结核性气道狭窄患者行球囊扩张治疗的最佳时机探讨

doi:10.3969/j.issn.1000-6621.2019.03.008

摘要/Abstract

摘要：

目的通过比较不同病理改变阶段结核性气道狭窄行球囊扩张治疗的效果及并发症等情况,探讨结核性气道狭窄患者行球囊扩张治疗的最佳时机。方法收集2015年1月1日至2017年12月31日于武汉市肺科医院就诊的左主支气管结核导致左主支气管狭窄(狭窄程度≥50%)的患者,共计62例。根据支气管镜检查所见的不同病理改变阶段分为A、B两组:A组32例,镜下表现为恢复期;B组30例,镜下表现为瘢痕期;均分别进行了球囊扩张术。观察两组患者的治疗效果及并发症。结果 A组患者球囊扩张的即时有效率为93.8%(30/32),平均球囊扩张(3.0±0.6)次;B组患者球囊扩张的即时有效率为73.3%(22/30例),平均球囊扩张(6.0±1.6)次。差异均有统计学意义(χ ²=4.77,P=0.03;t=9.89,P=0.01)。A组患者6个月再狭窄率[10.0%(3/30)]低于B组[27.3%(6/22),差异有统计学意义(χ ²=4.21,P=0.04)。A、B两组行球囊扩张术后发生少量出血、肉芽增生、胸痛的发生率分别为59.4%(19/32)与50.0%(15/30)、31.3%(10/32)与33.3%(10/30)、21.9%(7/32)与26.7%(8/30),差异均无统计学意义(χ ²值分别为0.55、0.03、0.19;P值分别为0.46、0.42、0.66)。结论结核性气道狭窄球囊扩张治疗的最佳时机宜选择在狭窄部位,且支气管镜下表现为急性炎症消退后的恢复期,而不是瘢痕期。

关键词: 结核, 气管狭窄, 气囊扩张术, 最佳时机

Abstract:

Objective To investigate the optimal time of balloon dilatation for tuberculous tracheal stenosis by comparing the effects and complications in different pathological stages.Methods A total of 62 patients with left main bronchial stenosis because of the tuberculosis (stenosis degree ≥50%) were collected from Wuhan Pulmonary Hospital from January 1, 2015 to December 31, 2017. The patients were divided into two groups through the different pathological stages. 32 cases in group A, which showed recovery period under bronchoscope; 30 cases in group B, which showed scar stage under bronchoscope, balloon dilatation was performed in both groups, and the treatment effects and complications of the two groups were observed.Results The immediate effective rate of balloon dilatation in group A was 93.8% (30/32) and the average times of balloon dilatation were (3.0±0.6). The immediate effective rate was 73.3% (22/30) in group B and the average times were (6.0±1.6). The differences were statistically significant (χ ²=4.77, P=0.03; t=9.89, P=0.01). The 6-month restenosis rate in group A (10.0% (3/30)) was lower than that in group B (27.3% (6/22)), the difference was statistically significant (χ ²=4.21, P=0.04). The incidence of minor hemorrhage, granulation hyperplasia and chest pain after balloon dilatation surgery in group A and B was 59.4% (19/32) and 50.0% (15/30), 31.3% (10/32) and 33.3% (10/30), 21.9% (7/32) and 26.7% (8/30), respectively. The difference was not statistically significant (χ ² were 0.55, 0.03 and 0.19, respectively; P values were 0.46, 0.42 and 0.66, respectively).Conclusion The optimal time of balloon dilatation for tuberculous tracheal stenosis was the recovery period after acute inflammation subsidence in the stenosis area rather than the scar stage.

Key words: Tuberculosis, Tracheal stenosis, Balloon dilation, Optimal time

胡智敏,靖秋生,吴鸣镝,张建爽,向嵘,程娅雯,王丽,周小曼. 结核性气道狭窄患者行球囊扩张治疗的最佳时机探讨[J]. 中国防痨杂志, 2019, 41(3): 283-287. doi: 10.3969/j.issn.1000-6621.2019.03.008

Zhi-min HU,Qiu-sheng JING,Ming-di WU,Jian-shuang ZHANG,Rong XIANG,Ya-wen CHENG,Li WANG,Xiao-man ZHOU. To discuss the best time of ballon dilatation for the treatment of airway stenosis of tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 283-287. doi: 10.3969/j.issn.1000-6621.2019.03.008

图/表 2

表1

表2

不同观察指标在A、B两组患者中的结果分析

观察指标	A组(32例)	B组(30例)	统计检验值	P值
即时有效[例数(有效率,%)]	30(93.8)	22(73.3)	χ²=4.77	0.03
平均扩张次数(次, $x ˉ$ ±s)	3.0±0.6	6.0±1.6	t=9.89	0.01
6个月后再狭窄[例数(再狭窄率,%)]	3(10.0)	6(27.3)	χ²=4.21	0.04
并发症[例数(发生率,%)]
出血	19(59.4)	15(50.0)	χ²=0.55	0.46
肉芽增生	10(31.3)	10(33.3)	χ²=0.03	0.42
胸痛	7(21.9)	8(26.7)	χ²=0.19	0.66

表2

参考文献 15

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一般情况	A组(32例)	B组(30例)	统计检验值	P值
性别			χ²=0.56	0.45
男	9(28.1)	6(20.0)
女	23(71.9)	24(80.0)
年龄组(岁)			χ²=0.29	0.59
18~	8(25.0)	7(23.3)
30~	15(46.9)	16(53.4)
40~	5(15.6)	4(13.3)
50~60	4(12.5)	3(10.0)
狭窄程度(%)			χ²=0.90	0.34
51~75	10(31.3)	12(40.0)
76~90	18(56.2)	16(53.3)
>90	4(12.5)	2(6.7)
狭窄长度(cm)			χ²=0.59	0.44
<1	2(6.2)	2(6.6)
1~	24(75.0)	20(66.7)
3~5	6(18.8)	8(26.7)