良性中心气道狭窄诊治规范的理解与认识

doi:10.6040/j.issn.1671-7554.0.2016.1708

摘要/Abstract

摘要： 良性中心气道狭窄是指由良性病变引起的中心气道狭窄,处理起来比较困难,最主要的原因是患者生存期长,患者及家属对疗效期望值更高,对手术引起的近期、远期严重并发症难以接受。而同时,良性气道狭窄治疗的长期并发症更容易发生。因此良性中心气道狭窄的处理是介入呼吸病学领域的一个难点。本文就良性中心气道狭窄病因、狭窄类型、诊断方法、治疗方法及介入治疗的规范与原则做一阐述。

关键词: 良性中心气道狭窄, 支气管介入治疗, 诊治

Abstract: Benign central airway stenosis is a central airway stenosis caused by benign lesions, and it is difficult to deal with. The main reason is that patients and their families are with high expectations on the treatment effect and can not accept the serious complications caused by the interventional therapy. However, the long-term complications of benign 山东大学学报 (医学版)55卷4期 -金发光.良性中心气道狭窄诊治规范的理解与认识 \=-airway stenosis are more likely to occur. Therefore, the treatment of benign central airway stenosis is a difficult field of interventional bronchoscopy. In this paper, we present the causes, types, diagnostic methods, treatment methods and principles of interventional treatment of benign central airway stenosis in detail, hoping it is helpful for the diagnosis and treatment of benign central airway stenosis.

Key words: Interventional bronchoscopy, Diagnosis and treatment, Benign central airway stenosis

中图分类号:

R768.1

金发光. 良性中心气道狭窄诊治规范的理解与认识[J]. 山东大学学报（医学版）, 2017, 55(4): 7-13.

JIN Faguang. Expatiation of the diagnosis and treatment of benign central airway stenosis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(4): 7-13.

参考文献

[1] Orons PD, Amesur NB, Dauber JH, et al. Balloon dilation and endobronchial stent placement for bronchial strictures after lung transplantation[J]. J Vasc Interv Radiol, 2000, 11(1): 89-99.
[2] Kim JH, Shin JH, Shim TS, et al. Efficacy and safety of a retrieval hook for removal of retrievable expandable tracheobronchial stents[J]. J Vasc Interv Radiol, 2004, 15(7): 697-705.
[3] 李龙芸. 中心气道狭窄的病因学及病理生理改变[J]. 中华结核和呼吸杂志, 2003, 26(7): 387-388.
[4] 金发光,李王平. 中心气道狭窄的诊断及介入治疗[J]. 医学与哲学:临床决策论坛版, 2008, 29(11): 7-9. JIN Faguang, LI Wangping. Diagnosis and interventional procedure of central airway stenosis[J]. Medicine and Philosophy(Clinical Decision Making Forum Edition), 2008, 29(11): 7-9.
[5] 王利换,张杰,王娟,等. 瘢痕性气道狭窄的血清蛋白质组学研究[J]. 中华结核和呼吸杂志, 2013, 36(7): 506-509. WNAG Lihuan, ZHANG Jie, WANG Juan, et al. Serum proteomic analysis of cicatricial airway stenosis[J]. Chin J Tuberc Respir Dis, 2013, 36(7): 506-509.
[6] 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
[7] Remy-Jardin M, Remy J, Deschildre F, et al. Obstructive lesions of the central airways: evaluation by using spiral CT with multiplanar and three-dimensional reformations[J]. Eur Radiol, 1996, 6(6): 807-816.
[8] Ferretti GR, Knoplioch J, Bricault I, et al. Central airway stenoses: preliminary results of spiral-CT-generated virtual bronchoscopy simulations in 29 patients[J]. Eur Radiol, 1997, 7(6): 854-859.
[9] Reed JM, O'Connor DM, Myer CR. Magnetic resonance imaging determination of tracheal orientation in normal children. Practical implications[J]. Arch Otolaryngol Head Neck Surg, 1996, 122(6): 605-608.
[10] 王广发. 中心气道狭窄的介入治疗[J]. 中华结核和呼吸杂志, 2003, 26(7): 388-391.
[11] Paone G, Nicastri E, Lucantoni G, et al. Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions[J]. Chest, 2005, 128(5): 3551-3557.
[12] 韩宝惠,孙加源.超声支气管镜引导下的经支气管针吸活检在呼吸疾病的应用[J].中华结核和呼吸杂志, 2010, 33(9): 641-642.
[13] 张良,毛锋,蔡明辉,等.纵隔镜与EBUS-TBNA对肺癌诊断和分期价值的比较研究[J].中国肺癌杂志, 2013, 16(6): 289-293. ZHANG Liang, MAO Feng, CAI Minghui, et al. A comparative study on the diagnosis and staging of lung cancer between mediastinoscopy and EBUS-TBNA[J]. Chin J Lung Cancer, 2013, 16(6): 289-293.
[14] Lunn WW, Sheller JR. Flow volume loops in the evaluation of upper airway obstruction[J]. Otolaryngol Clin North Am, 1995, 28(4): 721-729.
[15] Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis[J]. Eur Respir J, 2007, 30(1): 7-12.
[16] Almudhafer MM, Ai-Hassani FA, Benyan AK. Surgical management of benign tracheal stenosis in Basrah[J]. Qatar Med J, 2013, 2013(1): 42-47. doi:10.5339/qmj.2013.9.eCollection 2013.
[17] Krajc T, Janik M, Benej R, et al. Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases[J]. Interact Cardiovasc Thorac Surg, 2009, 9(6): 983-989.
[18] Gomez-Caro A, Morcillo A, Wins R, et al. Surgical management of benign tracheal stenosis[J]. Multimed Man Cardiothorac Surg, 2011, 2011(1111): mmcts.2010.004945. doi: 10.1510/mmcts.2010.004945.
[19] Soon JL, Agasthian T. Total tracheal resection for long-segment benign tracheal stenosis[J]. Ann Thorac Surg, 2008, 85(2): 654-656.
[20] Dedivitis R, Pfvetzenreiter EJ, Sertorio CB. Surgical treatment of benign tracheal stenosis in adults[J]. Int Surg, 2008, 93(6): 321-323.
[21] Bhora FY, Ayub A, Forleiter CM, et al. Treatment of benign tracheal stenosis using endoluminal spray cryotherapy[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(11): 1082-1087.
[22] Liang YL, Liu GN, Zheng HW, et al. Management of eenign tracheal stenosis by small-diameter tube-assisted bronchoscopic balloon dilatation[J]. Chin Med J(Engl), 2015, 128(10): 1326-1330.
[23] 李强,白冲,董宇超,等.高压球囊气道成形治疗良性近端气道狭窄[J].中华结核和呼吸杂志, 2002, 25(8): 481-484. LI Qiang, BAI Chong, DONG Yuchong, et al. Results of bronchoplasty by fiberoptic bronchoscopic balloon dilatation in the management of proximal benign tracheobronchial stenosis[J]. Chin J Tuberc Respir Dis, 2002, 25(8): 481-484.
[24] 丁卫民,王敬萍,傅瑜,等.球囊扩张术治疗支气管结核气道狭窄的临床价值[J].中华结核和呼吸杂志, 2010, 33(7): 510-514. DING Weimin, WANG Jingping, FU Yu, et al. The clinical value of balloon dilatation through flexible bronchoscope in the management of tracheobronchial stenosis in 149 cases of endobronchial tuberculosis[J]. Chin J Tuberc Respir Dis, 2010, 33(7): 510-514.
[25] Varela G, Jimenez MF. Benign tracheal stenosis should never be stented with metallic devices[J]. Arch Bronconeumol, 2016, 52(3): 121-122.
[26] 姚小鹏,李强,白冲,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, LI Qiang, BAI Chong, 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.
[27] Tsakiridis K, Darwiche K, Visouli AN, et al. Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea[J]. J Thorac Dis, 2012, 4(Suppl 1): 32-40.
[28] Sriram K, Robinson P. Recurrent airway obstructions in a patient with benign tracheal stenosis and a silicone airway stent: a case report[J]. Cases J, 2008, 1(1): 226.
[29] Schildge J, Hauk H. Successful treatment of benign tracheal stenosis with a silicone stent(Polyflex-Stent)over 5 years[J]. Pneumologie, 2001, 55(3): 152-158.
[30] 陈楠,张洁. 辅助性应用丝裂霉素C治疗良性气道狭窄的机制及研究进展[J].中华结核和呼吸杂志,2013,36(8): 592-594. CHEN Nan, ZHANG Jie. The mechanism and progress of topical application of mitomycin C as an adjunctive therapy for benign airway stenosis[J]. Chin J Tuberc Respir Dis, 2013, 36(8): 592-594.
[31] 崔嘉, 张杰, 王娟, 等. 局部应用丝裂霉素对良性瘢痕增生性气道狭窄抑制作用的初步研究[J]. 中华结核和呼吸杂志, 2012, 35(12): 901-906. CUI Jia, ZHANG Jie, WANG Juan, et al. Effect of topical application with mitomycin C in the management of benign cicatricial airway stenosis[J]. Chin J Tuberc Respir Dis, 2012, 35(12): 901-906.
[32] 陈愉,伍惠仪,李时悦.局部注射曲安奈德结合常规介入方法治疗难治性良性中央气道狭窄疗效及安全性的初步探讨[J].中华结核和呼吸杂志,2012,35(6): 415-418. CHEN Yu, WU Huiyi, LI Shiyue. Intralesional triamcinolone acetonide injection combined with conventional interventional modalities for the management of recalcitrant benign central airway stenosis: preliminary experience[J]. Chin J Tuberc Respir Dis, 2012, 35(6): 415-418.
[33] Rojas-Solano J, Becker HD. Bronchoscopic application of mitomycin-C as adjuvant treatment for benign airway stenosis[J]. J Bronchology Interv Pulmonol, 2011, 18(1): 53-55.
[34] 党斌温.中心气道管腔狭窄的病变类型和介入技术选择[J].国际呼吸杂志, 2009, 29(14): 888-890. DANG Binwen. Lesion types caused intraluminal stenosis of central airways and selecting interventional procedures[J]. Int J Respir, 2009, 29(14): 888-890.
[35] 党斌温.合理设计中心气道阻塞性病变的介入治疗方案[J].中华结核和呼吸杂志, 2007, 30(6): 452-455.
[36] 党斌温,张杰.局部麻醉及支气管软镜下氩气刀治疗中心气道阻塞性病变的安全性[J].中华结核和呼吸杂志, 2006, 29(11): 767-768.
[37] 李强,赵立军,白冲,等.微波热凝及高频电刀治疗支气管平滑肌瘤一例[J].中华结核和呼吸杂志, 2001, 24(12): 766.
[38] 党斌温,张杰.氩等离子体凝固切除中心气道内阻塞性病变的疗效[J].中华结核和呼吸杂志, 2007, 30(5): 330-333. DANG Binwen, ZHANG Jie. The efficacy of endobronchial argon plasma coagulation in the management of intraluminal obstructive lesion of the central airway[J]. Chin J Tuberc Respir Dis, 2007, 30(5): 330-333.
[39] Kim JH, Shin JH, Song HY, et al. Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance[J]. Chest, 2007, 131(4): 1114-1117.
[40] 王征宇,王永利,陈光利.可回收全覆膜金属支架治疗良性气管狭窄的并发症及处理[J].中华结核和呼吸杂志,2012,35(11):819-823. WANG Zhengyu, WANG Yongli, CHEN Guangli, et al. Complications and the management of fully covered retrievable metal stent placement in benign tracheal stenosis[J]. Chin J Tuberc Respir Dis, 2012, 35(11): 819-823.
[41] Plojoux J, Laroumagne S, Vandemoortele T, et al. Management of benign dynamic “A-shape” tracheal stenosis: a retrospective study of 60 patients[J]. Ann Thorac Surg, 2015, 99(2): 447-453.

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