支气管镜下微波固化、球囊扩张治疗支气管结核临床观察.docVIP

精品论文 参考文献 支气管镜下微波固化、球囊扩张治疗支气管结核临床观察 张庆 矫燕 刘畅 王箫寒 苏安娜 刘娜 张嶔垚 　　（辽宁省沈阳市胸科医院内窥镜科 110044） 　　【摘要】目的：评价支气管镜下微波固化、球囊扩张治疗支气管结核可行性。方法：选择气管支气管结核镜下分型：（干酪坏死型和肉芽增殖型）共143例，支气管表面干酪物、肉芽微波固化，温度40W-55W；干酪物、肉芽导致气道狭窄时，行球囊扩张术，球囊直径0.5cm、0.8cm、1.2cm，选择球囊压力大小为3-6atm(bar)。结果：143例患者中7例右中间支气管，多次球囊扩张支气管仍狭窄，远端结构不详，4例左肺上叶支气管亚段闭塞。132(91%)例患者平均微波固化3-4次，球囊扩张7-8次，干酪物、肉芽清除，支气管狭窄扩大。结论：研究表明支气管镜下微波固化、球囊扩张治疗气管支气管结核是可行的。狭窄处经球囊扩张，可迅速解决患者呼吸困难、微波可清除支气管内干酪物、肉芽，经2-3年时间定期支气管镜检查，未发现患者支气管结核复发，支气管再狭窄、虽然操作次数较多，患者有恐惧，但治疗效果明显，得到患者认可。 　　【关键词】支气管结核狭窄 球囊扩张 支气管镜。 　　【中图分类号】R521.2 【文献标识码】A 【文章编号】1672-5085（2014）18-0096-02 　　【Abstract】 objective To assess the efficacy of applying bronchofibroscope facilitated by microwave and sacculus to heal tracheal and bronchial tuberculosis with ulcer caseous necrosis and granulation generation. 【Methods】: Select 143 cases of tracheal and bronchial tuberculosis patients (ulcer caseous necrosis and granulation generation), then use microwave to solidify the ulcer caseous objects and granulation on the surface of the air tube of tracheal bronchus. Next, incise it with the current of 40W-55W. If the caseous objects and granulation cause airway constriction, use microwave to conduct incision and make sacculus expand. If the caseous objects and granulation cause airway obstruction and the opening is extremely narrow, put off microwave incision and avoid occluded scar from growing too quickly. Under this circumstance, sacculus expansion should be conducted first, then cut granulation around the opening. If the scar is completely occluded, surgery should be done in such case. The diameter of sacculus needs to be expanded to 0.5, 0.8, and 1.2cm, with its pressure from 3 to 6. 【Results】: All the patients of 143 cases go through microwave treatment and sacculus expansion. In two cases among all, the patients with caseous objects and granulation blocked in the right intermediate bronchus are conducted microwave incision, but they fai