关键词: 纤维支气管镜, 支气管疾病, 结核, 冷冻疗法, 综合疗法, 疗效比较研究

Abstract:

Sixty-four cases of ulcerative necrotizing and granulation proliferative endobronchial tuberculosis were collected from May 2015 to June 2018 in Panjin Infectious Diseases Hospital. All patients were treated with standardized antituberculosis drugs, aerosol inhalation, debridement through fiberoptic bronchoscope, and local perfusion of isoniazid injection. Among them, 31 patients who were admitted in March 2017 or before and did not receive bronchoscopy interventional cryotherapy were included as control group, and 33 patients who were admitted in April 2017 and later and underwent interventional cryotherapy via fiberoptic bronchoscope were included as observation group. The sputum negative conversion rate, microscopic manifestations, clinical symptoms, chest CT findings, shortness of breath index, treatment times and adverse reactions were observed. The sputum negative conversion rate, clinical treatment efficiency, microscopic efficiency and imaging efficiency of the observation group were 96.8% (30/31), 97.0% (32/33), 93.9% (31/33) and 90.9% (30/33), respectively, which were significantly higher than those of the control group (65.5% (19/29), 74.2% (23/31), 64.5% (20/31) and 67.7% (21/31)), and the differences were statistically significant (χ ² values were 9.78, 5.11, 8.55 and 5.30, P values were 0.002, 0.024, 0.003 and 0.021). The median number of interventions (quartile) (M(Q₁,Q₃)) and shortness of breath index after treatment in the observation group were 5 (4, 6) times and 1 (0, 1) scores, which were significantly lower than those in the control group (9 (8, 10) times and 2 (1, 2) scores), and the difference was statistically significant (Z values were 6.05 and 3.37, all P values <0.001). The incidence of adverse reactions in the observation group was 24.2% (8/33), compared with 25.8% (8/31) of the control group, there was no significant difference (χ ²=0.02, P=0.885). It is concluded that interventional cryotherapy with fiberoptic bronchoscope is a safe and effective treatment for ulcerative necrotizing and granulation proliferative endobronchial tuberculosis, with a high sputum negative conversion rate and a low incidence of adverse reactions.

Key words: Bronchoscopes, Bronchial diseases, Tuberculosis, Cryotherapy, Combined modality therapy, Comparative effectiveness research