经支气管镜介入技术治疗气道平滑肌瘤的临床研究

Clinical study on the treatment of airway leiomyoma by interventional bronchoscopy

摘要:

目的 探讨经支气管镜下联合荧光、氩离子束凝固术（APC）、二氧化碳冷冻术介入治疗气道平滑肌瘤的可行性及安全性，观察临床疗效。方法 回顾性分析2014年6月－2019年12月该院8例确诊为气道平滑肌瘤所致的气道阻塞患者，在支气管镜下联合荧光进行圈套、电切、APC和二氧化碳冷冻术治疗，观察气道打通程度、临床症状改善情况、并发症的发生率及复发情况，术中监测患者心率、血压、呼吸和血氧饱和度，比较治疗前后患者的气道狭窄分级情况、气促分级和Karnofsky评分（KPS）。评估此技术的疗效和安全性。结果 在8例平滑肌瘤中，行支气管镜下APC、电切和冷冻术共计21次，肿瘤切除后气道完全打通，临床症状完全缓解；无纵隔气肿、呼吸道穿孔及大出血等严重并发症；经随访，无复发。结论 经支气管镜下联合荧光进行APC、高频电刀和二氧化碳冷冻术在治疗气道平滑肌瘤导致的气道阻塞中疗效显著，可达到临床根治，避免了开胸手术创伤，适合临床推广。

Abstract:

Objective To investigate the feasibility and safety of bronchoscopy combined with fluorescence, argon plasma coagulation (APC), and cryotherapy in treatment of airway leiomyoma.Methods We retrospectively reviewed 8 patients with airway obstruction caused by airway leiomyoma from June 2014 to December 2019. All bronchoscopic interventions (APC, cryosurgery and electronic snare) were performed under fluorescence bronchoscopy. The heart rate, blood pressure, breath, oxyhemoglobin saturation and other vital signs were monitored. The postoperative airway obstruction situation, classification of shortness of breath and Karnofsky score (KPS) were compared with preoperative conditions to evaluate the efficacy and safety of this technique.Results 8 cases underwent 21 times of argon plasma coagulation, high frequency electric knife and cryotherapy completely opened up the airway, and the clinical symptoms were completely relieved. No serious complications was occurred.Conclusion To combine bronchoscopy with fluorescence, APC, cryotherapy and high frequency electrosurgical surgery to relieve airway obstruction caused by airway leiomyoma is significantly effective, which can achieve clinical cure, and avoid open-chest operation. It is suitable for clinical promotion.