结核后气道狭窄的非支架支气管镜下介入治疗方法

目的：随着人口流动及艾滋病患者的增加,结核患者也逐渐增多,活动性结核患者6.4%~40%会出现支气管结核,而超过90%的支气管结核患者会出现不同程度的气道狭窄。既往应用的手术及支架治疗方法各有利弊,并不适合所有患者。我中心采用非支架支气管镜下介入治疗方法(球囊扩张+冷冻+针形电刀+局部用药)治疗结核后气道狭窄,取得了满意的疗效。本文着重观察了新介入治疗方法治疗结核后气道狭窄的疗效及安全性。方法本研究纳入了24例结核后气道狭窄的患者,来自首都医科大学附属北京天坛医院呼吸科,时间从2012年1月至2014年4月。按病变类型分为2组,膜状环形狭窄3例,复杂型狭窄21例。在经过球囊扩张、冷冻和/或高频电刀治疗后,应用自制的导管在狭窄部位局部应用丝裂霉素或紫杉醇。主要评价指标为治疗的疗效、气道狭窄改善率、呼吸困难指数,并且观察了合并症的发生情况。结果根据我们的临床疗效判断标准,可供统计的24例患者中,16例治愈,6例有效,0例无效,2例失败,治愈率为66.7%,有效率为91.7%。不同类型的良性瘢痕性气道狭窄,其治疗疗效差异无统计学意义(P =0.267),并且未见到严重并发症的发生。结论对于结核后气道狭窄,非支架支气管镜下介入治疗方法可以取得很好的疗效,并且安全,在临床上值得推广。

Nonstent intervention treatment of airway stenosis after tuberculosis

complications were also observed.Results According to our clinical curative effect criteria,1 6 cases were cured,6 cases were effective,0 cases were ineffective,2 cases were failure,the cure rate was 66.7%,the effective rate was 91.7%.There were no statistically significant differences in the therapeutic efficacy of different types of airway stenosis(P =0.833),and no serious complications were observed.Conclusions In the treatment of airway stenosis after tuberculosis,nonstent intervention therapy can achieve good therapeutic effects and safety,and is worth popularizing in clinical medicine.