经电子支气管镜氩等离子体凝固联合高频电刀治疗气道狭窄的临床疗效分析
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摘要
目的探讨经电子支气管镜氩等离子体凝固(argon plasma coagulation,APC)联合高频电刀治疗气道狭窄的临床价值。方法研究对象选择2015年6月～2017年6月我院收治的气管、支气管恶性狭窄患者64例,采用随机数字表法将所有患者分为对照组和观察组,每组各32例。对照组患者给予高频电刀治疗,观察组患者给予APC+高频电刀治疗。比较两组临床疗效,同时比较两组治疗前后气促指数、肺功能FEV1、气道直径、气道横截面积及生活质量评分。结果对照组和观察组总有效率分别为71.88%和93.75%,观察组的总有效率显著高于对照组,差异具有统计学意义(P<0.05)。治疗前两组气促指数、肺功能FEV1差异无统计学意义(P>0.05),治疗后两组气促指数均较治疗前有所下降,肺功能FEV1较治疗前有所上升,且观察组气促指数显著低于对照组,差异具有统计学意义(P<0.05),肺功能FEV1显著高于对照组,差异具有统计学意义(P<0.05)。治疗前两组气道直径、气道横截面积差异无统计学意义(P>0.05),治疗后两组气道直径、气道横截面积均较治疗前有所上升,且观察组气道直径、气道横截面积显著高于对照组,差异具有统计学意义(P<0.05)。治疗前两组生活质量评分差异无统计学意义(P>0.05),治疗后两组生活质量评分均较治疗前有所上升,且观察组生活质量评分显著高于对照组,差异具有统计学意义(P<0.05)。结论经电子支气管镜氩等离子体凝固联合高频电刀治疗气道狭窄效果良好,可有效缓解患者气促及呼吸困难等临床症状,提高肺功能,提高生活质量。
Objective To investigate the clinical value of argon plasma coagulation(APC) via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis. Methods 64 patients with malignant tracheal and bronchial stenosis who were admitted to our hospital from June 2015 to June 2017 were selected as the study subjects. All patients were divided into control group and observation group by random number table method, with 32 cases in each group. Patients in the control group were given high-frequency electrotome. Patients in the observation group were given APC+high-frequency electrotome. The clinical efficacy was compared between the two groups. At the same time, the dyspnea index, pulmonary function FEV1, airway diameter, airway cross-sectional area and quality of life score were compared before and after treatment in both groups. Results The total effective rate in the control group and the observation group were 71.88% and 93.75%, respectively. The total effective rate in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the dyspnea index and FEV1 between the two groups before treatment(P>0.05). After treatment, the dyspnea index of both groups was decreased compared with that before treatment, and the pulmonary function FEV1 was increased compared with that before treatment. The dyspnea index in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The pulmonary function FEV1 was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in airway diameter and airway cross-sectional area between the two groups before treatment(P>0.05). After treatment, the airway diameter and airway cross-sectional area in the two groups were increased compared with that before treatment. The airway diameter and airway cross-sectional area in the observation group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the quality of life score between the two groups before treatment(P>0.05). After treatment, the quality of life scores in the two groups were increased compared with those before treatment. The quality of life scores in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05). Conclusion The argon plasma coagulation via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis has a favorable effect, which can effectively alleviate clinical symptoms such as shortness of breath and dyspnea, improve lung function and improve quality of life.
Objective To investigate the clinical value of argon plasma coagulation(APC) via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis. Methods 64 patients with malignant tracheal and bronchial stenosis who were admitted to our hospital from June 2015 to June 2017 were selected as the study subjects. All patients were divided into control group and observation group by random number table method, with 32 cases in each group. Patients in the control group were given high-frequency electrotome. Patients in the observation group were given APC+high-frequency electrotome. The clinical efficacy was compared between the two groups. At the same time, the dyspnea index, pulmonary function FEV1, airway diameter, airway cross-sectional area and quality of life score were compared before and after treatment in both groups. Results The total effective rate in the control group and the observation group were 71.88% and 93.75%, respectively. The total effective rate in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the dyspnea index and FEV1 between the two groups before treatment(P>0.05). After treatment, the dyspnea index of both groups was decreased compared with that before treatment, and the pulmonary function FEV1 was increased compared with that before treatment. The dyspnea index in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The pulmonary function FEV1 was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in airway diameter and airway cross-sectional area between the two groups before treatment(P>0.05). After treatment, the airway diameter and airway cross-sectional area in the two groups were increased compared with that before treatment. The airway diameter and airway cross-sectional area in the observation group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the quality of life score between the two groups before treatment(P>0.05). After treatment, the quality of life scores in the two groups were increased compared with those before treatment. The quality of life scores in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05). Conclusion The argon plasma coagulation via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis has a favorable effect, which can effectively alleviate clinical symptoms such as shortness of breath and dyspnea, improve lung function and improve quality of life.
引文
[1]刘蕾,马壮.经气管镜介入治疗恶性肿瘤致气道狭窄的临床研究[J].临床肺科杂志,2015,(8):1367-1369.
[2]徐春燕,邱忠民,吕寒静,等.支气管镜APC联合CO2冷冻术治疗结核性大气道狭窄的效果及其对气道、动脉血气、肺功能的影响[J].疑难病杂志,2016,15(4):358-361.
[3]李勤,何元兵,夏宇,等.经支气管镜介入治疗大气道狭窄40例疗效分析[J].中国内镜杂志,2015,21(8):884-886.
[4]闫芳,杨增荣,夏宇,等.不同联合介入方式治疗恶性中心气道重度狭窄患者的疗效观察[J].实用临床医药杂志,2017,21(7):35-38.
[5]林连城,柯明耀,曾俊莉,等.支气管镜下高频电刀与APC治疗恶性气道狭窄122例疗效分析[J].临床肺科杂志,2016,(2):375-377.
[6]王明月,娄卫华,申晓,等.不同术式治疗喉气管狭窄的疗效观察[J].听力学及言语疾病杂志,2016,24(3):240-244.
[7]鲁德玕,王超,陈方方,等.经支气管镜APC联合冷冻治疗肺癌所致气道内狭窄[J].国际呼吸杂志,2016,36(1):12-15.
[8]卢燕云,方琼,马志明,等.围术期护理联合呼吸功能训练对经支气管镜球囊扩张治疗的结核性气道狭窄患者依从性及生活质量的影响[J].国际医药卫生导报,2016,22(23):3710-3713.
[9]王国安,吴宏成,吴仕波,等.硬质气管镜联合电子支气管镜介入治疗良恶性复杂性气道狭窄[J].中国内镜杂志,2015,21(8):823-827.
[10]涂力,宋卫东,汤洁,等.联合应用高频电刀、冷冻、球囊扩张治疗良性气道狭窄的疗效分析[J].国际呼吸杂志,2017(24):1897-1900.
[11]梁永锋,丘新才.氩气刀联合冷冻术治疗肺部恶性肿瘤中央气道狭窄的疗效观察[J].重庆医学,2017,46(13):1817-1820.
[12]狄岩,孙扬,郭云,等.氩等离子体凝固联合冷冻治疗技术应用的研究进展[J].河北医药,2016,38(20):3173-3175.
[13]Bo-Ram L,In-Jae O,Ho-Sung L,et al.Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors[J].Clinical&Experimental Otorhinolaryngology,2015,8(4):396-401.
[14]Jia LI,Zhang HG,Zhu XH.Clinical study of high-frequency electric knife through fiberoptic bronchoscopy in the treatment of central airway tumor[J].Chinese Journal of Modern Drug Application,2017,11(15):16-17.
[15]Dai Y,Tian Q,Yang Z,et al.Argon plasma coagulation in treatment of patients with central airway obstruction under bronchoscope:An analysis of 72 cases[J].Academic Journal of Chinese Pla Medical School,2015.
[16]王洪武,张楠,李冬妹,等.恶性复杂中央气道病变的气管镜介入治疗[J].中国肺癌杂志,2016,19(12):854-858.
[17]丁银锋,陈龙,黄海东,等.支气管镜介入治疗原发性气管肿瘤的临床分析[J].中华结核和呼吸杂志,2017,40(6):435-439.
[18]刘庆华.氩气刀和高频电刀在老年人呼吸介入治疗中的应用[J].实用老年医学,2016,(1):16-19.
[19]Kιzιlg?z D,Aktas Z,Yιlmaz A,et al.Comparison of two new techniques for the management of malignant central airway obstruction:Argon plasma coagulation with mechanical tumor resection versus cryorecanalization[J].Surgical Endoscopy&Other Interventional Techniques,2017,(3):1-6.
[20]Sun JY,Sun DJ,Li XJ,et al.Clinical analysis on argon plasma coagulation(APC)under painless colonoscopy for treatment of patients with colorectal polyp canceration[J].European Review for Medical&Pharmacological Sciences,2016,20(2):264.
[2]徐春燕,邱忠民,吕寒静,等.支气管镜APC联合CO2冷冻术治疗结核性大气道狭窄的效果及其对气道、动脉血气、肺功能的影响[J].疑难病杂志,2016,15(4):358-361.
[3]李勤,何元兵,夏宇,等.经支气管镜介入治疗大气道狭窄40例疗效分析[J].中国内镜杂志,2015,21(8):884-886.
[4]闫芳,杨增荣,夏宇,等.不同联合介入方式治疗恶性中心气道重度狭窄患者的疗效观察[J].实用临床医药杂志,2017,21(7):35-38.
[5]林连城,柯明耀,曾俊莉,等.支气管镜下高频电刀与APC治疗恶性气道狭窄122例疗效分析[J].临床肺科杂志,2016,(2):375-377.
[6]王明月,娄卫华,申晓,等.不同术式治疗喉气管狭窄的疗效观察[J].听力学及言语疾病杂志,2016,24(3):240-244.
[7]鲁德玕,王超,陈方方,等.经支气管镜APC联合冷冻治疗肺癌所致气道内狭窄[J].国际呼吸杂志,2016,36(1):12-15.
[8]卢燕云,方琼,马志明,等.围术期护理联合呼吸功能训练对经支气管镜球囊扩张治疗的结核性气道狭窄患者依从性及生活质量的影响[J].国际医药卫生导报,2016,22(23):3710-3713.
[9]王国安,吴宏成,吴仕波,等.硬质气管镜联合电子支气管镜介入治疗良恶性复杂性气道狭窄[J].中国内镜杂志,2015,21(8):823-827.
[10]涂力,宋卫东,汤洁,等.联合应用高频电刀、冷冻、球囊扩张治疗良性气道狭窄的疗效分析[J].国际呼吸杂志,2017(24):1897-1900.
[11]梁永锋,丘新才.氩气刀联合冷冻术治疗肺部恶性肿瘤中央气道狭窄的疗效观察[J].重庆医学,2017,46(13):1817-1820.
[12]狄岩,孙扬,郭云,等.氩等离子体凝固联合冷冻治疗技术应用的研究进展[J].河北医药,2016,38(20):3173-3175.
[13]Bo-Ram L,In-Jae O,Ho-Sung L,et al.Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors[J].Clinical&Experimental Otorhinolaryngology,2015,8(4):396-401.
[14]Jia LI,Zhang HG,Zhu XH.Clinical study of high-frequency electric knife through fiberoptic bronchoscopy in the treatment of central airway tumor[J].Chinese Journal of Modern Drug Application,2017,11(15):16-17.
[15]Dai Y,Tian Q,Yang Z,et al.Argon plasma coagulation in treatment of patients with central airway obstruction under bronchoscope:An analysis of 72 cases[J].Academic Journal of Chinese Pla Medical School,2015.
[16]王洪武,张楠,李冬妹,等.恶性复杂中央气道病变的气管镜介入治疗[J].中国肺癌杂志,2016,19(12):854-858.
[17]丁银锋,陈龙,黄海东,等.支气管镜介入治疗原发性气管肿瘤的临床分析[J].中华结核和呼吸杂志,2017,40(6):435-439.
[18]刘庆华.氩气刀和高频电刀在老年人呼吸介入治疗中的应用[J].实用老年医学,2016,(1):16-19.
[19]Kιzιlg?z D,Aktas Z,Yιlmaz A,et al.Comparison of two new techniques for the management of malignant central airway obstruction:Argon plasma coagulation with mechanical tumor resection versus cryorecanalization[J].Surgical Endoscopy&Other Interventional Techniques,2017,(3):1-6.
[20]Sun JY,Sun DJ,Li XJ,et al.Clinical analysis on argon plasma coagulation(APC)under painless colonoscopy for treatment of patients with colorectal polyp canceration[J].European Review for Medical&Pharmacological Sciences,2016,20(2):264.