The effect of bronchoscopic argon plasma coagulation combined with cryotherapy and endobronchial isoniazid administration in the treatment of tuberculous endobronchial fistula

doi:10.3969/j.issn.1000-6621.2019.10.008

Abstract

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

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

Figures/Tables 2

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

References 17

[1]	中华医学会结核病学分会, 中华结核和呼吸杂志编辑委员会. 气管支气管结核诊断和治疗指南(试行). 中华结核和呼吸杂志, 2012,35(8):230-238.
[2]	李晖, 钱元福, 李拯民 , 等. 成人淋巴结支气管瘘41例观察报告. 中国防痨杂志, 1959,( 5):33-36.
[3]	张景熙, 白冲, 黄海东 , 等. 经气管镜冷冻联合药物灌注对透壁型纵隔支气管旁淋巴结结核的治疗作用. 中华结核和呼吸杂志, 2011,34(12):898-903. doi: 10.3760/cma.j.issn.1001-0939.2011.12.006
[4]	肖阳宝, 席钊, 罗林紫 , 等. 冷冻联合局部药物灌注治疗淋巴结瘘型气管支气管结核的结果分析. 中国防痨杂志, 2017,39(3):256-259.
[5]	金发光 . 支气管结核介入的诊治方案. 中华肺部疾病杂志(电子版), 2016,9(1):1-4.
[6]	黄景陶, 张仲卫 . 气道内肿瘤消融技术现状及进展. 实用肿瘤杂志, 2016,31(1):90-94.
[7]	王洪武 . 电子支气管镜的临床应用. 北京: 中国医药科技出版社, 2009: 1.
[8]	苏瑾文, 程小星 . 肺结核的保护性免疫和免疫病理机制进展. 中国热带医学, 2015,15(5):635-639.
[9]	苏政军, 龙会, 谢贝 , 等. 高温与多聚甲醛方法杀灭结核杆菌效果的观察. 现代医院, 2013,13(4):16-18.
[10]	陈志, 张广宇, 梁建琴 , 等. 氩等离子体凝固和冷冻序贯治疗支气管结核. 中国防痨杂志, 2011,33(2):99-102.
[11]	Erelel M, Yakar F, Yakar A . Endobronchial tuberculosis with lobar obstruction successfully treated by argon plasma coagulation. South Med J, 2009,102(10):1078-1081.
[12]	Jin F, Mu D, Xie Y , et al. Application of bronchoscopic argon plasma coagulation in the treatment of tumorous endobronchial tuberculosis: historical controlled trial. J Thorac Cardiovasc Surg, 2013,145(6):1650-1653.
[13]	穆德广, 金发光, 傅恩清 , 等. 经支气管镜氩气刀治疗气道狭窄临床观察. 中华肺部疾病杂志(电子版), 2011,4(3):23-25.
[14]	张丽琴, 王小伟, 赵毅超 . 支气管镜介导下冷冻联合氩等离子电凝技术治疗气道狭窄. 当代医学, 2014,20(23):108-109.
[15]	陈志, 张广宇, 王巍 . 支气管镜介入技术在支气管结核治疗中的应用进展. 中国防痨杂志, 2011,33(8):509-513.
[16]	杨红忠, 胡成平, 杨华平 , 等. 支气管镜介入冷冻治疗支气管结核. 中国防痨杂志, 2005,27(4):227-229.
[17]	Krishnan B, Shaukat A, Chakravorty I . Fatal haemoptysis in a young man with tuberculous mediastinal lymphadenitis. A case report and review of the literature. Respiration, 2009,77(3):333-336.

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