支气管镜下球囊扩张术治疗结核性支气管狭窄的临床价值

叶伟杰 黄雪芬 高炎超

【摘要】 目的：探究支氣管镜下球囊扩张术治疗结核性支气管狭窄的临床意义。方法：选取2016年1月-2017年7月在本院治疗并确诊为支气管内膜结核导致气管和支气管狭窄患者87例。按照治疗方法的不同将患者分为对照组（n=43）和试验组（n=44）。对照组行常规性的抗结核治疗，试验组行支气管镜下球囊扩张术治疗，比较两组患者治疗前后支气管直径、气促分级、FEV1的差异。结果：治疗后，试验组的支气管直径大于对照组，气促分级低于对照组，FEV1高于对照组，差异均有统计学意义（P<0.05）。治疗后，试验组的痰或气管分泌物涂片阴性和血清抗结核抗体阴性例数均多于对照组，红细胞沉降率低于对照组，差异均有统计学意义（P<0.05）。治疗后，试验组的肺功能分级、疗效均优于对照组，差异均有统计学意义（P<0.05）;试验组的并发症发生情况少于对照组，差异有统计学意义（P<0.05）。结论：气管镜下球囊扩张术治疗结核性支气管狭窄的效果较传统的治疗方式更具优越性，肺功能恢复好，并发症的发生率明显下降，值得临床推广。

【关键词】 支气管镜下球囊扩张术; 结核性; 支气管狭窄; 肺功能

【Abstract】 Objective：To explore the clinical significance of bronchoscopic balloon dilation in the treatment of tuberculous bronchial stenosis.Method：From January 2016 to July 2017，87 patients with tracheal and bronchial stenosis caused by endobronchial tuberculosis who were treated and diagnosed in our hospital were selected.Patients were divided into control group（n=43）and experimental group（n=44）according to different treatment methods.The control group received conventional anti-tuberculosis treatment，while the experimental group received bronchoscopic balloon dilatation.The differences of bronchial diameter，breathlessness grade and FEV1 between the two groups before and after treatment were compared.Result：After treatment，the bronchial diameter of the experimental group was larger than that of the control group，the breathlessness grade was lower than that of the control group，and FEV1 was higher than that of the control group，with statistically significant differences（P<0.05）.After treatment，the number of negative smears of sputum or tracheal secretions and negative anti-tuberculosis antibodies in the experimental group were higher than those in the control group，and the erythrocyte sedimentation rate was lower than that in the control group，with statistically significant differences（P<0.05）.After treatment，lung function grading and curative effect of the experimental group were better than those of the control group，the differences were statistically significant（P<0.05）.The incidence of complications in the experimental group was less than that in the control group，the difference was statistically significant（P<0.05）.Conclusion：The effect of endotracheal balloon dilation in the treatment of tuberculous bronchial stenosis is superior to the traditional treatment，with good recovery of lung function and significantly reduced incidence of complications，which is worthy of clinical promotion.

【Key words】 Bronchoscopic balloon dilatation; Tuberculous; Bronchial stenosis; Lung function

First-authors address：Hexian Memorial Hospital of Panyu District in Guangzhou City，Guangzhou 511400，China

doi：10.3969/j.issn.1674-4985.2019.08.035

支气管结核（EBTB）是由于结核分枝杆菌侵犯气管、支气管黏膜、黏膜下层或者深入破坏肌层及全软骨的结核病，多数继发于肺结核，少数继发于支气管淋巴结结核[1]，最终损伤后形成的瘢痕愈合可导致支气管狭窄或完全闭塞的一种疾病[2-3]。EBTB导致的支气管狭窄传统的治疗方式主要是外科手术[4]，然而开胸的手术创伤大，并发症较多，手术后可再次导致气道狭窄[5]，且早期EBTB患者的支气管无狭窄或是狭窄程度较小，临床上常表现为无症状或者仅仅有轻度的呼吸困难，因此在临床上很容易被漏诊，从而导致治疗不够及时进一步导致支气管部分或全部阻塞，甚至有窒息危险[6]，与此同时，还有一部分无法承受手术过程的患者，因而传统治疗方式没办法解决EBTB导致的支气管狭窄[7]。支气管镜下球囊扩张术是目前治疗……