经支气管镜氩等离子凝固治疗大气道阻塞性狭窄

目的 评价经支气管镜氩等离子凝固(APC)在大气道阻塞性狭窄治疗中的应用价值和安全性.方法 对389例大气道阻塞性狭窄患者进行经支气管镜APC治疗,1个月后,进行气道狭窄再通的疗效评价.结果 389例患者共进行了1121次APC治疗,操作过程中无一例死亡.完全有效138例(35.5%),部分有效143例(36.8%),轻度有效55例(14.1%),无效53例(13.6%).APC治疗大气道阻塞性狭窄的主要并发症为窦性心动过速136例(34.9%),不同程度出血51例(13.1%),血氧饱和度下降48例(12.3%),气道梗阻加重并窒息33例(8.5%),房性和室性心律失常24例(6.2%),术后短期气道阻塞加重18例(4.6%),气管支气管壁穿孔合并纵隔和皮下气肿3例(0.78%),均经相应处理得到缓解和改善.结论 对于大气道阻塞性狭窄的患者及时进行经支气管镜APC治疗,有利于迅速解除气道梗阻,改善呼吸困难.只要从严把握适应证,熟练掌握操作技术,术中加强监护,并能随时建立人工气道和机械通气支持,经支气管镜APC治疗大气道阻塞性狭窄是安全、可行的.

Efficacy and safety of argon plasma coagulation in the treatment of obstructive tracheobronchial stenosis

Objective To evaluate the efficacy and safety of argon plasma coagulation (APC) in the treatment of large airway obstruction. Methods Totally 389 patients with treacheobronchial stenosis were treated with APC (ARCO3000 type) by bronchoscopy. The stenoses were caused by carcinomas (203cases, 52.2%), metastatic tumors (67 cases, 17.2%), benign tumors (18 cases, 4.6%), granulomas (93 cases, 23.9%) and other lesions (8 cases, 2.1%). The rate of recanalization, relief of the symptoms, and complications were analyzed. Results 1121 times of APC treatment were performed in the 389patients. Complete recanalization was achieved in 138 cases (35.5%), partial in 143 (36.8%), mild in55 (14.1%) and none in 53 (13.6%). The major complications included: super-ventricular tachycardia in136 cases (34.9%), bleeding in 51 (13.1%), decrease in blood oxygen saturation in 48 (12.3%), asphyxia in 33 (8.5%), ventricular or super-ventricular arrhythmia in 24 (6.2%), short-term aggravation of airway obstruction in 18 (4.6%), and tracheal perforation in 3 (0.78%). All those complications were treated with various measures and no patient died of the complications during the procedure. Conclusion Argon plasma coagulation is effective and relatively safe in relieving the obstruction and dyspnea in patients with large airway obstruction caused by various reasons. However, for the patients with severe airway obstruction, argon plasma coagulation sometimes may cause severe or even lethal complications. Critical consideration of the indication, operators' skill and taking more precautions during the procedure are required to ensure the safety of argon plasma coagulation treatment.