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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (8): 827-834.doi: 10.19982/j.issn.1000-6621.20220114

• 论著 • 上一篇    下一篇

CO2冷冻联合钳夹治疗婴幼儿淋巴结瘘型气管支气管结核的疗效和安全性研究

赵艺迪, 张同强, 刘福军, 徐勇胜, 郭伟()   

  1. 天津市儿童医院呼吸科,天津 300134
  • 收稿日期:2022-04-07 出版日期:2022-08-10 发布日期:2022-08-03
  • 通信作者: 郭伟 E-mail:guowei79656@126.com
  • 基金资助:
    天津自然科学基金(21JCYBJC00460);天津科技人才培养计划项目(RC20020)

Study on the efficacy and safety of CO2 cryotherapy combined with forceps in the treatment of lymph node fistula tracheobronchial tuberculosis in infants

Zhao Yidi, Zhang Tongqiang, Liu Fujun, Xu Yongshen, Guo Wei()   

  1. Department of Respiratory, Tianjin Children’s Hospital, Tianjin 300134,China
  • Received:2022-04-07 Online:2022-08-10 Published:2022-08-03
  • Contact: Guo Wei E-mail:guowei79656@126.com
  • Supported by:
    Tianjin Natural Science Foundation(21JCYBJC00460);The Program of Tianjin Science and Technology Talent Cultivation(RC20020)

摘要:

目的: 评估CO2冷冻联合钳夹介入治疗对婴幼儿淋巴结瘘型气管支气管结核(tracheobronchial tuberculosis,TBTB)的疗效和安全性。方法: 回顾性分析2012年7月至2020年7月天津市儿童医院呼吸科接受纤维支气管镜介入治疗的7例淋巴结瘘型TBTB患儿的临床资料(包括年龄、性别、临床症状、诊断结果、CT特点、支气管镜下病灶特征),通过描述性总结分析介入治疗前后的咳嗽等级、CT及支气管镜下病灶改变。结果: 7例患儿中,男6例,女1例,年龄8个月至3岁,病程5~70d。所有患儿主要采用支气管镜下CO2冷冻联合钳夹治疗,介入次数为1~3次。介入治疗3个月后,5例患儿咳嗽评分从2分降为0分,治疗显效,2例患儿咳嗽评分从3分降为1分,治疗有效;5例患儿复查CT显示:肺门、纵隔肿大钙化的淋巴结、支气管阻塞、肺气肿、肺不张等表现与介入治疗前比较明显改善和好转。5例患儿中,4例患儿肺部病灶吸收≥1/2,治疗显效,1例患儿肺部病灶吸收<1/2,治疗有效。7例患儿复查纤维支气管镜可见镜下瘘口基本闭合,支气管病变明显吸收好转,管腔狭窄或阻塞情况较前减轻,支气管黏膜相对光滑。7例患儿中,5例患儿支气管病变吸收≥2/3,治疗显效,2例患儿支气管病变吸收好转但<2/3,治疗有效。所有患儿术中均无呼吸困难及血氧饱和度的下降。所有患儿术后均未出现气胸、纵隔气肿、气道痉挛、管腔水肿、大出血等严重并发症。应用纤维支气管镜介入随访3~6个月,除1例患儿失访,6例患儿均未见病灶复发。结论: CO2冷冻联合钳夹介入治疗婴幼儿淋巴结瘘型TBTB取得良好的治疗效果,未见气管支气管狭窄、软化、阻塞性肺炎、肺不张等合并症的发生,该治疗方式安全有效。

关键词: 结核, 支气管, 儿童, 治疗结果

Abstract:

Objective: To evaluate the efficacy and safety of CO2 cryotherapy combined with forceps in the treatment of infants with lymph node fistula tracheobronchial tuberculosis (TBTB). Methods: The clinical data, including age, gender, clinical symptoms, diagnosis, imaging features, and characteristics of lesions under bronchoscope, of seven children with lymph node fistula TBTB were retrospectively analyzed. All the patients underwent fiberoptic bronchoscope interventional therapy in the Respiratory Department of Tianjin Children’s Hospital from July 2012 to July 2020. The cough grade, CT and bronchoscopic lesion changes before and after the intervention were analyzed by descriptive summary. Results: Among the 7 patients, 6 were male and 1 was female, aged from 8 months to 3 years, and the duration of the disease ranged from 5 to 70 d. All the children were treated mainly with bronchoscopic CO2 cryotherapy combined with forceps, and the number of interventions was 1 to 3 times. Three months after intervention, the cough scores of decreased from 2 to 0 in 5 patients, which was dramatic effective, and decreased from 3 to 1 in 2 patients, which was mild effective. It was showed by the CT reexamination that the manifestations of enlarged and calcified lymph nodes in the hilum and mediastinum, bronchial obstruction, emphysema, and pulmonary atelectasis of the five patients were significantly improved compared with those before the intervention. Among the five patients,≥1/2 of the lung lesions absorbed was found in four, the treatment was dramatic effective; and the other one had <1/2 of the lung lesions absorbed, the treatment was mild effective. Reexamination of fiberoptic bronchoscopy in 7 children showed that the the fistula was basically closed, the bronchial lesions were significantly absorbed and improved, the lumen stenosis or obstruction was reduced, and the bronchial mucosa was relatively smooth. Among the 7 patients, 5 of them had bronchial lesion absorption of ≥2/3, which was dramatic effective, and 2 of them had improved bronchial lesion absorption but <2/3, which was mild effective. No patients had intraoperative respiratory distress or decrease in oxygen saturation. None of the patients had any serious postoperative complications such as pneumothorax, mediastinal emphysema, airway spasm, luminal edema, or hemorrhage. They were followed up for 3-6 months with the application of fiberoptic bronchoscope intervention, except for one, and no recurrence of lesions was observed in any of the 6 patients. Conclusion: CO2 cryotherapy combined with forceps intervention for infant with lymph node fistula TBTB achieved good therapeutic results, and no complications such as tracheobronchial stenosis, softening, obstructive pneumonia, or pulmonary atelectasis were observed, therefore, this treatment is safe and effective.

Key words: Tuberculosis, Bronchi, Child, Treatment outcome

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