支气管镜下球囊扩张术治疗结核性支气管狭窄的临床价值

目的:探讨经支气管镜球囊扩张术治疗结核性支气管狭窄的临床价值。方法:对确诊为结核性支气管狭窄的患者22例进行球囊扩张治疗,充血水肿型待水肿消退后、糜烂坏死及肉芽增生型待坏死增生病灶好转后仍旧狭窄者行扩张,瘢痕型直接进行扩张,分别测定扩张术前、术后和最后一次球囊扩张治疗后狭窄段气道直径、气促评分和FEV1,对其并发症的发生情况及6¹2个月随访情况进行评价,治疗前后比较采用配对资料t检验,P<0.05有统计意义。结果:22例患者气道狭窄段直径明显增大(t=6.651,P<0.05),95.4%患者扩张术后气道直径即刻增大,其中充血水肿型、糜烂坏死型及瘢痕型扩张后均为100%,肉芽增生型扩张后75.0%。扩张后气促评分明显降低(t=5.151,P<0.05),FEV1明显增加(t=5.152,P<0.05)。经过612个月随访情况进行评价,治疗前后比较采用配对资料t检验,P<0.05有统计意义。结果:22例患者气道狭窄段直径明显增大(t=6.651,P<0.05),95.4%患者扩张术后气道直径即刻增大,其中充血水肿型、糜烂坏死型及瘢痕型扩张后均为100%,肉芽增生型扩张后75.0%。扩张后气促评分明显降低(t=5.151,P<0.05),FEV1明显增加(t=5.152,P<0.05)。经过6¹2个月随访,再狭窄率为31.8%,其中充血水肿型及糜烂坏死型均为40.0%,肉芽增生型再狭窄率为50.0%,瘢痕型再狭窄率为12.5%。22例患者均无严重并发症。结论:支气管镜下球囊扩张术是一种简单、安全、有效的治疗方法,它对以纤维瘢痕为主的结核性支气管狭窄疗效较好,而对非瘢痕性结核性支气管狭窄远期疗效不佳。

Clinical Analysis of Bronchoscopic Treatment of Patients with Tubercular Bronchial Stenosis

Objective：To assess the value of balloon dilation using a bronchoscopy in the management of tubercular bronchial Patients with tubercular bronchial stenosis were managed by balloon using the bronchoscope. Each patient under-went bronchoscopy,in which a balloon catheter was sent to stenosis segment from the working channel and positioned across the stenosis.Airway diameters,dyspnea index and complications were evaluated in all patients and FEV1 was tested before and after high pressure balloon dilatations,airway average diameter incrcased（t=6.651,P 〈0.05）,dyspnea index decreased （t=5.151,P〈0.05） and FEV1 inereased（t =5.152,P 〈0.05）.The rate of restenosis after 6～12 months was 31.8%.No severe complication was found in all patients.Couclusion：Fiberoptic bronchoscopic balloon dilation is a simple,rapid, safe and effective method to treat tubercular bronchial stenosis.