经支气管镜钬激光治疗中央气道狭窄的临床分析

发布时间：2018-04-13 06:00

本文选题：中央气道狭窄 + 支气管镜　；参考：《山东大学》2015年硕士论文

【摘要】：目的：评价可弯曲电子支气管镜介导下应用钬激光技术治疗由良、恶性病变导致的中央气道狭窄的近期临床疗效。方法：选择于2014年7月至12月在我院呼吸内科经过影像学及支气管镜检查确诊的中央气道狭窄的患者10例,患者均有不同程度的咳嗽、呼吸困难等临床症状。其中良性病变3例,肺癌5例(鳞癌2例,腺癌2例,小细胞肺癌1例)食管癌侵及气管2例。在可弯曲电子支气管镜介导下应用钬激光技术尽可能的切除病变部位,通畅管腔,观察记录治疗前及最后一次介入治疗后的气促评级、气道直径及血气分析(PaO2、PaCO2及Sa02)、呼吸频率、心率变化及治疗后管腔狭窄再通的有效率,并记录术中及术后并发症的发生情况,评价近期临床疗效,术后随访3月观察管腔再狭窄发生情况。结果：10例患者共经过了18次激光治疗,每人治疗次数为1-3次,经钬激光治疗后患者咳嗽、胸闷憋喘症状明显缓解,治疗前及最后一次治疗后患者的气促评级由治疗前的(3.50+0.85)减少至(1.50+1.08)(P0.01),有显著性差异；气道直径由(3.37+0.67)mm增加至(8.75+1.24)mm(P0.01)；Pa02、PaC02及Sa02均得到明显的改善；呼吸频率减小,从治疗前的(22.10±2.33)减小到(16.70±0.82)(次/分)((P0.01),有统计学意义。心率减慢,由治疗前的(87.90±4.61)减少至(73.40+7.43)(次/分)(P0.01)。其中治疗后狭窄再通的有效率结果为：完全有效3例(占30%),部分有效6例(占60%),轻度有效1例(占10%),无效0例,有效率可达100%。术中1例患者出现一过性低氧血症,2例患者出现窦性心动过速,余患者未出现其他严重并发症,部分患者术后诉呼吸道分泌物略有增加、痰中带血,可自行缓解。随访3月内,行CT及支气管镜等相关检查,有2例良性病变的患者气道发生再狭窄。结论：经可弯曲电子支气管镜介导下钬激光治疗中央气道狭窄可取得良好的近期疗效,可迅速通畅管腔、缓解患者呼吸困难的症状,对于良性病变经多次治疗后可达到治愈目的,对于恶性病变的患者可作为一种姑息性治疗,能提高患者的生活质量,为患者进行下一步治疗争取时间。
[Abstract]:Objective: to evaluate the efficacy of holmium laser technique in the treatment of central airway stenosis caused by benign and malignant lesions.Methods: from July to December 2014, 10 patients with central airway stenosis diagnosed by radiology and bronchoscopy in our hospital were selected. All the patients had different degrees of cough, dyspnea and other clinical symptoms.There were 3 cases of benign lesions, 5 cases of lung cancer (2 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, 1 case of small cell lung cancer), 2 cases of esophageal carcinoma invading trachea.Ho: YAG laser technique was used to remove the lesion as much as possible and to open the lumen under the bendable electron bronchoscope. The respiratory rate was observed and recorded before and after the last interventional therapy. The airway diameter and blood gas were analyzed by PaO2 and Sa02C, and the respiratory rate was observed.The changes of heart rate and the effective rate of recanalization of lumen stenosis after treatment were recorded. The incidence of intraoperative and postoperative complications was recorded, the short-term clinical effect was evaluated, and the incidence of restenosis was observed after 3 months follow-up.Results 10 patients underwent 18 times of laser treatment, each of whom was treated 1-3 times. After holmium laser treatment, the patients' cough, chest choking and wheezing were obviously alleviated.It decreased from 22.10 卤2.33 before treatment to 16.70 卤0.82g / min (P 0.01g / min), which was statistically significant.The heart rate decreased from 87.90 卤4.61 to 73.407.43g / min (P 0.01g / min).The effective rate of recanalization of stenosis after treatment was as follows: 3 cases were completely effective (30 cases), 6 cases were partially effective (60 cases), 1 case was mild effective (10 cases), 0 cases were ineffective, the effective rate could reach 100%.One patient had transient hypoxemia and 2 patients had sinus tachycardia during the operation. No other serious complications were found in the remaining patients. Some patients had a slight increase in respiratory secretions and blood in the sputum.During 3 months follow-up, CT and bronchoscopy were performed. Restenosis occurred in 2 patients with benign lesions.Conclusion: holmium laser in the treatment of central airway stenosis by bendable electron bronchoscope can obtain good short-term curative effect, can quickly open the lumen and relieve the symptoms of dyspnea in patients.The patients with benign diseases can be cured after many treatments, and the patients with malignant lesions can be treated as palliative treatment, which can improve the quality of life of the patients and buy time for the patients to take the next step of treatment.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

【参考文献】