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目的评价经支气管镜球囊扩张术治疗不同类型支气管结核气道狭窄的疗效。方法回顾2008年4月—2013年9月在宜昌市第三人民医院确诊为不同类型结核性支气管狭窄的患者52例,分别于术前及最后一次球囊扩张治疗后当天对狭窄段气道直径、气促评分和第1秒用力呼气容积(FEV1.0)进行测定,对其并发症的发生情况进行评价,并对患者进行2~6个月随访。结果 52例患者分别接受气管镜球囊扩张术2~6次,平均(3.22±1.24)次。其中18例炎症浸润型、10例溃疡坏死型及15例瘢痕狭窄型扩张术后与术前比较,狭窄段平均气道直径明显增大(P<0.01),气促降低(P<0.05),肺功能FEV1.0值明显升高(P<0.01);9例肉芽增殖型术后与术前狭窄段平均气道直径无明显变化(P>0.05),气促评分无明显变化(P>0.05),肺功能FEV1.0无明显变化(P>0.05)。经6个月随访,9例出现明显再次狭窄,再狭窄率为20.9%(9/43)。其主要并发症胸痛发生率为23.07%(12/52),创面出血发生率为13.46%(7/52),感染发生率为1.92%(1/52),未出现其他严重并发症,各并发症均无特殊处理。结论炎症浸润型、溃疡型及瘢痕型气道狭窄适合支气管球囊扩张术治疗,肉芽增生型支气管结核气道狭窄应采取冷冻、氩气刀及球囊扩张术等综合治疗方法;因而术前的支气管结核分型更有助于对支气管球囊扩张术后疗效评估。
Objective To evaluate the efficacy of bronchoscopic balloon dilation in the treatment of airway stenosis of different types of bronchial tuberculosis. Methods From April 2008 to September 2013, 52 patients with different types of tuberculous bronchial stenosis were diagnosed in the Third People’s Hospital of Yichang City. The airway diameter of stenosis was measured on the day before and after the last balloon dilation , Shortness of breath score and forced expiratory volume in one second (FEV1.0) were measured. The incidence of complications was evaluated, and the patients were followed up for 2 to 6 months. Results 52 patients received tracheoscope balloon dilatation 2 to 6 times, with an average of (3.22 ± 1.24) times. There were 18 cases of inflammatory infiltration, 10 cases of ulcer necrosis and 15 cases of scar expansion. Compared with preoperative, the mean airway diameter of stenosis increased significantly (P <0.01) The FEV1.0 of lung function was significantly increased (P <0.01). There was no significant change in mean airway diameter between 9 cases of granulation proliferation and preoperative stenosis (P> 0.05) ), Pulmonary function FEV1.0 no significant change (P> 0.05). After 6 months of follow-up, 9 cases showed significant restenosis and restenosis rate was 20.9% (9/43). The main complications of chest pain rate was 23.07% (12/52), wound bleeding rate was 13.46% (7/52), infection rate was 1.92% (1/52), no other serious complications, the occurrence of complications No special treatment of disease. Conclusion Inflammatory infiltration, ulcer and scar-type airway stenosis are suitable for bronchial balloon dilatation. Granulomatous bronchial tuberculosis airway stenosis should be treated by a combination of freezing, argon knife and balloon dilatation. Therefore, preoperative Bronchial tuberculosis classification is more helpful for the evaluation of the curative effect of bronchiectasis.