喉罩通气下冷冻联合球囊扩张治疗严重良性中央气道狭窄的临床研究

doi:10.6040/j.issn.1671-7554.0.2014.108

摘要/Abstract

摘要： 目的观察喉罩通气下经电子支气管镜冷冻联合球囊扩张治疗严重良性气道狭窄的近、远期疗效和安全性.方法选取2011年1月至2013年12月严重良性中央气道狭窄的患者45例,在喉罩通气下给予冷冻联合球囊扩张治疗,比较治疗前后气道直径、一秒用力呼气容积(FEV1)、Hugh-Jones分级、血氧分压(PaO₂)和生活质量评分等指标的变化,并随访治疗的近、远期疗效和并发症.结果经过3~8个疗程治疗后,气道直径、FEV1、Hugh-Jones分级、PaO₂和生活质量评分等指标有明显改善(P<0.05).45例患者中38例(84.4%)缓解良好,狭窄部位气管内径达到原气管内径50%以上,肺叶完全复张;7例(15.6%)缓解良好,肺叶部分复张.近期不良反应:咽痛、咳嗽11例(22.4%),出血17例(37.8%),气胸2例(4.4%);随访18个月远期效果:5例(11.1%)患者出现再狭窄(平均2.5个月),给予冷冻及球囊扩张治疗后缓解.结论喉罩通气下冷冻联合球囊扩张治疗严重良性气道狭窄效果显著、安全性高、疗效确切,值得推广.

关键词: 球囊扩张, 喉罩, 冷冻治疗, 气道狭窄

Abstract: Objective To observe the short- and long-term efficacy and safety of cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask. Methods Forty-five patients with severe benign central airway stenosis were envolved from January 2011 to December 2013. The patients were treated with cryotherapy and balloon dilation under general anesthesia through laryngeal mask. The airway diameter, forced expiratory volume in one second (FEV1), Hugh-Jones classification, partial pressure of oxygen (PaO₂) and quality of life scores were compared before and after treatment. The short- and long-term efficacy and complications were followed up. Results After three to eigth courses of treatment, airway diameter, FEV1, Hugh-Jones classification, PaO₂ and quality of life scores were improved significantly (P<0.05). Thirty-eight patients (84.4%) relieved well. Their tracheal diameters reached more than 50% of the original ones and the corresponding lung lobes reexpaned completely. The lung lobes of 7 patients (15.6%) reexpanded partly. Recent adverse reactions were sore throat and cough (11 cases, 22.4%), bloody sputum (17 cases, 37.8%), and pneumothorax (2 cases, 4.4%). With the follow-up for 18 months, restenosis occurred in 5 patients (11.1%, 2.5 months averagely). After the treatment of cryotherapy and balloon dilation, the symptoms relieved. Conclusion Cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask is effect and safe, worthy to be promoted clinically.

Key words: Balloon dilation, Airway stenosis, Laryngeal mask, Cryotherapy

中图分类号:

R562

史小武, 赵苏. 喉罩通气下冷冻联合球囊扩张治疗严重良性中央气道狭窄的临床研究[J]. 山东大学学报（医学版）, 2014, 52(11): 68-72.

SHI Xiaowu, ZHAO Su. Clinical research of cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(11): 68-72.

参考文献

[1] Lorenz R R. Adult laryngotracheal stenosis:etiology and surgical management[J]. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6):467-472.
[2] Marulli G, Rizzardi G, Bortolotti L, et al. Single-staged laryngotracheal resection and reconstruction for benign strictures in adults[J]. Interact Cardiovasc Thorac Surg, 2008, 7(2):227-230.
[3] Mostfa B E, El Fiky L, El Sharnoubi M. Non-intubation traumatic laryngotracheal stenosis:management policies and results[J]. Eur Arch Otorhinolaryngol, 2006, 263(7):632-636.
[4] Dutau H, Musani A I, Plojoux J, et al. The use of self-expandable metallic stents in the airways in the adult population[J]. Expert Rev Respir Med, 2014, 8(2):179-190.
[5] 史小武,杨钢,赵苏,等.气道支架治疗甲状腺癌所致气管狭窄的临床观察[J].中华内分泌外科杂志, 2013, 7(4):32-35. SHI Xiaowu, YANG Gang, ZHAO Su, et al. Analysis of airway stent implantation in the treatment of tracheal stenosis caused by thyroid carcinoma[J]. Chinese Journal of Endocrine Surgery, 2013, 7(4):32-35.
[6] Rakesh K, Govind K. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures[J].Gastrointest Endosc, 2002, 56(6):829-834.
[7] 姚晓鹏,白冲,李强,等.气管与主支气管良性狭窄金属支架植入后再狭窄及处理[J].中华内科杂志, 2005, 44(12):885-889. YAO Xiaopeng, BAI Chong, LI Qiang, et al. Restenosis and its management after metallic stents implantation in benign tracheal and main bronchial stenosis[J]. Chinese Journal of Internal Medicine, 2005, 44(12):885-889.
[8] 金发光,傅恩清,谢永宏,等.难治性中心气道狭窄的综合介入治疗[J].中华呼吸与结核杂志, 2010, 33(1):21-24. JING Faguang, FU Enqing, XIE Yonghong, et al.The application of combined interventional procedures for the management of intractable central airway stenosis[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2010, 33(1):21-24.
[9] 苏柱泉,魏晓群,钟长镐,等.良性气管狭窄158例病因及介入治疗疗效分析[J].中华呼吸与结核杂志, 2013, 36(9):651-654. SU Zhuqiang, WEI Xiaoqun, ZHONG Changhao, et al. The causes and efficacy of benign tracheal stenosis[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2013, 36(9):651-654.
[10] 张杰,王娟,王婷,等.经支气管镜治疗良性瘢痕增生性气道狭窄方法的比较[J].中华结核和呼吸杂志, 2011, 34(5):334-338. ZHANG Jie, WANG Juan, WANG Ting, et al.A pilot study on interventional bronchoscopy in the management of aieway stenosis with benign hyperplasia[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2011, 34(5):334-338.
[11] 王广发. 良性中心气道狭窄的介入治疗[J]. 中华结核和呼吸杂志, 2010, 33(1):14-16. WANG Guangfa. Interventional management of benign airway stenosis[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2010, 33(1):14-16.
[12] 李亚强,李强,白冲,等.良性中央气道狭窄386例病因分析及腔内介入治疗的疗效评价[J].中华结核和呼吸杂志, 2008, 31(5):364-368. LI Yaqiang, LI Qiang, BAI Chong, et al. Causes of benign central airway stenoses and the efficacy of interventional treatments through flexible bronchoscopy[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2008, 31(5):364-368.
[13] Barros Casas D, Fernández-Bussy S, Folch E, et al.Non-malignant central airway obstruction[J]. Arch Bronconeumol, 2014, 50(8):345-354.
[14] Vergnon J M, Huber R M, Moghissi K. Place of cryotherapy, brachytherapy and photodynamic therapy in bronchoscopy of lung cancers[J]. Eur Respir J, 2006, 28(1):200-218.
[15] Kim J H, Shin J H, Song H Y,et al.Tracheobronchial laceration after balloon dilation for benign strictures:incidence and clinical significance[J]. Chest, 2007, 131(4):1114-1117.
[16] Fernando H C, Dekeratry D, Downie G, et al. Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway[J]. Eur J Cardiothorac Surg, 2011, 40(5):1177-1180.
[17] Lee S H, Choi W J, Sung S W, et al. Endoscopic cryotherapy of lung and bronchial tumors:a systematic review [J]. Korean J Intern Med, 2011, 26(2):137-144.
[18] Venhaus M, Behn C, Freitag L, et al.Simulations and experiments of the balloon dilatation of airway stenoses[J]. Biomed Tech (Berl), 2009, 54(4):187-195.
[19] Galluccio G, Lucantoni G, Battistoni P, et al. Interventional endoscopy in the management of benign tracheal stenosis:definitive treatment at long-term follow-up[J]. Eur J Cardiothorac Surg, 2009, 35(3):429-433.

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