目的 观察支气管镜介入治疗对结核性主支气管重度狭窄或闭锁并一侧全肺不张的疗效.方法 1999年7月至2009年9月第二军医大学长海医院收治的90例结核性主支气管重度狭窄或闭锁并一侧全肺不张患者,其中男13例,女77例,年龄13～71岁,平均(31±10)岁.根据是否放置支架分为介入治疗组(53例)和支架置入组(37例),介入治疗组采用高频电凝、球囊扩张及冷冻等治疗方法,支架置入组在介入治疗的基础上置入金属支架.比较2组患者治疗前和病情稳定后影像学、支气管镜下表现及气促指数,观察治疗有效率、起效时间及再狭窄率,比较不同病程患者之间的疗效差异.2组资料比较显著性检验采用χ2检验.气促指数、病程的显著性检验采用Wilcoxon秩和检验.结果 治疗3个月后支架置入组显效率(36/37)和总有效率(37/37)均优于介入治疗组(22/53,43/53,χ2=29.595、6.060,均P<0.05),支架置入组的起效时间(0.25个月)较介入治疗组(1.60个月)明显缩短.所有患者治疗后气促指数均较前明显改善,支架置入组与介入治疗组比较差异有统计学意义(u=-2.478,P<0.05).治疗有效者中位病程为2.0个月,好转者为3.5个月,无效者为5.0个月,有效与无效者相比,差异有统计学意义(u=-3.079,P<0.01).对治疗有效者随访结果显示,再狭窄发生率达72%(26/36),显著高于介入治疗组的32%(7/22,χ2=9.090,P<0.01).发生再狭窄的中位时间介入治疗组为4个月,支架置入组为6个月.治疗有效后第12个月复查支气管镜,支架置入组的显效率(15/25,60%)及总有效率(22/25,88%)均优于介入治疗组(7/24,29%,14/24,60%,χ2=10.559,10.261,均P<0.01).支架置入组中主支气管闭锁患者的总有效率(10/11,91%)明显高于介入治疗组(7/14,50%,Fisher检验,P<0.05).组内比较主支气管重度狭窄与闭锁者的有效率无明显差异.结论 支气管镜下高频电凝、球囊扩张及冷冻等常规介入治疗及支架置入均是治疗导致肺不张的结核性主支气管重度狭窄或闭锁的有效方法.其中支架置入的疗效更好,症状改善更快.支架置入的疗效较好,但再狭窄发生率高,易发生在支架置入后6个月,应加强随访.病程对疗效有显著影响,病程长者疗效较差.因此对于出现呼吸困难,特别是肺不张的支气管结核患者,应尽早治疗.
目的 觀察支氣管鏡介入治療對結覈性主支氣管重度狹窄或閉鎖併一側全肺不張的療效.方法 1999年7月至2009年9月第二軍醫大學長海醫院收治的90例結覈性主支氣管重度狹窄或閉鎖併一側全肺不張患者,其中男13例,女77例,年齡13～71歲,平均(31±10)歲.根據是否放置支架分為介入治療組(53例)和支架置入組(37例),介入治療組採用高頻電凝、毬囊擴張及冷凍等治療方法,支架置入組在介入治療的基礎上置入金屬支架.比較2組患者治療前和病情穩定後影像學、支氣管鏡下錶現及氣促指數,觀察治療有效率、起效時間及再狹窄率,比較不同病程患者之間的療效差異.2組資料比較顯著性檢驗採用χ2檢驗.氣促指數、病程的顯著性檢驗採用Wilcoxon秩和檢驗.結果 治療3箇月後支架置入組顯效率(36/37)和總有效率(37/37)均優于介入治療組(22/53,43/53,χ2=29.595、6.060,均P<0.05),支架置入組的起效時間(0.25箇月)較介入治療組(1.60箇月)明顯縮短.所有患者治療後氣促指數均較前明顯改善,支架置入組與介入治療組比較差異有統計學意義(u=-2.478,P<0.05).治療有效者中位病程為2.0箇月,好轉者為3.5箇月,無效者為5.0箇月,有效與無效者相比,差異有統計學意義(u=-3.079,P<0.01).對治療有效者隨訪結果顯示,再狹窄髮生率達72%(26/36),顯著高于介入治療組的32%(7/22,χ2=9.090,P<0.01).髮生再狹窄的中位時間介入治療組為4箇月,支架置入組為6箇月.治療有效後第12箇月複查支氣管鏡,支架置入組的顯效率(15/25,60%)及總有效率(22/25,88%)均優于介入治療組(7/24,29%,14/24,60%,χ2=10.559,10.261,均P<0.01).支架置入組中主支氣管閉鎖患者的總有效率(10/11,91%)明顯高于介入治療組(7/14,50%,Fisher檢驗,P<0.05).組內比較主支氣管重度狹窄與閉鎖者的有效率無明顯差異.結論 支氣管鏡下高頻電凝、毬囊擴張及冷凍等常規介入治療及支架置入均是治療導緻肺不張的結覈性主支氣管重度狹窄或閉鎖的有效方法.其中支架置入的療效更好,癥狀改善更快.支架置入的療效較好,但再狹窄髮生率高,易髮生在支架置入後6箇月,應加彊隨訪.病程對療效有顯著影響,病程長者療效較差.因此對于齣現呼吸睏難,特彆是肺不張的支氣管結覈患者,應儘早治療.
목적 관찰지기관경개입치료대결핵성주지기관중도협착혹폐쇄병일측전폐불장적료효.방법 1999년7월지2009년9월제이군의대학장해의원수치적90례결핵성주지기관중도협착혹폐쇄병일측전폐불장환자,기중남13례,녀77례,년령13～71세,평균(31±10)세.근거시부방치지가분위개입치료조(53례)화지가치입조(37례),개입치료조채용고빈전응、구낭확장급냉동등치료방법,지가치입조재개입치료적기출상치입금속지가.비교2조환자치료전화병정은정후영상학、지기관경하표현급기촉지수,관찰치료유효솔、기효시간급재협착솔,비교불동병정환자지간적료효차이.2조자료비교현저성검험채용χ2검험.기촉지수、병정적현저성검험채용Wilcoxon질화검험.결과 치료3개월후지가치입조현효솔(36/37)화총유효솔(37/37)균우우개입치료조(22/53,43/53,χ2=29.595、6.060,균P<0.05),지가치입조적기효시간(0.25개월)교개입치료조(1.60개월)명현축단.소유환자치료후기촉지수균교전명현개선,지가치입조여개입치료조비교차이유통계학의의(u=-2.478,P<0.05).치료유효자중위병정위2.0개월,호전자위3.5개월,무효자위5.0개월,유효여무효자상비,차이유통계학의의(u=-3.079,P<0.01).대치료유효자수방결과현시,재협착발생솔체72%(26/36),현저고우개입치료조적32%(7/22,χ2=9.090,P<0.01).발생재협착적중위시간개입치료조위4개월,지가치입조위6개월.치료유효후제12개월복사지기관경,지가치입조적현효솔(15/25,60%)급총유효솔(22/25,88%)균우우개입치료조(7/24,29%,14/24,60%,χ2=10.559,10.261,균P<0.01).지가치입조중주지기관폐쇄환자적총유효솔(10/11,91%)명현고우개입치료조(7/14,50%,Fisher검험,P<0.05).조내비교주지기관중도협착여폐쇄자적유효솔무명현차이.결론 지기관경하고빈전응、구낭확장급냉동등상규개입치료급지가치입균시치료도치폐불장적결핵성주지기관중도협착혹폐쇄적유효방법.기중지가치입적료효경호,증상개선경쾌.지가치입적료효교호,단재협착발생솔고,역발생재지가치입후6개월,응가강수방.병정대료효유현저영향,병정장자료효교차.인차대우출현호흡곤난,특별시폐불장적지기관결핵환자,응진조치료.
Objective To observe the therapeutic efficacy of bronchoscopic interventional therapy on severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis.MethodsNinety patients with severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis, who had received bronchoscopic interventional therapy, were divided into group A and B according to whether stents had been implanted or not. Patients in group A had been treated with electrocautery, balloon dilatation and cryotherapy. Group B had been treated with metallic stent implantation on the basis of the above interventional management. In order to observe the effectiveness, the time needed for taking effect and restenosis rate were noted. The efficacy between patients with different disease courses, radiology, bronchoscopy and dyspnea index were evaluated before treatment and after the patients' conditions were stable. Results Three months after treatment, the good response rate and the total effective rate of group B were higher than those of group A, 97% vs 42% (χ2=29.595, P<0.05), 100% vs 81% (χ2=6.060,P<0.05), respectively. The time needed for taking effect in group B was significantly shorter than that in group A, 0.25 month vs 1.6 month. The dyspnea indexes of both groups were significantly improved after treatment, but the improvement of group B was more significant than that of group A(u=-2.478,P<0.05). The disease course of patients with different therapeutic efficacy was evaluated, and the median disease course was 2 months in good response efficacy patients, 3.5 months in improved patients, and 5 months in ineffective patients; the difference being significant between ineffective and good response efficacy patients (u=-3.079, P<0.01). The restenosis rate of group B was significantly higher than that of group A, 72% vs 32% (χ2=9.090,P<0.01). The median restenosis time was 4 months in group A, and 6 months in group B. Bronchoscopy follow-up 12 months after the initial effective treatment showed that the good response rate and the total effective rate of group B were better than those of group A, 60% vs 29%(χ2=10.559, P＜0.01), 88% vs 60%(χ2=10.261, P＜0.01, respectively), and the total effective rate of main bronchial atresia patients in group B was significantly higher than that in group A, 90% vs 50% (Fisher's exact test, P<0.05). There was no significant difference in effectiveness between severe stenosis and atresia patients in group A and B.Conclusion Electrocautery, balloon dilatation, cryotherapy and stent implantation were effective methods to treat severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis. Among them, the therapeutic efficacy was better and the symptoms improved more quickly in patients with stent implantation. The efficacy of stent implantation was better than that of conventional interventional therapy, but the incidence of restenosis was also higher. Following-up should be emphasized in this group of patients. Disease courses were associated with the therapeutic efficacy; longer disease course was related to worse therapeutic efficacy, and restenosis occurred earlier. So interventional therapy should be initiated earlier for bronchial tuberculosis with dyspnea, especially for that complicated by atelectasis.
