CAJ | 학술논문

目的观察硬质支气管镜在中心气道狭窄治疗中的有效性和安全性.方法回顾性分析2008年12月至2014年12月北京大学第一医院接受硬质支气管镜检查和治疗的所有中心气道狭窄患者资料,比较其硬质支气管镜治疗前后气道狭窄程度百分比、肺功能、生活质量的变化,探讨硬质支气管镜手术缓解中心气道狭窄的作用,以及硬质支气管镜手术中的并发症.结果共有132例严重中心气道狭窄的患者接受了209例次硬质支气管镜检查和治疗.患者年龄9～85岁(中位年龄59岁),男性占65％(86/132),恶性肿瘤占68％(90/132).首次经硬质支气管镜治疗后受累气道狭窄程度明显减轻,气管狭窄程度术前为(63.3±22.4)％,术后为(17.8±16.0)％;左主支气管术前为(71.1±23.9)％,术后为(27.0±24.0)％,右主支气管术前为(73.0±26.2)％,术后为(34.9±29.8)％,差异有统计学意义(t值分别为21.9、12.3和11.2,均P＜0.01).肺功能检查结果显示,流速相关指标FEV1术前为(1.6±0.8)L,术后为(2.0 ±0.8)L,差异有统计学意义(t=3.84,P＜0.01).除扩张狭窄的气道外,本组还在硬质支气管镜下进行了支架置入、毁损支架取出、碎石等可弯曲镜下难以完成的操作.所有病例均没有出现危及生命的并发症.结论硬质支气管镜可以快速开通气道,并在保证通气的前提下进行腔内复杂操作,可用于伴有呼吸衰竭的中心气道狭窄患者.
목적 관찰경질지기관경재중심기도협착치료중적유효성화안전성.방법 회고성분석2008년12월지2014년12월북경대학제일의원접수경질지기관경검사화치료적소유중심기도협착환자자료,비교기경질지기관경치료전후기도협착정도백분비、폐공능、생활질량적변화,탐토경질지기관경수술완해중심기도협착적작용,이급경질지기관경수술중적병발증.결과 공유132례엄중중심기도협착적환자접수료209례차경질지기관경검사화치료.환자년령9～85세(중위년령59세),남성점65％(86/132),악성종류점68％(90/132).수차경경질지기관경치료후수루기도협착정도명현감경,기관협착정도술전위(63.3±22.4)％,술후위(17.8±16.0)％;좌주지기관술전위(71.1±23.9)％,술후위(27.0±24.0)％,우주지기관술전위(73.0±26.2)％,술후위(34.9±29.8)％,차이유통계학의의(t치분별위21.9、12.3화11.2,균P＜0.01).폐공능검사결과현시,류속상관지표FEV1술전위(1.6±0.8)L,술후위(2.0 ±0.8)L,차이유통계학의의(t=3.84,P＜0.01).제확장협착적기도외,본조환재경질지기관경하진행료지가치입、훼손지가취출、쇄석등가만곡경하난이완성적조작.소유병례균몰유출현위급생명적병발증.결론 경질지기관경가이쾌속개통기도,병재보증통기적전제하진행강내복잡조작,가용우반유호흡쇠갈적중심기도협착환자.
Objective Rigid bronchoscopy has expanded for therapeutic purposes lately.It has a large diameter working channel,the ability to maintain proper ventilation during operation,and the capacity to deal with massive bleeding and other complications.Our purpose was to describe the effectiveness and safety of rigid bronchoscopy in central airway stenosis.Methods We retrospectively analyzed all patients who had received rigid bronchoscopy for central airway obstruction in our respiratory department of this teaching hospital between December of 2008 and December of 2014.The advantages and limitations of the operations were analyzed through observing the changes of the degree of stenosis,pulmonary function,and Karnofsky performance status scale.Complications were also recorded.Results Totally 209 rigid bronchoscopic procedures were performed in 132 patients with central airway stenosis (86 men;median age,59 years;range,9 to 85 years),of them 68％ was malignancy.The rigid bronchoscopy provided immediate relief of central airway obstruction.Tracheal obstruction was (63.3 ± 22.4) ％ before and (17.8 ± 16.0) ％ after the procedures;obstruction in the left main bronchus was (71.1 ± 23.9)％ before and (27.0 ± 24.0) ％ after the procedures;and the right main bronchus was (73.0 ± 26.2) ％ before and (34.9 ± 29.8) ％ after the procedures,(t =21.85,12.27,11.17 separately,P ＜ 0.0l).Spirometry revealed that FEV1 improved significantly from (1.6 ± 0.8) L before to (2.0 ± 0.8) L after the procedures.Besides,many sophisticated procedures,such as stent implantation,corrupted metal stent removing and lithotripsy were performed under rigid bronchoscopy.There were no fatal complications.Conclusions Rigid bronchoscopy provides immediate relief of central airway obstruction and maintains proper ventilation during sophisticated intraluminal operations.It provides better visualization for advanced procedures and is an optimal selection for securing the airway in severe central airway obstruction even with respiratory failure.