经支气管镜钬激光技术治疗支气管结石的疗效分析*

Analysis of sedation on broncholiths through bronchoscope with holmiun laser*

摘要:

目的 评价经支气管镜应用钬激光技术治疗支气管结石的疗效。方法 2008年1月-2015年12月，应用钬激光技术治疗支气管结石病12例，其中男7例，女5例；年龄35～64岁，中位年龄49岁。12例均因咳嗽、气促、咯血和咯石等症状就诊。支气管结石发病部位：左主气管侧6例，右中间支气管4例，主支气管2例。胸部CT检查12例，均表现为支气管腔内的高密度影，并阻塞管腔，可伴有远端支气管狭窄、扩张、阻塞性肺炎或肺门纵隔淋巴结钙化。经电子支气管镜检查12例，肉芽包裹样病灶9例，结石样病灶3例。12例患者均在右美托米定复合舒芬太尼镇静下经电子支气管钬激光技术治疗。结果 全组手术顺利，手术时间45～90 min，平均60 min，术中患者心率稳定，血氧饱和度无下降，血压平稳，血流动力学稳定，患者未诉不适，无明显心肺衰竭等并发症发生，术中无大出血、气胸等并发症。术后全组病例呼吸系统症状均改善，平均术后住院（2.5±1.4）d。12例随访1～24个月，平均6个月，无结石复发及严重呼吸道感染。结论 用右美托米定复合舒芬太尼镇静下经电子支气管镜用钬激光技术治疗气管结石安全、可行，治疗效果明显，为临床治疗气管结石提供了一种新的治疗手段。

Abstract:

Objective To evaluate the curative effect of sedation on broncholiths through bronchoscope with holmium laser. Methods From Jan.2008 to Dec. 2015, 12 cases with broncholiths through bronchoscope with holmium laser, male 7, female 5; the age from 35 to 64.12 cases visit a doctor when they cough, panting, haemoptysis and cough out stones. The predilection sites of bronchinal calculus: left main bronchus in 6, right middle bronchus in 4, main bronchus in 2. Thoracic computerized tomography was performed in 12 patients, which showed bronchial intraluminal high-density shadow with distal bronchial stenosis, bronchiectasis, COPD, hilar calcifications, or mediastinal lymph node calcifications. Through bronchoscopy examination was performed in 12 cases, Broncholiths were found in 9 patients and granulomatous lesion wrapping hard lesions in 3 patients.12 cases were treated by using Dexmedetomidine combined with Sufentanil for sedation through of bronchoscope with holmiun laser. Results All the operations were successful, the operation time 45～90 min, average 60 min . During the surgery, the patient have stable heart rate, oxygen saturation without falling, blood pressure is stable, stable hemodynamics, the patients did not complain of discomfort, without obvious heart and lung failure and other complications occurred, the operation without bleeding, pneumothorax, complications. All cases of postoperative respiratory system were improved after operation. The average time stay in hospital was (2.5 ± 1.4) days. Follow-up for 1～24 months (mean, 6 months) in 12 cases found no recurrence of stones and serious respiratory tract infection. Conclusions The method of Dexmedetomidine combined with Sufentanil for sedation on broncholiths through of bronchoscope with holmiun laser is safey, feasible and therapeutic effects were clearly, which provides a new method for the clinical on Broncholiths.