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中国防痨杂志 ›› 2013, Vol. 35 ›› Issue (12): 1020-1024.

• 论著 • 上一篇    下一篇

经支气管镜介入治疗气管支气管结核的近期临床效果初步分析

崔嘉 徐建华 刘福升 陈立公   

  1. 100095 北京老年医院感染疾病科（崔嘉），胸外科（徐建华、刘福升）；深圳市福田区慢性病防治院结核病防治科（陈立公）
  • 收稿日期:2013-07-30 出版日期:2013-12-10 发布日期:2014-03-04
  • 通信作者: 崔嘉 E-mail:cjxdj615@163.com

Recent effect of interventional bronchoscopic treatment for tracheobronchial tuberculosis

CUI Jia, XU Jian-hua, LIU Fu-sheng, CHEN Li-gong   

  1. Department of Infectious Diseases, Beijing Geriatric Hospital, Beijing 100095, China
  • Received:2013-07-30 Online:2013-12-10 Published:2014-03-04
  • Contact: CUI Jia E-mail:cjxdj615@163.com

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摘要： 目的 回顾性分析经支气管镜介入治疗气管支气管结核的近期临床效果。方法 收集2010年1月至2012年9月北京老年医院收治的溃疡坏死型及肉芽增殖型初治气管支气管结核患者共67例，均采用3HRZE/9HRE抗结核治疗，同时给予异烟肼注射液雾化吸入治疗。支气管镜介入治疗患者34例纳入治疗组，其中气管镜下单纯冷冻治疗患者19例，冷冻后仍有明显狭窄接受了球囊扩张术治疗患者15例，其余33例仅内科药物治疗的患者纳入对照组。对治疗6个月的患者痰菌、影像变化及气管镜下病变情况进行分析。两组间计量资料以（x±s）表示，正态分布资料采用t检验，计数资料采用χ2 检验，检验水准α=0.05。结果 治疗6个月后痰菌阴转率治疗组（89.7%，26/29）高于对照组（65.4%，17/26），差异有统计学意义（χ2=4.734，P=0.030）；影像显示病灶吸收有效率治疗组（85.3%，29/34）高于对照组（57.6%，19/33），差异有统计学意义（χ2=6.333，P=0.012）；支气管镜下治疗有效率治疗组（73.5%，25/34）高于对照组（48.5%，16/33），差异有统计学意义（χ2=4.423，P=0.035）；而治疗组中冷冻联合球囊扩张治疗的镜下有效率（93.3%，14/15）高于单纯冷冻治疗的镜下有效率（57.9%，11/19），差异有统计学意义（P=0.047）。结论 内科化疗方法联合经支气管镜介入治疗溃疡坏死型及肉芽增殖型支气管结核优于单纯内科抗结核治疗，而冷冻联合球囊扩张术缓解支气管狭窄优于单纯冷冻治疗。

关键词: 结核, 支气管/治疗, 支气管镜检查, 药物疗法, 冷冻疗法, 气囊扩张术

Abstract: Objective  To retrospectively analyze the clinical effect of interventional bronchoscopy for tracheobronchial tuberculosis.  Methods  From January 2010 to September 2012, sixty-seven patients in our hospital with initial tracheobronchial tuberculosis were enrolled. Thirty-four patients receiving interventional bronchoscopy and chemotherapy of tuberculosis(3HRZE/9HRE) were included in the treated group. Nineteen patients in the treated group received cryotherapy treatment only. Other fifteen patients in treated group received balloon dilatation after cryotherapy treatment. Thirty-three patients receiving chemotherapy of tuberculosis(3HRZE/9HRE) only were included in the control group. Both groups were treated with isoniazide aerosol inhalation. For these patients receiving 6 months treatment, we analyzed the sputum negative rates, the improvement rate of X-ray manifestations and the improvement rate of lesions founded by bronchoscopy. T-test and chi-square test were used for statistics.  Results  After 6 months, the treated group showed the sputum negative conversion rates was 89.7%（26/29）.It was higher than the control group(65.4%,17/26).There was statistical difference between the two groups （χ2=4.734, P=0.030). The treated group showed the improvement rate of X-ray manifestations was 85.3%（29/34）. It was higher than the control group(57.6%，19/33). There was statistical difference between the two groups （χ2=6.333,P=0.012). The treated group showed the improvement rate of lesions founded by bronchoscopy was 73.5%（25/34）.It was higher than the control group(48.5%,16/33).There was statistical difference between the two groups (χ2=4.423, P=0.035). The recovery rate receiving both cryotherapy and ballon dilatation was 93.3%(14/15). It was higher than that of only receiving cryotherapy by bronchoscopy (57.9%,11/19). There was statistical difference between the two groups (P=0.047).  Conclusion  This study suggests chemotherapy treatment combined with interventional bronchoscopy is superior to single chemotherapy treatment for granulation hyperplastic and ulcerative necrotizing bronchial tuberculosis, cryotherapy treatment by bronchoscopy combined with balloon dilatation is superior to single cryotherapy treatment.

Key words: Tuberculosis, bronchi/therapy, Bronchoscopy, Drug therapy, Cryotherapy, Balloon dilatation

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