Abstract:

Objective To evaluate the therapeutic effect and safety of Endobronchial Ultrasound (EBUS)-guided isoniazid administration combined with cryotherapy in patients with subtype Ⅵ tracheobronchial tuberculosis (TBTB). Methods A total of 41 eligible patients who received treatment in Hunan Chest Hospital from January 2014 to December 2018 were included. 20 patients who received EBUS-guided isoniazid administration (0.2 g,once a week,a total of 53 times) plus cryotherapy were treatment group, 21 patients who received cryotherapy plus ebdobronchial isoniazid administration (0.2 g,once a week,a total of 198 times) were control group. Times of interventional therapy patients need to take, curative effects and complications of those two groups were analyzed. Results The treatment group received bronchoscopic cryotherapy for 134 times, and the median (quartile) (M(Q₁,Q₃)) was 6.0 (5.0,8.0) times/case,the control group received bronchoscopic cryotherapy for 198 times, and the median (quartile) (M(Q₁,Q₃)) was 9.0(6.0,13.0) times/case,the difference was statistically significant (Z=-2.336,P=0.019). Comparing the median (quartile)(M(Q₁,Q₃)) time of necrosis disappearance at the airway fistula after treatment in the treatment group (24.0(15.3,33.0) weeks) with the control group (43.0(21.5,57.5) weeks), the median time for treatment group was shorter, and the difference was statistically significant (Z=-2.572,P=0.010). The median (quartile)(M(Q₁,Q₃)) time of fistula healing in the treatment group (31.0(20.8,46.0) weeks) was shorter than the control group (56.0(31.0,77.5) weeks) too, the difference was statistically significant (Z=-2.688,P=0.007). Airway recanalization was completely effective in 19 cases in the treatment group, and in 1 case it was partially effective, while in the control group in 17 cases completely effective, and in 4 cases partially effective. The total effective rate was 100.0%. There were no serious complications such as drug-induced hepatic and renal dysfunction, mediastinal abscess, bronchial-mediastinum fistula, or hemorrhage in both groups. Conclusion EBUS-guided isoniazid administration combined with cryotherapy for subtype Ⅵ TBTB can help to clear necrosis, reduce the times of interventional therapy needed, shorten the interventional therapy time, and be safe and effective.

Key words: Tuberculosis,tracheobronchial, Bronchial fistula, Tuberculosis,lymph nodes, Cryotherapy, Administration,topical, Ultrasonography,interventiona, Comparative effectiveness research