支气管镜下微波固化、球囊扩张治疗支气管结核临床观察

支气管镜下微波固化、球囊扩张治疗支气管结核临床观察

发表时间：2014-07-21T14:31:51.780Z 来源：《中外健康文摘》2014年第18期供稿作者：张庆矫燕刘畅王箫寒苏安娜刘娜张嶔垚[导读] 支气管结核早期X线无明显改变，无特异性。CT：显示：大气道管壁增厚、支气管狭窄、变细，阻断，出现肺不张，阻塞性炎症。张庆矫燕刘畅王箫寒苏安娜刘娜张嶔垚（辽宁省沈阳市胸科医院内窥镜科 110044）【摘要】目的：评价支气管镜下微波固化、球囊扩张治疗支气管结核可行性。方法：选择气管支气管结核镜下分型：（干酪坏死型和肉芽增殖型）共143例，支气管表面干酪物、肉芽微波固化，温度40W-55W；干酪物、肉芽导致气道狭窄时，行球囊扩张术，球囊直径0.5cm、0.8cm、1.2cm，选择球囊压力大小为3-6atm(bar)。结果：143例患者中7例右中间支气管，多次球囊扩张支气管仍狭窄，远端结构不详，4例左肺上叶支气管亚段闭塞。132(91%)例患者平均微波固化3-4次，球囊扩张7-8次，干酪物、肉芽清除，支气管狭窄扩大。结论：研究表明支气管镜下微波固化、球囊扩张治疗气管支气管结核是可行的。狭窄处经球囊扩张，可迅速解决患者呼吸困难、微波可清除支气管内干酪物、肉芽，经2-3年时间定期支气管镜检查，未发现患者支气管结核复发，支气管再狭窄、虽然操作次数较多，患者有恐惧，

但治疗效果明显，得到患者认可。【关键词】支气管结核狭窄球囊扩张支气管镜。【中图分类号】R521.2 【文献标识码】A 【文章编号】1672-5085（2014）18-0096-02 【Abstract】 objective To assess the efficacy of applying bronchofibroscope facilitated by microwave and sacculus to heal tracheal and bronchial tuberculosis with ulcer caseous necrosis and granulation generation. 【Methods】: Select 143 cases of tracheal and bronchial tuberculosis patients (ulcer caseous necrosis and granulation generation), then use microwave to solidify the ulcer caseous objects and granulation on the surface of the air tube of tracheal bronchus. Next, incise it with the current of 40W-55W. If the caseous objects and granulation cause airway constriction, use microwave to conduct incision and make sacculus expand. If the caseous objects and granulation cause airway obstruction and the opening is extremely narrow, put off microwave incision and avoid occluded scar from growing too quickly. Under this circumstance, sacculus expansion should be conducted first, then cut granulation around the opening. If the scar is completely occluded, surgery should be done in such case. The diameter of sacculus needs to be expanded to 0.5, 0.8, and 1.2cm, with its pressure from 3 to 6. 【Results】: All the patients of 143 cases go through microwave treatment and sacculus expansion. In two cases among all, the patients with caseous objects and granulation blocked in the right intermediate bronchus are conducted microwave incision, but they fail to follow the prescription of treatment strictly, so in the recovery time the occlusion can’t be expanded in time. In three cases among all, the left main bronchus is severely narrow and the opening is still closed partly, nevertheless the situation of the patients’ difficulty in breathing is improved obviously. In four cases among all, brackets are inserted in the patients who have tracheal stricture, but the stricture still exists and granulation grows on tubal wall. After conducting microwave incision 3 to 4 times and sacculus expansion 7to 8 times, the condition of the patients is basically well till now. 【Conclusio】: The research indicates that bronchofibroscope facilitated by microwave and sacculus is an important approach to heal tracheal and bronchial tuberculosis. This approach can solve the patients’ difficulty in breathing quickly, clean up caseous objects and granulation in airway, and expand the stricture. This achievement can’t be reached by applying medication to the whole body. According to 2 to 3years’ observation, the patients’ bronchial tuberculosis doesn’t relapse. In spite of the growth of granulation, bronchus stricture again after expansion, more operation times and great pain for the patients, the efficacy of this treatment is comparably apparent and is approved by the patients. 【Key words】tracheobronchialstenosis balloondilatation branchofiberoscope 支气管结核气道内生长干酪物、结核肉芽及后期瘢痕狭窄，是支气管内膜结核临床治疗上一大难题，雾化吸入、激素应用、全身抗结核用药无法控制瘢痕狭窄形成[1]，本院自2010年1月-2013年9月通过支气管镜下微波固化、球囊扩张术治疗支气管结核病人143例，得到较为满意效果，现总结如下：

一.临床资料与方法

1.1 一般资料143例患者例来源住院、门诊，经内科抗结核治疗，选择支气管结核干酪坏死型32例，肉芽增殖型28例，混合存在84例，男性41例，女性101例，年龄在9-67岁，女性多于男性。好发部位：左总支气管及左下叶59例，左肺上、舌叶33例，右肺上叶及右总支气管开口30例，右肺中间支气管10例，气管11例，左肺多于右肺。X线：支气管结核早期X线无明显改变，无特异性。CT：显示：大气道管壁增厚、支气管狭窄、变细，阻断，出现肺不张，阻塞性炎症。

临床症状：早期肺结核症状表现不明显，乏力、低热，盗汗较少，有咳嗽或刺激性咳嗽，少数有咳血，咳带粘稠痰，不同程度出现呼吸困难，活动后呼吸困难加重，一部分患者有哮鸣音。

1.2方法：采用日本OLYMPUS BF-1T60、 BF-P60型纤维支气管镜，球囊，微波治疗机，导管，心电监护。术前30min注射安定5mg，2%利多卡因表面麻醉。镜进入气管观察病灶的部位，干酪物、肉芽，病灶广泛程度，将天线探出镜前端大约2cm，温度40-55W，每次时间2-5min；球囊经镜钳孔进入狭窄支气管，每次给压2-6atm，持续1-2min，局部喷洒异烟肼注射液0.4mg+2ml生理盐水、阿米卡星注射液

0.4m+2ml生理盐水。

二.结果143例患者中132（91%)经3-4次镜下微波固化、支气管狭窄患者经7-8次球囊扩张术，呼吸困难得到迅速缓解，排痰通畅，患有肺不张得到恢复，其中7例右中间支气管严重狭窄患者，经多次扩张仍狭窄，但患者呼吸困难得到改善，4例右肺上叶支气管亚段闭塞，4例左总气管严重狭窄患者微波切开后未能严格按照治疗方案治疗，一度中断治疗，后又经系统微波，球囊治疗，治疗次数增多，但狭窄处得到有效控制，呼吸功能恢复正常。镜下治疗过程持续6-12月，抗结核全身用药18-22月，观察2-3年，未见复发。

三.讨论