronchoscopy in the management of airway stenosis with benign hyperplasia

Objective To evaluate the efficacy of different interventional bronchoscopic techniques for the management of benign cicatricial hyperplasia airway stenosis,and to study the factors associated with the treatment effects.Methotis From December 2004 to December 2009,36 patients with cicatricial airway stenosis were admitted to our department.An investigation was made to analyze the effects by different interventional bronchoscopie treatments.The most suitable treatment modality for cicatricial airway stenosis was explored and described.Results For the 36 patients,the disease was cured in 9,improved in 10,not improved in 12,and failure in 5.The care rate,effective rate and ineffective rate were 25%,53%and 47%,respectively.Further analysis showed that the effective rate was 8%and 82%respectively for the electrical coagulation therapy and the balloon dilation eombined with needle electrical knife and/or cryotherapy.Restenosis extension after operation occurred in 67%of the cases by electrical coagulation therapy,but only 12% of casesby the balloon dilation combined with needle electrical knife and/or cryotherapy.Conclusions Our experience demonstrated that for the treatment of airway cicatricial stenosis,electrical coagulation might induce and worsen serious airway restenosis resulting in failure of treatment.On the other hand,balloon dilation combined with needle dectrical knife and/or cryotherapy might be a relative safe and effective therapy for airway cicatricial stenosis.