球囊扩张术治疗结核性气道狭窄的疗效评价

目的探讨球囊扩张术治疗结核性气道狭窄的价值。方法15例结核性气管和支气管狭窄病人,经临床、肺功能评价后,在透视下经纤维支气管镜进行气道球囊扩张术,每周扩张1次,连续3次,多叶狭窄病例采用分段扩张法,评价气道开放、近期疗效和肺功能改善情况。结果15例病人共扩张50次,平均3．3次,气道开放为90．6％,气道直径在扩张前后有显著性差异(t=6．783 0,P＜0．05),扩张后肺功能有明显的改善(t=5．152 7,P＜0．05);6个月内再狭窄率为18％,4例支气管狭窄合用支架。结论球囊扩张术对以纤维疤痕为主的气道狭窄疗效好,以肉芽增生为主的气道狭窄应多次扩张,必要时并用其他手段。球囊扩张术治疗结核性气道狭窄是气道开放、改善肺功能的较好介入手段。

Effect of balloon dilation in the treatment of tuberculous tracheobronchial stenosis

Objective To evaluate the value of balloon dilation in the treatment of tuberculous tracheo-bronchial stenosis. Methods Balloon brochoplasty transbronchoscope was performed (1 times every week) with fluoroscopic guidance 3 times in 15 patients with tracheobronchial stenosis after clinical evaluation and functional evaluation of lung. The cases with multiple stenosis used the method of segments dilation. The situation of airway opening immediately, short-term effect and functional improvement of lung were evaluated. Results Balloon brochoplasty was performed with fluoroscopic guidance 50 times in 15 patients (average 3.3 times each patient) . The rate of airway opening immediately was 90.6% , the airway diameter after dilation showed significant difference with that before dilation (t= 6.7830, P < 0.05) , pulmonary function showed obvious improvement after dilation (t=5.1527, P < 0.05) . The rate of restenosis after 6 months was 18% , and self-expanding metal stents were used in 4 patients with tracheobronchial stenosis. Conclusion balloon dilation has better effect on fiber scar tracheobronchial stenosis. The granulation tracheobronchial stenosis should be dilated several times and could be used in conjunction with other methods. Treatment of tuberculous tracheobronchial stenosis with balloon dilation might be a better interventional method to open airway and improve pulmonary function.