315例瘢痕狭窄型支气管结核的临床分析

目的通过对瘢痕狭窄型支气管结核的临床资料分析,提高临床医生对该类型支气管结核的认识。方法回顾2013年4月至2015年10月在我科呼吸内镜中心进行诊治的315例瘢痕狭窄型支气管结核患者的临床资料,分析其形成因素、病变特点、治疗方法以及愈后。结果 315例患者共进行镜下治疗923例次,涉及的介入治疗方法包括氩气刀、电刀、冷冻、高压球囊扩张等;61.0%患者进行2次及以上治疗,行5次以上治疗的患者病变多为混合型狭窄;多部位狭窄例数占总例数的49.8%,位置以左主支气管最多,段及段以下支气管以左上叶固有支最多;瘢痕狭窄形成后介入治疗方法以球囊扩张为主,扩张比例最高的为左肺下叶;狭窄形成因素主要为结核本身造成的支气管破坏,而非介入干预;早期介入治疗干预患者总体愈后良好。结论瘢痕狭窄型支气管结核为支气管结核常见的类型,常发生于其他类型支气管结核治疗修复过程中,高压球囊扩张为主要的治疗方法,早期治疗有利于患者的长期愈后。

Clinical features of 315 patients suffered from endobronchial tuberculosis with cicatricial stenosis

Objective To analyze the clinical features of patients who suffered from endobronchial tuberculosis with cicatricial stenosis, and to improve the recognition of clinical doctors. Methods The clinical information including forming factors, pathological features, treatment and prognosis of 315 patients suffered from endobronchial tuberculosis with cicatricial stenosis was analyzed retrospectively from April 2013 to October 2015. Results A total of 923 times interventional treatments included argon plasma coagulation, high frequency electrotomeargon, cryotherapy, high pressure balloon dilatation, etc were used to 315 patients. Twice treantments were used in 61.0% paitents. Mixed type stenosis was observed in patients who accepted more than five times treatments. Multiple-position stenosis cases accounted for 49. 8% of the total. Left main bronchus stenosis was the most. Inherent upper left lobe was the most in segmental bronchus. High pressure balloon dilatation was the main interventional treatment after formation of cicatricial stenosis. Left lower lobe was treated by ballon dilatation most frequently. Factors of stenosis were mainly caused by bronchial tuberculosis itself, rather than interventional treatment. Patients prognosis were good overall with early interventional treatment. Conclusions Cicatricial stenosis is one of the common types of endobronchial tuberculosis and often occurs in the process of improvment of other types of endobronchial tuberculosis. High pressure balloon dilatation is the main treatment for this type. Early treatment for patients will acquire good long-term prognostic.