经气管镜介入治疗恶性气道狭窄95例临床分析

发布时间：2018-02-16 21:46

本文关键词： 介入治疗恶性气道狭窄疗效评价　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过回顾性研究95例恶性气道狭窄患者的临床资料,分析恶性气道狭窄病因构成情况,讨论并评价经电子支气管镜介入治疗恶性气道狭窄的疗效与安全性。方法:回顾性总结2015年1月-2016年12月在我院呼吸科住院部恶性气道狭窄患者95例,对恶性气道狭窄的病因构成进行分析。对使用经电子支气管镜介导下高频电、冷冻、支架置入、氩等离子体凝固(APC)等方法治疗恶性气道狭窄患者,评价其治疗效果,同时对术中及术后并发症进行分析,评价介入治疗的安全性。结果:1、病因构成:95例恶性气道狭窄患者,肺癌患者92例(97.5%),其中腺癌45例(47.2%)、鳞状上皮细胞癌28例(29.4%),小细胞未分化癌16例(16.8%),大细胞癌2例,类癌4例。甲状腺癌气管侵犯2例,肾癌肺转移1例,均经病理证实;2、经气管镜使用热消融办法治疗恶性气道狭窄,总有效率达100%,KPS评分由术前62.54±5.28,增加至78.75±7.72(p0.05);3、腔内介入治疗术中最多见的并发症有出血、一过性低氧血症、心律失常,均能得到有效控制而不影响操作。结论:1、肺癌是导致恶性气道狭窄的主要病因,其中腺癌占第一位;2、经气管镜介入治疗恶性气道狭窄,可在短时间内切除瘤体组织并清除腔内坏死组织,达到解除气道梗阻,缓解症状目的,为肿瘤后续治疗一定程度上创造有利条件;其中热消融(高频电、APC)通过电烧灼组织发生凝固坏死效应,可短时间内直接或者部分去除梗阻部位的瘤体或者坏死肉芽组织,具有放化疗及手术没有的优势;3、气管镜腔内介入治疗具有创伤程度轻、并发症少等优势,值得临床广泛推广;4、经气管镜腔内介入恶性气道狭窄,作为一种姑息性治疗手段,只能部分解决腔内梗阻问题,根本上辅以有效的局部及全身治疗或者联合有效的放化疗效果显著。
[Abstract]:Objective: to study the clinical data of 95 patients with malignant airway stenosis and analyze the etiological factors of malignant airway stenosis. To discuss and evaluate the efficacy and safety of interventional treatment of malignant airway stenosis with electronic bronchoscopy methods: from January 2015 to December 2016, 95 cases of malignant airway stenosis in respiratory department in our hospital were retrospectively summarized. To analyze the etiological factors of malignant airway stenosis, to evaluate the therapeutic effect of high frequency electricity, cryopreservation, stent implantation and argon plasma coagulation (APC) in the treatment of malignant airway stenosis. At the same time, the intraoperative and postoperative complications were analyzed, and the safety of interventional therapy was evaluated. There were 92 cases of lung cancer, including 45 cases of adenocarcinoma (47.2%), 28 cases of squamous cell carcinoma (29. 4%), 16 cases of small cell undifferentiated carcinoma (16 cases), 2 cases of large cell carcinoma (2 cases), 4 cases of carcinoid carcinoma, 2 cases of tracheal invasion of thyroid carcinoma and 1 case of lung metastasis of renal carcinoma. All of them were proved by pathology. The total effective rate was 100%, from 62.54 卤5.28 to 78.75 卤7.72 p0.05 ~ 3. The most common complications in intraluminal interventional therapy were hemorrhage, transient hypoxemia and arrhythmia. The total effective rate was 100 卤5.28, and the KPS score increased from 62.54 卤5.28 to 78.75 卤7.72 p0.05. The most common complications in intraluminal interventional therapy were hemorrhage, transient hypoxemia and arrhythmia. Conclusion: lung cancer is the main cause of malignant airway stenosis, in which adenocarcinoma occupies the first place. It can remove the tumor tissue and remove the necrotic tissue in the lumen in a short time so as to relieve the airway obstruction and relieve the symptoms and create favorable conditions for the follow-up treatment of the tumor to a certain extent. Thermal ablation (APC) can directly or partially remove the tumor or necrotic granulation tissue in the obstruction area in a short time by electrocautery. It has the advantages of radiotherapy, chemotherapy and surgery. The endoscopy interventional therapy has the advantages of light trauma and less complications, so it is worth popularizing widely in clinic. The transtracheal endoscopy interventional malignant airway stenosis is regarded as a palliative treatment. The problem of intracavitary obstruction can only be partially solved with effective local and systemic treatment or combined chemotherapy and radiotherapy.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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