CAJ | 학술논문

目的评价局部应用丝裂霉素C对良性瘢痕增生性气道狭窄的抑制作用、安全性及可行性.方法良性瘢痕增生性气道狭窄患者20例,分为对照组和丝裂霉素组,每组10例.对照组采用单纯气管镜下介入治疗,包括球囊扩张、氩等离子体凝固术或电刀、冷冻及支架植入等,丝裂霉素组采用气管镜下介入治疗联合在狭窄气道局部使用丝裂霉素C(浓度为0.4 g/L,剂量根据狭窄段长度计算,1 ml/cm),给药方法为气管镜下导管滴注.在狭窄起始段上方1 cm处进行气管镜下拍照截图,使用Digimizer软件测量治疗前后狭窄管腔的横截面积.随访时间3个月,观察气道内局部使用丝裂霉素C的安全性及疗效.结果对照组治疗前、后的气道平均横截面积分别为(22 ± 13) mm2及(23±11) mm2,丝裂霉素组治疗前、后的气道平均横截面积分别为(20±8)mm2和(34±12) mm2,对照组与丝裂霉素组治疗后平均气管横截面积增加量分别为(1±10) mm2与(15±13) mm2,差异有统计学意义.对照组与丝裂霉素组3个月内平均每例介入治疗次数分别为(2.8±1.5)次和(1.8±0.9)次,差异无统计学意义.对照组与丝裂霉素组治疗后3个月呼吸困难指数改善率分别为30％与80％,差异有统计学意义；丝裂霉素组患者在观察期内均未出现与药物相关的并发症.结论局部应用丝裂霉素C作为一种辅助治疗方式可有效抑制良性瘢痕增生性气道狭窄；利用导管滴注实现气道内局部给药是一种方便、经济且有效的方法；气道内局部应用丝裂霉素C安全性好.
목적 평개국부응용사렬매소C대량성반흔증생성기도협착적억제작용、안전성급가행성.방법 량성반흔증생성기도협착환자20례,분위대조조화사렬매소조,매조10례.대조조채용단순기관경하개입치료,포괄구낭확장、아등리자체응고술혹전도、냉동급지가식입등,사렬매소조채용기관경하개입치료연합재협착기도국부사용사렬매소C(농도위0.4 g/L,제량근거협착단장도계산,1 ml/cm),급약방법위기관경하도관적주.재협착기시단상방1 cm처진행기관경하박조절도,사용Digimizer연건측량치료전후협착관강적횡절면적.수방시간3개월,관찰기도내국부사용사렬매소C적안전성급료효.결과 대조조치료전、후적기도평균횡절면적분별위(22 ± 13) mm2급(23±11) mm2,사렬매소조치료전、후적기도평균횡절면적분별위(20±8)mm2화(34±12) mm2,대조조여사렬매소조치료후평균기관횡절면적증가량분별위(1±10) mm2여(15±13) mm2,차이유통계학의의.대조조여사렬매소조3개월내평균매례개입치료차수분별위(2.8±1.5)차화(1.8±0.9)차,차이무통계학의의.대조조여사렬매소조치료후3개월호흡곤난지수개선솔분별위30％여80％,차이유통계학의의；사렬매소조환자재관찰기내균미출현여약물상관적병발증.결론 국부응용사렬매소C작위일충보조치료방식가유효억제량성반흔증생성기도협착；이용도관적주실현기도내국부급약시일충방편、경제차유효적방법；기도내국부응용사렬매소C안전성호.
Objective To assess the efficacy and safety of topical application of mitomycin-C in the management of benign cicatricial airway stenosis (BCAS),and to discuss the feasibility of catheter drip to achieve the topical appilication of mitomycin-C.Methods Twenty patients with BCAS were divided into control group and experimental group (topical application of mitomycin-C).Patients in control group were treated only with interventional bronchoscopy which including balloon dilation,argon plasma coagulation/electrotomy,cryotherapy,stent placement and so on,while patients in experimental group were treated with interventional bronchoscopy adjuncted with topical application of mitomycin-C (0.4 mg/ml).According to the length of airway lesion,the dosage was 1 ml/cm.Topical application of mitomycin-C was achieved by catheter drip.Photographs were taken at the place above the proximal end of airway stenosis and a software called Digimizer was used to measure the cross sectional area of stenosed airway.A 3-month follow-up was done to observe the safety and curative effect of topical application mitomycin-C in airway.Results Ten patients (3 male and 7 female) ranging in age from 20 to 71 years [mean (36 ± 17) years] enrolled in control group and 10 patients (5 male and 5 female) ranging in age from 20 to 74 years [mean (42 ± 18)years] enrolled in experimental group.The average airway cross-sectional areas before and after treatment of 2 groups were (22±13) mm2,(23±11) mm2(control group) and (20±8) mm2,(34 ±12) mm2(experimental group),respectively.The average increased airway cross-sectional areas of experimental group and control group before and after treatment were (15 ± 13) mm2 and (1 ± 10) mm2 respectively,which had statistical differences.The average times of treatment during 3 months were (2.8 ± 1.5) in control group vs (1.8 ± 0.9) in experimental group which had statistical differences.The 3-month effective rate was 90％ of experimental group vs 40％ of control group,and the symptom improvement rate was 80％ of experimental group vs 30％ of control group.There were significant differences in outcomes between two groups.No drug-related complications occurred in experimental group during the follow-up period.Conclusions Mitomycin-C is an effective adjuvant treatment method in the management of BCAS.Topical application of mitomycin-C in airway is safety.Catheter drip to achieve the topical application of mitomycin-C in airway is a convenient,economical and effective method.