喉罩通气下冷冻联合球囊扩张治疗严重良性中央气道狭窄的临床研究

目的 观察喉罩通气下经电子支气管镜冷冻联合球囊扩张治疗严重良性气道狭窄的近、远期疗效和安全性.方法 选取2011年1月至2013年12月严重良性中央气道狭窄的患者45例,在喉罩通气下给予冷冻联合球囊扩张治疗,比较治疗前后气道直径、一秒用力呼气容积(FEV1)、Hugh-Jones分级、血氧分压(PaO₂)和生活质量评分等指标的变化,并随访治疗的近、远期疗效和并发症.结果 经过3~8个疗程治疗后,气道直径、FEV1、Hugh-Jones分级、PaO₂和生活质量评分等指标有明显改善(P<0.05).45例患者中38例(84.4%)缓解良好,狭窄部位气管内径达到原气管内径50%以上,肺叶完全复张;7例(15.6%)缓解良好,肺叶部分复张.近期不良反应:咽痛、咳嗽11例(22.4%),出血17例(37.8%),气胸2例(4.4%);随访18个月远期效果:5例(11.1%)患者出现再狭窄(平均2.5个月),给予冷冻及球囊扩张治疗后缓解.结论 喉罩通气下冷冻联合球囊扩张治疗严重良性气道狭窄效果显著、安全性高、疗效确切,值得推广.

Clinical research of cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask

Objective To observe the short- and long-term efficacy and safety of cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask. Methods Forty-five patients with severe benign central airway stenosis were envolved from January 2011 to December 2013. The patients were treated with cryotherapy and balloon dilation under general anesthesia through laryngeal mask. The airway diameter, forced expiratory volume in one second (FEV1), Hugh-Jones classification, partial pressure of oxygen (PaO₂) and quality of life scores were compared before and after treatment. The short- and long-term efficacy and complications were followed up. Results After three to eigth courses of treatment, airway diameter, FEV1, Hugh-Jones classification, PaO₂ and quality of life scores were improved significantly (P<0.05). Thirty-eight patients (84.4%) relieved well. Their tracheal diameters reached more than 50% of the original ones and the corresponding lung lobes reexpaned completely. The lung lobes of 7 patients (15.6%) reexpanded partly. Recent adverse reactions were sore throat and cough (11 cases, 22.4%), bloody sputum (17 cases, 37.8%), and pneumothorax (2 cases, 4.4%). With the follow-up for 18 months, restenosis occurred in 5 patients (11.1%, 2.5 months averagely). After the treatment of cryotherapy and balloon dilation, the symptoms relieved. Conclusion Cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask is effect and safe, worthy to be promoted clinically.