本文選題：纖維支氣管鏡　切入點：介入治療　出處：《鄭州大學》2016年碩士論文

【摘要】：背景及目的在世界范圍內(nèi),與全身其他組織器官的原發(fā)惡性腫瘤比較,肺癌患者的發(fā)病率及病死率均是最高的。最近幾十年來,隨著手術(shù)、放化療及靶向治療等綜合治療手段的進步,使得部分肺癌患者的存活率有所提高,總體而言其存活率并沒有得到顯著改善[1]。晚期腫瘤患者的全身性多發(fā)轉(zhuǎn)移和漸進性消耗及其他惡病質(zhì)等通常是肺癌病人的直接死亡原因,另外,也有部分患者死于腫瘤的局部進展。肺癌患者大約20%~40%在腫瘤晚期會出現(xiàn)中央性氣道狹窄(central airway obstruction,CAO)[2-3],食管癌、縱膈腫瘤及甲狀腺癌的局部進展、腎癌及其他惡性腫瘤疾病的肺部轉(zhuǎn)移也可以引發(fā)中央性氣道狹窄,導致頑固性咳嗽、呼吸困難、阻塞性肺炎的發(fā)生,甚或危及生命。惡性中央氣道狹窄的治療是呼吸內(nèi)科醫(yī)師在臨床醫(yī)療活動中經(jīng)常遇到并且頗為棘手的一種呼吸危重癥。近年來,隨著介入肺臟病學新技術(shù)的廣泛開發(fā)以及在臨床工作中的快速推廣應(yīng)用,使得中央氣道狹窄的治療方法呈現(xiàn)出多樣化的局面,同時其已經(jīng)成為呼吸科治療肺部疾病的重要技術(shù)手段之一。本研究旨在通過對48例惡性中央氣道狹窄病人經(jīng)纖維支氣管鏡引導氣道支架置入前后患者氣道阻塞癥狀、氣促評級、Kamofsky評分(KPS評分)、血氣分析、肺功能等指標改變的比較及并發(fā)癥的分析,研究氣道支架置入在治療惡性中央性氣道狹窄的臨床療效和安全性。方法收集2012年2月-2014年10月于鄭州大學第二附屬醫(yī)院呼吸內(nèi)科氣管鏡室診治的48例惡性中央氣道狹窄患者的臨床資料,均經(jīng)纖維支氣管鏡引導置入氣道金屬支架,分析比較氣道支架置入前后患者的呼吸困難改善程度、氣促評級、Kamofsky評分(KPS評分)、血氣分析、肺功能等指標的變化,并對術(shù)中、術(shù)后近期、遠期并發(fā)癥發(fā)生情況進行分析,以此來進行評價其臨床療效和安全性。結(jié)果48例氣道狹窄患者一共置入54枚氣道金屬支架,一次性置入成功45例患者(93.75%),氣道金屬支架置入以后,氣道阻塞癥狀明顯緩解,呼吸困難立即減輕,近期有效率達100%。全組病人治療以后,與治療前進行比較,治療前Pa O2(mm Hg)51.8±8.0,Pa CO2(mm Hg)64.7±12.6,Sa O2(%)83.5±8.8,氣促分級3.9±0.2,Kamofsky評分(KPS評分)60.25±6.10,VC(L)1.77±0.54,FEV1(L)1.44±0.47,PEF(L)2.91±1.33,治療以后Pa O2(mm Hg)72.4±11.3,Pa CO2(mm Hg)43.2±6.4,Sa O2(%)94.7±3.9,氣促分級2.1±0.5,Kamofsky評分(KPS評分)79.56±8.90,VC(L)2.83±0.30,FEV1(L)1.85±0.54,PEF(L)3.83±1.57,差異均有統(tǒng)計學意義(P0.05)。近期有效率達100%,本研究中患者的平均生存時間為3~5個月。所有患者在支架置入過程中及術(shù)后近期、遠期均未發(fā)生與支架相關(guān)的嚴重并發(fā)癥。結(jié)論經(jīng)由纖維支氣管鏡下氣道金屬支架置入是失去手術(shù)時機的腫瘤晚期合并中央氣道狹窄患者的有效的姑息性介入治療方法。本操作療效顯著、安全有效,能夠即刻解除氣道狹窄,緩解呼吸困難不適癥狀,術(shù)中、術(shù)后近遠期并發(fā)癥少且輕。為后續(xù)的綜合治療贏得了時間,術(shù)后聯(lián)合放療、化療及分子靶向治療,可以延長晚期腫瘤合并中央氣道狹窄患者的生存時間。該項介入治療方法值得在臨床上推廣開展。
[Abstract]:Background and purpose in the world, primary malignant tumors compared with other organs, the incidence and mortality of lung cancer are the highest. In recent decades, with surgery, chemotherapy and targeted therapy of comprehensive treatment progress, make part of patients with lung cancer survival rate improved overall, the survival rate has not been significantly improved systemic [1]. in patients with advanced tumor metastasis and progressive cachexia and other consumption usually is the direct cause of death of lung cancer patients. In addition, there are also local progression of tumors. Some patients died of lung cancer patients about 20%~40% will be the central airway stenosis in advanced cancer (central airway obstruction, CAO [2-3]), locally advanced esophageal cancer, mediastinal tumor and thyroid cancer, renal cell carcinoma and other malignant diseases of lung metastasis can also lead to the central airway The narrow, lead to intractable cough, dyspnea, obstructive pneumonia, or even life-threatening. Malignant central airway stenosis is the treatment of respiratory physicians often encounter a critical respiratory disease and difficult in clinical activities. In recent years, with the extensive development of interventional cardiology and pulmonary new technology in clinical work the rapid popularization and application, the treatment of central airway stenosis showing a variety of situation, at the same time, it has become one of the important technical means to the Department of respiration for treatment of pulmonary diseases. This study aims to 48 cases of malignant central airway stenosis by fiberoptic bronchoscope after airway stent implantation in patients with airway obstruction, dyspnea rating, Kamofsky score (KPS score), blood gas analysis, comparison and analysis of complications of pulmonary function changes in indicators such as the study of airway stent in the treatment of malignant The clinical efficacy and safety of airway stenosis. Methods the clinical data of February 2012 -2014 year in October in the diagnosis and treatment of the Second Affiliated Hospital of Zhengzhou University Department of respiratory medicine bronchoscope room 48 cases of malignant central airway stenosis, were confirmed by fiberoptic bronchoscope guided placement of airway metal bracket, analysis and comparison of airway stent patients before and after the improvement of dyspnea shortness of breath, rating, Kamofsky score (KPS score), blood gas analysis, pulmonary function index, and intraoperative, postoperative and long-term complications were analyzed in order to evaluate the clinical efficacy and safety. Results 48 cases of patients with airway stenosis were implanted 54 pieces of airway stent, disposable successful placement in 45 patients (93.75%), airway stent implantation, airway obstruction symptoms, dyspnea alleviated immediately, the recent efficiency of 100%. groups. 浜烘不鐤椾互鍚，

本文編號：1712491