35例结核分枝杆菌感染致气管支气管软化症的临床分析
|
摘要
目的分析总结气管支气管软化症的成因、临床特点,寻求合理治疗方法。方法对我们收治的35例结核性气管支气管软化症患者临床特点、治疗方法、预后等回顾性分析。结果软化部位以左右主支气管多见(分别占25.7%、17.1%);结核化疗方案及镜下介入治疗对于气管支气管结核临床疗效满意,但对较严重的气管支气管软化症患者来说,大多需要无创呼吸辅助通气及支架置入等多种治疗手段。结论气管支气管结核可引起气道不同程度的软化,支气管镜检查是确诊最佳手段,原发病的治疗是关键及早干预治疗直接影响预后。
Objective To summarize the causes and clinical features of tracheobronchomalacia( TBM) and to seek rational treatment. Methods The clinical features,treatment and final outcomes of 35 cases of tuberculous tracheobronchomalacia were retrospectively reviewed. Results The left and right main bronchus are the common softening sites( respectively 25. 7%,17. 1%). The clinical efficacy of tracheobronchial tuberculosis was satisfactory by tuberculosis chemotherapy and interventional treatment. But the TBM patients needed a variety of treatment,such as noninvasive ventilation and stent placement and other treatment. Conclusion The tracheobronchial tuberculosis can result in airway softening with varying degrees. The bronchoscopy is the best mean for the diagnosis of TBM. The treatment of primary disease is the key and early intervention directly affect the prognosis.
Objective To summarize the causes and clinical features of tracheobronchomalacia( TBM) and to seek rational treatment. Methods The clinical features,treatment and final outcomes of 35 cases of tuberculous tracheobronchomalacia were retrospectively reviewed. Results The left and right main bronchus are the common softening sites( respectively 25. 7%,17. 1%). The clinical efficacy of tracheobronchial tuberculosis was satisfactory by tuberculosis chemotherapy and interventional treatment. But the TBM patients needed a variety of treatment,such as noninvasive ventilation and stent placement and other treatment. Conclusion The tracheobronchial tuberculosis can result in airway softening with varying degrees. The bronchoscopy is the best mean for the diagnosis of TBM. The treatment of primary disease is the key and early intervention directly affect the prognosis.
引文
[1]段亮,陈晓峰.成人气管软化症[J].中华结核和呼吸杂志,2011,34(5):380-382.
[2]张廷梅,熊敏,吴鉴文,等.支气管结核单纯化疗和介入综合治疗近期效果观察[J].中国防痨杂志,2008,30(3):206-209.
[3]林红英,丁树枝,周静敏,等.持续气道正压通气联合激素治疗气管软化症一例[J].中华结核和呼吸杂志,2002,25(12):747.
[4]郝俊芳,于水,刘秀清.放射治疗致气管软化一例[J].中国肿瘤临床与康复,2007,14(5):456.
[5]邓新宇,成英,刘志新,等.右位主动脉弓致成人气管支气管软化症1例报道[J].医学信息,2015,45:440.
[6]邹卫,许栋生,王科平,等.前上纵隔肿瘤手术后气管软化的临床处理[J].中华胸心血管外科杂志,2007,23(6):422.
[7]Majid A,Sosa AF,Ernst A,et al.Pulmonary function and flow-volume loop patterns in patients with tracheobronchomalacia[J].Respir Care,2013,58(9):1521-1526.
[8]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.气管支气管结核诊断和治疗指南(试行)[S].中华结核和呼吸杂志,2012,35(8):581-587.
[9]Johnson TH,Mikita JJ,Wilson RJ,et al.Acquired Tracheomalacia1[J].Radiology,1973,109(3):577-580.
[10]Nuutinen J.Acquired tracheobronchomalacia[J].Eur J Respir Dis,1982,63(5):380-387.
[11]Ernst A,Majid A,Feller-Kopman D,et al.Airway stabilization with silicone stents for treating adult tracheobronchomalacia:a prospective observational study[J].Chest,2007,132(2):609-616.
[12]Gilkeson RC,Ciancibello LM,Hejal RB,et al.Tracheobronchomalacia:dynamic airway evaluation with multidetector CT[J].AJR Am J Roentgenol,2001,176(1):205-210.
[13]Imaizumi H,Kaneko M,Mori K,et al.Reversible acquired tracheobronchomalacia of a combined crescent type and saber-sheath type[J].J Emerg Med,1995,13(1):43-49.
[14]Ferretti GR,Jankowski A,Perrin MA,et al.Multi-detector CT evaluation in patients suspected of tracheobronchomalacia:comparison of end-expiratory with dynamic expiratory volumetric acquisitions[J].Eur J Radiol,2008,68(2):340-346.
[15]Murgu S,Colt H.Tracheobronchomalacia and excessive dynamic airway collapse[J].Clin Chest Med,2013,34(3):527-555.
[16]李志莹,宋冰,陈济明,等.气管支气管软化症误诊为支气管哮喘1例[J].疑难病杂志,2010,9(8):634-635.
[17]Murgu SD,Colt HG.Treatment of adult tracheobronchomalacia and excessive dynamic airway collapse:an update[J].Treat Respir Med,2006,5(2):103-115.
[2]张廷梅,熊敏,吴鉴文,等.支气管结核单纯化疗和介入综合治疗近期效果观察[J].中国防痨杂志,2008,30(3):206-209.
[3]林红英,丁树枝,周静敏,等.持续气道正压通气联合激素治疗气管软化症一例[J].中华结核和呼吸杂志,2002,25(12):747.
[4]郝俊芳,于水,刘秀清.放射治疗致气管软化一例[J].中国肿瘤临床与康复,2007,14(5):456.
[5]邓新宇,成英,刘志新,等.右位主动脉弓致成人气管支气管软化症1例报道[J].医学信息,2015,45:440.
[6]邹卫,许栋生,王科平,等.前上纵隔肿瘤手术后气管软化的临床处理[J].中华胸心血管外科杂志,2007,23(6):422.
[7]Majid A,Sosa AF,Ernst A,et al.Pulmonary function and flow-volume loop patterns in patients with tracheobronchomalacia[J].Respir Care,2013,58(9):1521-1526.
[8]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.气管支气管结核诊断和治疗指南(试行)[S].中华结核和呼吸杂志,2012,35(8):581-587.
[9]Johnson TH,Mikita JJ,Wilson RJ,et al.Acquired Tracheomalacia1[J].Radiology,1973,109(3):577-580.
[10]Nuutinen J.Acquired tracheobronchomalacia[J].Eur J Respir Dis,1982,63(5):380-387.
[11]Ernst A,Majid A,Feller-Kopman D,et al.Airway stabilization with silicone stents for treating adult tracheobronchomalacia:a prospective observational study[J].Chest,2007,132(2):609-616.
[12]Gilkeson RC,Ciancibello LM,Hejal RB,et al.Tracheobronchomalacia:dynamic airway evaluation with multidetector CT[J].AJR Am J Roentgenol,2001,176(1):205-210.
[13]Imaizumi H,Kaneko M,Mori K,et al.Reversible acquired tracheobronchomalacia of a combined crescent type and saber-sheath type[J].J Emerg Med,1995,13(1):43-49.
[14]Ferretti GR,Jankowski A,Perrin MA,et al.Multi-detector CT evaluation in patients suspected of tracheobronchomalacia:comparison of end-expiratory with dynamic expiratory volumetric acquisitions[J].Eur J Radiol,2008,68(2):340-346.
[15]Murgu S,Colt H.Tracheobronchomalacia and excessive dynamic airway collapse[J].Clin Chest Med,2013,34(3):527-555.
[16]李志莹,宋冰,陈济明,等.气管支气管软化症误诊为支气管哮喘1例[J].疑难病杂志,2010,9(8):634-635.
[17]Murgu SD,Colt HG.Treatment of adult tracheobronchomalacia and excessive dynamic airway collapse:an update[J].Treat Respir Med,2006,5(2):103-115.