本文選題：中央氣道狹窄 + 支氣管鏡　； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的：評(píng)價(jià)可彎曲電子支氣管鏡介導(dǎo)下應(yīng)用鈥激光技術(shù)治療由良、惡性病變導(dǎo)致的中央氣道狹窄的近期臨床療效。方法：選擇于2014年7月至12月在我院呼吸內(nèi)科經(jīng)過影像學(xué)及支氣管鏡檢查確診的中央氣道狹窄的患者10例,患者均有不同程度的咳嗽、呼吸困難等臨床癥狀。其中良性病變3例,肺癌5例(鱗癌2例,腺癌2例,小細(xì)胞肺癌1例)食管癌侵及氣管2例。在可彎曲電子支氣管鏡介導(dǎo)下應(yīng)用鈥激光技術(shù)盡可能的切除病變部位,通暢管腔,觀察記錄治療前及最后一次介入治療后的氣促評(píng)級(jí)、氣道直徑及血?dú)夥治?PaO2、PaCO2及Sa02)、呼吸頻率、心率變化及治療后管腔狹窄再通的有效率,并記錄術(shù)中及術(shù)后并發(fā)癥的發(fā)生情況,評(píng)價(jià)近期臨床療效,術(shù)后隨訪3月觀察管腔再狹窄發(fā)生情況。結(jié)果：10例患者共經(jīng)過了18次激光治療,每人治療次數(shù)為1-3次,經(jīng)鈥激光治療后患者咳嗽、胸悶憋喘癥狀明顯緩解,治療前及最后一次治療后患者的氣促評(píng)級(jí)由治療前的(3.50+0.85)減少至(1.50+1.08)(P0.01),有顯著性差異；氣道直徑由(3.37+0.67)mm增加至(8.75+1.24)mm(P0.01)；Pa02、PaC02及Sa02均得到明顯的改善；呼吸頻率減小,從治療前的(22.10±2.33)減小到(16.70±0.82)(次/分)((P0.01),有統(tǒng)計(jì)學(xué)意義。心率減慢,由治療前的(87.90±4.61)減少至(73.40+7.43)(次/分)(P0.01)。其中治療后狹窄再通的有效率結(jié)果為：完全有效3例(占30%),部分有效6例(占60%),輕度有效1例(占10%),無效0例,有效率可達(dá)100%。術(shù)中1例患者出現(xiàn)一過性低氧血癥,2例患者出現(xiàn)竇性心動(dòng)過速,余患者未出現(xiàn)其他嚴(yán)重并發(fā)癥,部分患者術(shù)后訴呼吸道分泌物略有增加、痰中帶血,可自行緩解。隨訪3月內(nèi),行CT及支氣管鏡等相關(guān)檢查,有2例良性病變的患者氣道發(fā)生再狹窄。結(jié)論：經(jīng)可彎曲電子支氣管鏡介導(dǎo)下鈥激光治療中央氣道狹窄可取得良好的近期療效,可迅速通暢管腔、緩解患者呼吸困難的癥狀,對(duì)于良性病變經(jīng)多次治療后可達(dá)到治愈目的,對(duì)于惡性病變的患者可作為一種姑息性治療,能提高患者的生活質(zhì)量,為患者進(jìn)行下一步治療爭(zhēng)取時(shí)間。
[Abstract]:Objective: to evaluate the efficacy of holmium laser technique in the treatment of central airway stenosis caused by benign and malignant lesions.Methods: from July to December 2014, 10 patients with central airway stenosis diagnosed by radiology and bronchoscopy in our hospital were selected. All the patients had different degrees of cough, dyspnea and other clinical symptoms.There were 3 cases of benign lesions, 5 cases of lung cancer (2 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, 1 case of small cell lung cancer), 2 cases of esophageal carcinoma invading trachea.Ho: YAG laser technique was used to remove the lesion as much as possible and to open the lumen under the bendable electron bronchoscope. The respiratory rate was observed and recorded before and after the last interventional therapy. The airway diameter and blood gas were analyzed by PaO2 and Sa02C, and the respiratory rate was observed.The changes of heart rate and the effective rate of recanalization of lumen stenosis after treatment were recorded. The incidence of intraoperative and postoperative complications was recorded, the short-term clinical effect was evaluated, and the incidence of restenosis was observed after 3 months follow-up.Results 10 patients underwent 18 times of laser treatment, each of whom was treated 1-3 times. After holmium laser treatment, the patients' cough, chest choking and wheezing were obviously alleviated.It decreased from 22.10 鹵2.33 before treatment to 16.70 鹵0.82g / min (P 0.01g / min), which was statistically significant.The heart rate decreased from 87.90 鹵4.61 to 73.407.43g / min (P 0.01g / min).The effective rate of recanalization of stenosis after treatment was as follows: 3 cases were completely effective (30 cases), 6 cases were partially effective (60 cases), 1 case was mild effective (10 cases), 0 cases were ineffective, the effective rate could reach 100%.One patient had transient hypoxemia and 2 patients had sinus tachycardia during the operation. No other serious complications were found in the remaining patients. Some patients had a slight increase in respiratory secretions and blood in the sputum.During 3 months follow-up, CT and bronchoscopy were performed. Restenosis occurred in 2 patients with benign lesions.Conclusion: holmium laser in the treatment of central airway stenosis by bendable electron bronchoscope can obtain good short-term curative effect, can quickly open the lumen and relieve the symptoms of dyspnea in patients.The patients with benign diseases can be cured after many treatments, and the patients with malignant lesions can be treated as palliative treatment, which can improve the quality of life of the patients and buy time for the patients to take the next step of treatment.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

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相關(guān)期刊論文 前3條

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本文編號(hào)：1743209