电子支气管镜下冷冻介入治疗支气管结核的临床疗效及安全性评价

doi:10.19983/j.issn.2096-8493.20210098

摘要/Abstract

摘要：

目的: 评价经电子支气管镜下冷冻介入治疗支气管结核的临床疗效及安全性。方法: 选择三亚市人民医院2016年12月至2019年11月收治的支气管结核患者作为研究对象。通过随机数字表法,从2018年1月以前我院未开展电子支气管镜下冷冻治疗时收治的59例患者中抽取30例患者,作为对照组;从2018年2月以后我院开展电子支气管镜下冷冻治疗后收治的75例患者中抽取30例患者,作为观察组。对照组接受规范的抗结核药物治疗,观察组在药物治疗基础上联合电子支气管镜下冷冻治疗,治疗3个月后观察患者的临床疗效。比较两组患者治疗总有效率、深部痰涂片抗酸染色转阴率、治疗前后气道内径改善情况及并发症发生情况。 结果: 观察组治疗总有效率(96.7%,29/30)和深部痰菌转阴率(90.0%,27/30)均高于对照组[分别为76.7%(23/30)和66.7%(20/30)],差异均有统计学意义(χ²=5.192,P=0.023;χ²=4.812,P=0.028)。观察组治疗后气道内径[(7.65±1.78)mm]较治疗前[(5.22±1.56)mm]明显增大,差异有统计学意义(t=5.632,P<0.001),对照组治疗后气道内径[(6.37±1.69)mm]较治疗前[(5.50±1.46)mm]增大,但差异无统计学意义(t=0.539,P=0.592)。观察组患者均未出现严重并发症。结论: 经电子支气管镜冷冻介入治疗支气管结核能提高支气管结核的治疗效果,改善气道狭窄,缩短患者病程,具有较高的有效性和安全性。

关键词: 结核, 支气管疾病, 支气管镜检查, 冷冻疗法

Abstract:

Objective: To evaluate the clinical efficacy and safety of cryointerventional treatment under electronic bronchoscope for patients with bronchial tuberculosis. Methods: Patients with bronchial tuberculosis, who were treated in Sanya People’s Hospital from December 2016 to November 2019, were enrolled in this study. By random number table method, 30 patients were selected as the control group from 59 patients who were treated in the hospital before January 2018 and electronic bronchoscopic cryotherapy had not been used at that time; 30 patients were selected as the observation group from 75 patients who received treatment of cryotherapy under electronic bronchoscope in our hospital after February 2018. The patients in the control group received standard anti-tuberculosis drug treatment, while the pateints in the observation group received a combined treatment of cryotherapy under electronic bronchoscope and anti-tuberculosis drug treatment. The clinical treatment outcomes of the patients was evaluated after 3 months of treatment. The overall treatment effectiveness rate, the negative conversion rate of acid fast staining smear examination with deep sputum, the improvement of airway diameter and the incidence of complications before and after treatment were compared between the two groups. Results: The overall effectiveness rate (96.7%, 29/30) and the negative conversion rate of deep sputum (90.0%, 27/30) in the observation group patients were higher than those in the control group patients (76.7% (23/30) and 66.7% (20/30), respectively)(χ²=5.192, P=0.023; χ ²=4.812, P=0.028). The airway inner diameter ((7.65±1.78) mm) in the observation group patients was significantly larger than that before treatment ((5.22±1.56) mm), and the difference was statistically significant (t=5.632, P<0.001). The airway inner diameter ((6.37±1.69) mm) in the control group patients was larger than that before treatment ((5.50±1.46) mm), but the difference was not statistically significant (t=0.539, P=0.592). There were no serious complications in the observation group patients. Conclusion: Cryointerventional therapy with electronic bronchoscope can improve the treatment outcomes of the patients with bronchial tuberculosis, improve airway stenosis of the pateints and shorten their disease courses. It is a treatment method with high effectiveness and safety.

Key words: Tuberculosis, Bronchial diseases, Bronchoscopy, Cryotherapy

中图分类号:

R523

赵光强, 王彬, 陈运庭, 梁文笑, 梁桂林, 林容. 电子支气管镜下冷冻介入治疗支气管结核的临床疗效及安全性评价[J]. 结核与肺部疾病杂志, 2022, 3(1): 14-18. doi: 10.19983/j.issn.2096-8493.20210098

ZHAO Guang-qiang, WANG Bin, CHEN Yun-ting, LIANG Wen-xiao, LIANG Gui-lin, LIN Rong. Clinical efficacy and safety evaluation of cryointerventional therapy under electronic bronchoscope for patients with bronchial tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(1): 14-18. doi: 10.19983/j.issn.2096-8493.20210098

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一般资料	对照组(30例)	观察组(30例)	检验值	P值
性别[例(构成比,%)]			0.604	0.791
男性	10(33.3)	11(36.7)
女性	20(66.7)	19(63.3)
年龄(岁,$\bar{x}±s$)	42.83±2.67	40.93±2.48	0.522	0.604
合并疾病[例(百分率,%)]
肺结核	12(40.0)	13(43.3)	0.069	0.793
支气管扩张	5(16.7)	4(13.3)	0.131	0.718
糖尿病	4(13.3)	3(10.0)	0.162	0.688
高血压	2(6.7)	3(10.0)	0.218	0.640

项目	对照组(30例)	观察组(30例)	t值	P值
症状改善时间(d,$\bar{x}±s$)
咳嗽	17.20±4.60	14.47±2.96	2.736	0.008
咳痰	18.27±4.23	15.67±4.10	2.420	0.019
气短	15.83±4.85	13.47±2.91	2.292	0.026
气道内径(mm,$\bar{x}±s$)
治疗前	5.50±1.46	5.22±1.56	0.726	0.471
治疗后	6.37±1.69	7.65±1.78	4.698	<0.001