CAJ | 학술논문

目的：评价支气管镜下微波固化、球囊扩张治疗支气管结核可行性。方法：选择气管支气管结核镜下分型：（干酪坏死型和肉芽增殖型）共143例，支气管表面干酪物、肉芽微波固化，温度40W-55W；干酪物、肉芽导致气道狭窄时，行球囊扩张术，球囊直径0.5c m、0.8c m、1.2c m，选择球囊压力大小为3-6atm(bar)。结果：143例患者中7例右中间支气管，多次球囊扩张支气管仍狭窄，远端结构不详，4例左肺上叶支气管亚段闭塞。132(91%)例患者平均微波固化3-4次，球囊扩张7-8次，干酪物、肉芽清除，支气管狭窄扩大。结论：研究表明支气管镜下微波固化、球囊扩张治疗气管支气管结核是可行的。狭窄处经球囊扩张，可迅速解决患者呼吸困难、微波可清除支气管内干酪物、肉芽，经2-3年时间定期支气管镜检查，未发现患者支气管结核复发，支气管再狭窄、虽然操作次数较多，患者有恐惧，但治疗效果明显，得到患者认可。
목적：평개지기관경하미파고화、구낭확장치료지기관결핵가행성。방법：선택기관지기관결핵경하분형：（간락배사형화육아증식형）공143례，지기관표면간락물、육아미파고화，온도40W-55W；간락물、육아도치기도협착시，행구낭확장술，구낭직경0.5c m、0.8c m、1.2c m，선택구낭압력대소위3-6atm(bar)。결과：143례환자중7례우중간지기관，다차구낭확장지기관잉협착，원단결구불상，4례좌폐상협지기관아단폐새。132(91%)례환자평균미파고화3-4차，구낭확장7-8차，간락물、육아청제，지기관협착확대。결론：연구표명지기관경하미파고화、구낭확장치료기관지기관결핵시가행적。협착처경구낭확장，가신속해결환자호흡곤난、미파가청제지기관내간락물、육아，경2-3년시간정기지기관경검사，미발현환자지기관결핵복발，지기관재협착、수연조작차수교다，환자유공구，단치료효과명현，득도환자인가。
objective To assess the efficacy of applying bronchofibroscope facilitated by microwave and sacculus to heal tracheal and bronchial tuberculosis with ulcer caseous necrosis and granulation generation. [Methods]: Select 143 cases of tracheal and bronchial tuberculosis patients (ulcer caseous necrosis and granulation generation), then use microwave to solidify the ulcer caseous objects and granulation on the surface of the air tube of tracheal bronchus. Next, incise it with the current of 40W-55W. If the caseous objects and granulation cause airway constriction, use microwave to conduct incision and make sacculus expand. If the caseous objects and granulation cause airway obstruction and the opening is extremely narrow, put off microwave incision and avoid occluded scar from growing too quickly. Under this circumstance, sacculus expansion should be conducted first, then cut granulation around the opening. If the scar is completely occluded, surgery should be done in such case. The diameter of sacculus needs to be expanded to 0.5, 0.8, and 1.2cm, with its pressure from 3 to 6. [Results]: Al the patients of 143 cases go through microwave treatment and sacculus expansion. In two cases among al, the patients with caseous objects and granulation blocked in the right intermediate bronchus are conducted microwave incision, but they fail to folow the prescription of treatment strictly, so in the recovery time the occlusion can’t be expanded in time. In three cases among al, the left main bronchus is severely narrow and the opening is stil closed partly, nevertheless the situation of the patients’ difficulty in breathing is improved obviously. In four cases among al, brackets are inserted in the patients who have tracheal stricture, but the stricture stil exists and granulation grows on tubal wal. After conducting microwave incision 3 to 4 times and sacculus expansion 7to 8 times, the condition of the patients is basicaly wel til now. [Conclusio]: The research indicates that bronchofibroscope facilitated by microwave and sacculus is an important approach to heal tracheal and bronchial tuberculosis. This approach can solve the patients’ difficulty in breathing quickly, clean up caseous objects and granulation in airway, and expand the stricture. This achievement can’t be reached by applying medication to the whole body. According to 2 to 3years’ observation, the patients’ bronchial tuberculosis doesn’t relapse. In spite of the growth of granulation, bronchus stricture again after expansion, more operation times and great pain for the patients, the efficacy of this treatment is comparably apparent and is approved by the patients.