高频电凝联合冷冻治疗结核干酪样坏死的价值

目的:探讨经支气管镜高频电凝联合冷冻治疗结核干酪样坏死的应用基础及疗效。方法:本研究为病例对照研究。采用非随机抽样方法纳入2019年1月至2021年12月湖南省胸科医院通过支气管镜诊治的气管支气管结核患者101例。根据冷冻及高频电凝治疗前，钳夹病变气道坏死物难易程度；HE染色及Masson染色分析坏死物结构及纤维化程度...

Value of high-frequency electrocoagulation combined with cryotherapy for tuberculosis associated caseous necrosis

Objective To explore the basic application and therapeutic effect of bronchoscopic high-frequency electrocoagulation(HFEC)combined with cryotherapy for tuberculosis associated caseous necrosis.Methods This case-control,non-random study included 101 patients with tracheobronchial tuberculosis,who diagnosed by bronchoscopy in Hunan Chest Hospital from January 2019 to December 2021.Before intervention of HFEC combined with cryotherapy,according to the difficulty of using clamp technique in airway necrosis,the structure and fibrosis of necrosis being analyzing by HE staining and Masson staining,those patients were divided into soft group(n=34,received bronchoscopic cryotherapy)and tough group(n=67);the patients in tough group were also divided into tough control group(n=35,received bronchoscopic cryotherapy from January 2019 to December 2020)and tough experimental group(n=32,received bronchoscopic HFEC combined with cryotherapy from January 2021 to December 2021).Immunohistochemistry was used to compare the expression of transforming growth factor beta 1(TGF-β1)and collagen-1(Col-1)of soft and tough necrosis;as well as the therapeutic effect among three groups were compared after intervention.Results Masson staining quantitative analysis showed that the expression of collagen fibers in caseous necrosis in tough group was higher than that in soft group([0.155±0.058]μm2vs[0.077±0.054]μm2);immunohistochemistry results indicated that the protein positive expression rate of TGF-β1,Col-1 in caseous necrosis were increased in tough group than in soft group(all P<0.05);the frequency of bronchoscopy cryotherapy was decreased in tough experimental group than in tough control group(5.0[4.0,5.8]times/cases vs 6.0[4.0,10.0]times/cases,Z=2.76,P=0.006);the disappearance time to airway necrosis was shorter in tough experimental group than in tough control group(8.0[6.0,10.0]weeks vs 10.0[6.0,13.0]weeks,Z=2.49,P=0.013).Conclusions When inflammation and fibrosis of tuberculous tough necrosis were obvious,tuberculous airway stenosis was likely to be tendency aggravate.The application of HFEC combined with cryotherapy for tuberculosis associated caseous necrosis is capable of expediting clear necrosis,reducing frequency of interventional treatments,with safe and effective.