溃疡穿孔型Ⅵ型支气管结核患者经支气管镜氩气刀联合冷冻及异烟肼灌注治疗的疗效评价

doi:10.3969/j.issn.1000-6621.2019.10.008

摘要/Abstract

摘要：

目的评估经支气管镜氩气刀联合冷冻及异烟肼灌注治疗溃疡穿孔型Ⅵ型支气管结核(endobronchial tuberculosis,EBTB)患者的临床效果。方法搜集2013年1月至2018年8月湖南省胸科医院收治的符合纳入标准的65例溃疡穿孔型Ⅵ型EBTB患者的临床资料,将2017年1月之前收治的31例接受经支气管镜冷冻+异烟肼灌注治疗的患者作为对照组,将2017年1月至2018年8月前收治的34例接受经支气管镜氩气刀+冷冻+异烟肼灌注治疗的患者作为观察组。观察并分析两组患者瘘口愈合时间、治疗效果及并发症情况。采用SPSS 19.0软件进行数据的统计学分析,计量资料采用t检验或秩和检验,计数资料采用χ ²检验,均以P<0.05为差异有统计学意义。结果对照组和观察组患者分别进行经支气管镜介入治疗241例次和222例次,例均治疗次数分别为(7.81±2.20)次/例和(6.53±2.05)次/例,差异有统计学意义(t=2.425,P=0.018)。对照组行冷冻+异烟肼灌注治疗次数(3.45±0.91)次/例,高于观察组行氩气刀+冷冻+异烟肼灌注治疗(2.59±0.82)次/例(t=3.987,P<0.001)。对照组瘘口愈合中位时间[12.0(10.0, 12.0) 周]长于观察组[10.0(8.0,12.0)周](Z=-2.001,P=0.045)。对照组和观察组患者治疗后痊愈和有效者分别为29例和33例、2例和1例,治疗有效率均为100.00%(χ ²=0.000,P=1.000)。两组患者在治疗过程中均未出现与治疗相关的支气管-纵隔瘘、大出血或氩气刀相关气体栓塞等严重并发症。结论对溃疡穿孔型Ⅵ型EBTB行经支气管镜氩气刀联合冷冻及异烟肼灌注治疗,可减少治疗次数、缩短瘘口愈合时间,安全有效,值得推广。

关键词: 结核, 肺, 支气管疾病, 支气管瘘, 支气管镜检查, 投药, 局部, 氩等离子凝固术, 消融技术, 疗效比较研究

Abstract:

Objective To evaluate the therapeutic effect of argon plasma coagulation (APC) combined with cryotherapy and endobronchial isoniazid (INH) administration in patients with type Ⅵ endobronchial tuberculosis (EBTB) who developed mediastinal lymph node ulcer and fistula in bronchus.Methods A total of 65 eligible patients who received treatment in Hunan Chest Hospital from January 2013 to August 2018 were included. Thirty-one of them before January 2017, who received cryotherapy plus endobronchial local INH administration were control group; and the other 34 patients from January 2017 to August 2018, who received APC combined with cryotherapy and endobronchial local INH administration by using flexible bronchoscopy were test group. SPSS 19.0 software was used to analyzed the time to fistula recovery, efficacy, and complications after treatment. Quantitstive data were compared by t test or rank sum test, and count data were compared by χ ² test. P<0.05 was consedered statistically significant.Results Patients received endobronchial treatments 241 times (7.81±2.20 times per patient) in control group, which was significantly higher than test group (222 times (6.53±2.05 times per patient))(t=2.425, P=0.018). Patients received cryotherapy plus endobronchial local INH administration 3.45±0.91 times per patient in control group, and APC combined with cryotherapy and endobronchial local INH administration 2.59±0.82 times per patient in test group, the difference between two groups was statistically significant (t=3.987,P<0.001). Time to fistula recovery [M (Q₁,Q₃)] was 12.0 (10.0,12.0) weeks in control group, which was significantly higher than test group (10.0 (8.0,12.0) weeks)(Z=-2.001, P=0.045). Twenty-nine patients had a full recovery and 2 patients had a partial recovery in control group, while,33 patients and 1 patient in test group, Finally, the therapeutic efficacy were 100.00% in both two groups,and (χ ²=0.000,P=1.000). Severe complications including mediastinal bronchial fistula, fatal bleeding, and air embolism by APC did not occur during our procedures.Conclusion APC combined with cryotherapy and endobronchial INH administration is a safe and effective therapeutic approach which can reduce the times of endoscopic procedure and shorten the fistula recovery time for type Ⅵ EBEB patients with ulcer and fistula.

Key words: Tuberculosis, pulmonary, Bronchial diseases, Bronchial fistula, Bronchoscopy, Administration, topical, Argon plasma coagulation, Ablation techniques, Comparative effectiveness research

罗林紫,肖阳宝,席钊,肖洁,罗莉,卢志斌,罗海龙,丁衍. 溃疡穿孔型Ⅵ型支气管结核患者经支气管镜氩气刀联合冷冻及异烟肼灌注治疗的疗效评价[J]. 中国防痨杂志, 2019, 41(10): 1107-1112. doi: 10.3969/j.issn.1000-6621.2019.10.008

Lin-zi LUO,Yang-bao XIAO,Zhao XI,Jie XIAO,Li LUO,Zhi-bin LU,Hai-long LUO,Yan DING. The effect of bronchoscopic argon plasma coagulation combined with cryotherapy and endobronchial isoniazid administration in the treatment of tuberculous endobronchial fistula[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1107-1112. doi: 10.3969/j.issn.1000-6621.2019.10.008

图/表 2

表1

表2

两组患者治疗过程中不同治疗方式的应用情况

组别	支气管镜下治疗例次数	支气管镜下治疗 [次/例, $x ˉ$ ±s]	含冷冻或氩气刀支气管镜下治疗[次/例, $x ˉ$ ±s]	仅异烟肼灌注治疗 [次/例,M(Q₁,Q₃)]
对照组(31例)	241	7.81±2.20	3.45±0.91^a	4.0(3.5,5.0)
观察组(34例)	222	6.53±2.05	2.59±0.82^b	4.0(3.0,5.0)
统计值		t=2.425	t=3.987	Z=-0.821
P值		0.018	<0.001	0.412

表2

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瘘口资料	对照组(31例)	观察组(34例)	χ²值	P值
位置
右中间干	6(19.4)	10(29.4)	0.844	0.347
右中叶	5(16.2)	6(17.6)	0.027	0.870
右上叶	5(16.1)	4(11.8)	0.022	0.881
左下叶	5(16.1)	2(5.9)	0.866	0.352
左上叶	4(12.9)	3(8.8)	0.017	0.897
右主支气管	4(12.9)	4(11.8)	0.000	1.000
左上下叶开口	1(3.2)	2(5.9)	0.000	1.000
右下叶	1(3.2)	1(2.9)	0.000	1.000
左主支气管	0(0.0)	2(5.9)	-	0.493
最长径(mm)
0~	13(41.9)	10(29.4)	1.112	0.292
6~	16(51.6)	20(58.8)	0.431	0.559
12~	2(6.5)	4(11.8)	0.096	0.756