支气管镜引导气道金属支架置入在治疗恶性气道狭窄中的临床价值研究

发布时间：2018-04-05 01:04

  本文选题：纤维支气管镜　切入点：介入治疗　出处：《郑州大学》2016年硕士论文

【摘要】：背景及目的在世界范围内,与全身其他组织器官的原发恶性肿瘤比较,肺癌患者的发病率及病死率均是最高的。最近几十年来,随着手术、放化疗及靶向治疗等综合治疗手段的进步,使得部分肺癌患者的存活率有所提高,总体而言其存活率并没有得到显著改善[1]。晚期肿瘤患者的全身性多发转移和渐进性消耗及其他恶病质等通常是肺癌病人的直接死亡原因,另外,也有部分患者死于肿瘤的局部进展。肺癌患者大约20%~40%在肿瘤晚期会出现中央性气道狭窄(central airway obstruction,CAO)[2-3],食管癌、纵膈肿瘤及甲状腺癌的局部进展、肾癌及其他恶性肿瘤疾病的肺部转移也可以引发中央性气道狭窄,导致顽固性咳嗽、呼吸困难、阻塞性肺炎的发生,甚或危及生命。恶性中央气道狭窄的治疗是呼吸内科医师在临床医疗活动中经常遇到并且颇为棘手的一种呼吸危重症。近年来,随着介入肺脏病学新技术的广泛开发以及在临床工作中的快速推广应用,使得中央气道狭窄的治疗方法呈现出多样化的局面,同时其已经成为呼吸科治疗肺部疾病的重要技术手段之一。本研究旨在通过对48例恶性中央气道狭窄病人经纤维支气管镜引导气道支架置入前后患者气道阻塞症状、气促评级、Kamofsky评分(KPS评分)、血气分析、肺功能等指标改变的比较及并发症的分析,研究气道支架置入在治疗恶性中央性气道狭窄的临床疗效和安全性。方法收集2012年2月-2014年10月于郑州大学第二附属医院呼吸内科气管镜室诊治的48例恶性中央气道狭窄患者的临床资料,均经纤维支气管镜引导置入气道金属支架,分析比较气道支架置入前后患者的呼吸困难改善程度、气促评级、Kamofsky评分(KPS评分)、血气分析、肺功能等指标的变化,并对术中、术后近期、远期并发症发生情况进行分析,以此来进行评价其临床疗效和安全性。结果48例气道狭窄患者一共置入54枚气道金属支架,一次性置入成功45例患者(93.75%),气道金属支架置入以后,气道阻塞症状明显缓解,呼吸困难立即减轻,近期有效率达100%。全组病人治疗以后,与治疗前进行比较,治疗前Pa O2(mm Hg)51.8±8.0,Pa CO2(mm Hg)64.7±12.6,Sa O2(%)83.5±8.8,气促分级3.9±0.2,Kamofsky评分(KPS评分)60.25±6.10,VC(L)1.77±0.54,FEV1(L)1.44±0.47,PEF(L)2.91±1.33,治疗以后Pa O2(mm Hg)72.4±11.3,Pa CO2(mm Hg)43.2±6.4,Sa O2(%)94.7±3.9,气促分级2.1±0.5,Kamofsky评分(KPS评分)79.56±8.90,VC(L)2.83±0.30,FEV1(L)1.85±0.54,PEF(L)3.83±1.57,差异均有统计学意义(P0.05)。近期有效率达100%,本研究中患者的平均生存时间为3~5个月。所有患者在支架置入过程中及术后近期、远期均未发生与支架相关的严重并发症。结论经由纤维支气管镜下气道金属支架置入是失去手术时机的肿瘤晚期合并中央气道狭窄患者的有效的姑息性介入治疗方法。本操作疗效显著、安全有效,能够即刻解除气道狭窄,缓解呼吸困难不适症状,术中、术后近远期并发症少且轻。为后续的综合治疗赢得了时间,术后联合放疗、化疗及分子靶向治疗,可以延长晚期肿瘤合并中央气道狭窄患者的生存时间。该项介入治疗方法值得在临床上推广开展。
[Abstract]:Background and purpose in the world, primary malignant tumors compared with other organs, the incidence and mortality of lung cancer are the highest. In recent decades, with surgery, chemotherapy and targeted therapy of comprehensive treatment progress, make part of patients with lung cancer survival rate improved overall, the survival rate has not been significantly improved systemic [1]. in patients with advanced tumor metastasis and progressive cachexia and other consumption usually is the direct cause of death of lung cancer patients. In addition, there are also local progression of tumors. Some patients died of lung cancer patients about 20%~40% will be the central airway stenosis in advanced cancer (central airway obstruction, CAO [2-3]), locally advanced esophageal cancer, mediastinal tumor and thyroid cancer, renal cell carcinoma and other malignant diseases of lung metastasis can also lead to the central airway The narrow, lead to intractable cough, dyspnea, obstructive pneumonia, or even life-threatening. Malignant central airway stenosis is the treatment of respiratory physicians often encounter a critical respiratory disease and difficult in clinical activities. In recent years, with the extensive development of interventional cardiology and pulmonary new technology in clinical work the rapid popularization and application, the treatment of central airway stenosis showing a variety of situation, at the same time, it has become one of the important technical means to the Department of respiration for treatment of pulmonary diseases. This study aims to 48 cases of malignant central airway stenosis by fiberoptic bronchoscope after airway stent implantation in patients with airway obstruction, dyspnea rating, Kamofsky score (KPS score), blood gas analysis, comparison and analysis of complications of pulmonary function changes in indicators such as the study of airway stent in the treatment of malignant The clinical efficacy and safety of airway stenosis. Methods the clinical data of February 2012 -2014 year in October in the diagnosis and treatment of the Second Affiliated Hospital of Zhengzhou University Department of respiratory medicine bronchoscope room 48 cases of malignant central airway stenosis, were confirmed by fiberoptic bronchoscope guided placement of airway metal bracket, analysis and comparison of airway stent patients before and after the improvement of dyspnea shortness of breath, rating, Kamofsky score (KPS score), blood gas analysis, pulmonary function index, and intraoperative, postoperative and long-term complications were analyzed in order to evaluate the clinical efficacy and safety. Results 48 cases of patients with airway stenosis were implanted 54 pieces of airway stent, disposable successful placement in 45 patients (93.75%), airway stent implantation, airway obstruction symptoms, dyspnea alleviated immediately, the recent efficiency of 100%. groups. 浜烘不鐤椾互鍚，

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