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目的:探究支气管镜下氩等离子体凝固术(APC)联合冷冻治疗中央型肺癌患者伴大气道阻塞的临床疗效。方法:选取2010年1月至2016年11月收治的80例中央型肺癌伴大气道阻塞患者,根据随机数表法将其分为观察组和对照组各40例。对照组实施气管腔内放疗,观察组于支气管镜下对突入大气道的肿物行氩等离子体凝固术及冷冻治疗。比较两组治疗后临床症状改善情况、肺功能参数[用力肺活量(FVC)和第一秒用力呼气容积(FEV_1)]、气促等级、生活质量Karnofsky评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分及气道再通效果。结果:观察组咳嗽、胸痛、呼吸困难及咯血症状的改善率均高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者FVC和FEV_1均有所提高,观察组改善更加明显,组间比较差异均有统计学意义(P<0.05)。治疗后两组患者气促等级、SAS评分和SDS评分下降,生活质量Karofsky评分提高,观察组改善更加明显,组间比较差异均有统计学意义(P<0.05)。两组的不良反应发生率差异无统计学意义(P>0.05)。观察组治疗有效率为97.5%(39/40),对照组为65.0%(26/40),差异有统计学意义(P<0.05)。结论:对于晚期中央型肺癌造成的大气道阻塞,支气管镜下氩等离子体凝固术联合冷冻治疗可迅速改善症状,提高患者生活质量,减轻心理负担,短期内效果优于气管腔内放疗。
Objective: To investigate the clinical efficacy of bronchoscopic argon plasma coagulation (APC) combined with cryotherapy in patients with central lung cancer complicated with airway obstruction. Methods: From January 2010 to November 2016, 80 patients with central lung cancer and airway obstruction admitted to our hospital were divided into the observation group and the control group according to the random number table method. In the control group, intra-tracheal radiotherapy was performed. The observation group underwent argon plasma coagulation and cryotherapy on the mass of the airway that broke into the bronchoscope. The improvement of clinical symptoms, pulmonary function parameters (FVC and FEV_1), severity of depression, Karnofsky scores of quality of life, SAS scores , Depression self-rating scale (SDS) score and airway recanalization effect. Results: The improvement rates of cough, chest pain, dyspnea and hemoptysis were all higher in the observation group than those in the control group (P <0.05). After treatment, the FVC and FEV_1 in both groups were improved, the improvement in the observation group was more obvious, the difference between the two groups was statistically significant (P <0.05). After treatment, the two groups of patients had lower degree of breath, SAS score and SDS score, and the quality of life Karofsky score improved. The improvement in the observation group was more obvious. The differences between the two groups were statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). The effective rate of observation group was 97.5% (39/40) and that of control group was 65.0% (26/40), the difference was statistically significant (P <0.05). CONCLUSION: Bronchoscopically argon plasma coagulation combined with cryotherapy can improve the quality of life and reduce the psychological burden in patients with late-stage central lung cancer, which is superior to tracheal endotherapy in short-term.