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国际呼吸杂志

创刊年:1981年

刊   期:半月刊

主   编:阎锡新

主   任:张雷

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邮   编:050017

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邮发 代号:18-12

中国连续出版物号:ISSN 1673-436X

CN 13-1368/R

2017 年   第 37 卷   第 8 期   半月刊

支气管镜介入技术治疗结核性瘢痕性中心气道狭窄的对照研究

陈敏 薄丽艳 王琰 颜西刚 潘蕾 李王平 金发光 穆德广

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  [摘要] 目的 探讨当前我国常用的支气管镜介入技术治疗结核性瘢痕性中心气道狭窄的安全 性和有效性,探索针对该类患者的最佳治疗方法。方法 结核性瘢痕性中心气道狭窄患者85例,根据 采用的不同介入治疗方法将患者分为4组:A 组给予单纯球囊扩张;B组给予球囊扩张联合冷冻;C 组给予球囊扩张联合针形电刀;D组给予球囊扩张联合局部应用丝裂霉素。每例患者给予每周1次的 介入治疗,连续4周,初次治疗后于第5、9、13、21、25、29周进行疗效评价。评价指标:气促评 分、KPS评分、狭窄程度、狭窄长度以及治疗有效率和临床受益率。结果 各组患者治疗后气促评 分、KPS评分、狭窄程度均显著改善,组间差异无统计学意义。除球囊扩张联合冷冻组治疗有效率较 低 (82.4%)外,其余3组患者有效率和临床受益率均在90%以上,4组间比较差异无统计学意义。 结论 上述方法均能有效治疗结核性瘢痕性气道狭窄,组间差异无统计学意义。出于减少治疗程序, 减轻费用,在上述4种方法中,我们推荐单独球囊扩张治疗结核性瘢痕性中心气道狭窄。

  [Abstract] Objective To explore the safety and effectiveness of the commonly used Interventional bronchoscopy in the treatment of Tuberculous scar central airway stenosis, and find out the best treatment method for this kind of patients. Methods 85 cases of Patients with Tuberculous scar central airway stenosis were divided into four groups A group using only balloon dilation; group B balloon dilation and freezing; group C using balloon dilation and topical application of mitomycin; D group with balloon dilation and needle-shaped electric knife. Each patient was treated with interventional therapy once a week for 4 weeks, and the efficacy was evaluated at fifth, 9, 13, 21, 25, and 27 weeks. Evaluation index dyspnea score, KPS, degree of stenosis, length of stenosis, efficiency, and clinical yields. Results Compared with before treatment, the dyspnea score, KPS and the degree of stenosis was significantly improved in all patients after treatment, no significant differences between groups(all P <0.05).The four groups of patients with efficiency and clinical yields were more than 90%. A total of 7 cases were dropped, due to individual factors. Conclusion The above methods can be effective in the treatment of tuberculous scar stenosis, there is no statistical significance between the four groups. For the reduction of treatment procedures and cost, we recommend the use of separate balloon dilation.

  [关键词] 气管瘢痕狭窄 支气管镜 介入治疗

  [Key words]

  [中图分类号]

  [DOI]

  [基金项目]卫生公益性行业科研专项 (201402024)

  [作者简介]

  [作者单位] 第四军医大学唐都医院呼吸内科

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