内镜下激光治疗重度良性中心气道狭窄疗效分析

李梦怡; 宫蓓蕾; 李伟; 沈圆兵; 武静; 许园园; 张雅婷; 陈余清

doi:10.16766/j.cnki.issn.1674-4152.002488

内镜下激光治疗重度良性中心气道狭窄疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.002488

李梦怡¹,
宫蓓蕾^{1, 2, 3},
李伟^{1, 2, 3},
沈圆兵^{1, 2, 3},
武静^{1, 2, 3},
许园园^{1, 2, 3},
张雅婷¹,
陈余清^{1, 2, 3, ,}

1.
蚌埠医学院第一附属医院呼吸与危重症医学科，安徽蚌埠 233004
2.
安徽省呼吸系病临床基础重点实验室，安徽蚌埠 233004
3.
安徽省呼吸系统疾病(肿瘤)临床医学研究中心，安徽蚌埠 233004

基金项目:

安徽省教育厅自然科学研究重点项目 KJ2019A0389

安徽省重点研究与开发计划项目 202004j07020010

安徽省省级大学生创新创业训练计划项目 S202010367035

详细信息

通讯作者:
陈余清，E-mail: bbmccyq@126.com

中图分类号: R562R454.2
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- 被引次数: 0
出版历程
- 收稿日期: 2021-10-08
- 网络出版日期: 2022-09-21

Treatment of severe benign central airway stenosis with laser under bronchoscope

LI Meng-yi¹,
GONG Bei-lei^{1, 2, 3},
LI Wei^{1, 2, 3},
SHEN Yuan-bing^{1, 2, 3},
WU Jing^{1, 2, 3},
XU Yuan-yuan^{1, 2, 3},
ZHANG Ya-ting¹,
CHEN Yu-qing^{1, 2, 3
, ,}

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的良性疤痕增生性中心气道狭窄病因复杂、治疗存在挑战，本文探讨内镜下激光治疗疤痕增生性气道狭窄的安全性和有效性。方法选择2016年3月—2021年9月在蚌埠医学院第一附属医院经呼吸内镜激光治疗的良性疤痕增生性中心气道狭窄患者23例，回顾性研究患者的临床资料。基于英国医学研究委员会呼吸困难指数(mMRC)、生活质量评价量表(SF-36)评价患者气道通畅和生活质量的改善情况，动态评估治疗的有效性，监测并发症评估安全性。结果患者年龄为(57.43±10.85)岁，男女比例为1.87 5∶ 1。既往气管切开术后是狭窄最常见的原因(56.5%)，其次是气管插管(43.5%)。内镜下激光治疗23例(23/23，100.0%)患者症状均好转，气道通畅，改善了患者生活质量，SF-36评分[(107.02±10.72)分]显著高于术前[(70.34±6.17)分，t=19.877, P < 0.001]，mMRC显著下降(P < 0.001)。操作激光过程中和治疗后近期未观察到并发症。23例患者随访时间为1~60个月，平均14.39个月，中位随访时间为8.0(4.0，23.0)个月。17例(17/23，73.9%)患者在随访中出现再狭窄，其中12例(12/17，70.6%)需再次介入治疗。结论内镜下激光消融良性疤痕增生性中心气道狭窄安全有效，表现为患者呼吸功能及生活质量的显著改善，尤其适用于危急重症患者。
- 激光 /
- 气管镜 /
- 良性中心气道狭窄
Abstract: Objective The aetiology of benign central airway stenosis is complex, and the treatment is challenging. This paper discusses the safety and effectiveness of laser under bronchoscope for treating severe benign hyperplasia central airway stenosis. Methods Total 23 patients with benign hyperplasia central airway stenosis treated by laser under bronchoscope in the First Affiliated Hospital of Bengbu Medical College from March 2016 to September 2021 were studied retrospectively. The improvement of airway patency and quality of life were evaluated by using the modified Medical Research Council Dyspnea Scale (mMRC) and short form 36 questionnaire (SF-36), the effectiveness of treatment was dynamically evaluated. The complications were monitored, and the safety was evaluated. Results The average age of patients was (57.43±10.85) years old, and the male-to-female ratio was 1.87 5∶ 1. Previous tracheotomy was the most common cause of stenosis (56.5%), followed by endotracheal intubation (43.5%). The symptoms of 23 patients (23/23, 100.0%) were improved, the airway was unobstructed, and the quality of life was improved. The SF-36 score [(107.02±10.72) points] was significantly higher than that before operation [(70.34±6.17) points, t=-19.877, P < 0.001], and the mMRC score decreased significantly (P < 0.001). There were no intraoperative and postoperative complications. Twenty-three patients were followed up for 1-60 months, with an average of 14.39 months and a median of 8.0 (4.0, 23.0) months. Seventeen cases (17/23, 73.9%) had re-stenosis during follow-up, of which 12 cases (12/17, 70.6%) needed interventional treatment. Conclusion Laser ablation of benign hyperplasia central airway stenosis through endoscopy is safe and effective, which shows the significant improvement of patients' respiratory function and quality of life, especially for critically ill patients.
- Laser /
- Bronchoscope /
- Benign central airway stenosis

HTML全文

图 1 支气管镜下激光治疗良性中心气道狭窄

注：A、D示声门下/气管重度狭窄(激光治疗前)；B、E示内镜下激光治疗；C、F示声门下/气管狭窄段(激光治疗后)。

Figure 1. Figure 1 Bronchoscopic laser treatment of benign central airway stenosis

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表 1 良性疤痕增生性中心气道狭窄患者的形态学分类

Table 1. Morphological classification of patients with benign scar hyperplastic central airway stenosis

狭窄位置	例数(%)	狭窄程度	例数(%)	狭窄长度	例数(%)
声门下	4(17.4)	51%~75%(3级)	2(8.7)	＜2 cm	11(47.8)
气管	18(78.3)	76%~90%(4级)	15(65.2)	≥2 cm	12(52.2)
主支气管	1(4.3)	＞90%(5级)	6(26.1)

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表 2 良性疤痕增生性中心气道狭窄患者治疗前后观察指标比较

Table 2. Comparison of observation indexes of patients with benign scar hyperplastic central airway stenosis before and after treatment

时间	气管狭窄程度[M(P₂₅, P₇₅)，%]	mMRC [M(P₂₅, P₇₅), 级]	SF-36 (x±s, 分)
术前	90.00(80.00，90.00)	4(3，4)	70.34±6.17
术后	25.00(10.00，25.00)	1(0，1)	107.02±10.72
统计量	4.241^a	4.295^a	19.877^b
P值	< 0.001	< 0.001	< 0.001
注：^a为Z值，^b为t值。

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