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目的探讨经纤维支气管镜引导球囊扩张术治疗结核性支气管狭窄的临床价值及安全性。方法选取20例结核性支气管狭窄患者作为研究对象,对有肺结核的患者给予全身抗结核治疗,并经纤维支气管镜引导进行球囊扩张术后观察治疗效果。结果 20例患者均接受球囊扩张次数为2~5次。患者多为左上叶以上的支气管,仅2例为左下叶尖段支气管。20例患者经球囊扩张术结束后支气管直径为(6.3±1.5)mm,优于扩张前直径的(2.6±1.3)mm,差异有统计学意义(P<0.01)。20例患者中有3例术中或术后出现轻度胸痛,1 d后胸痛症状自行消失;有9例患者球囊扩张术后狭窄段支气管创面轻度出血,但治疗后出血即刻停止。20例患者均未出现并发症。对球囊扩张成功的20例患者进行随访发现:2个月后气管直径为(6.2±1.3)mm,7个月后气管直径为(6.0±1.4)mm。所有患者的狭窄气管均得到了不同程度的增宽且咳嗽、咳痰、气促等症状均得到了明显缓解;12例存在抗酸杆菌阳性患者均转阴,经过纤维支气管镜复查发现患者支气管腔始终保持在通畅状态。结论经纤维支气管镜引导球囊扩张术治疗结核性支气管狭窄是一种安全、有效和简便的方法,可显著缓解患者的支气管狭窄引流不畅,并有效治疗痰抗酸杆菌反复阳性患者的临床症状。
Objective To investigate the clinical value and safety of bronchoscope guided balloon dilation in the treatment of tuberculous bronchial stenosis. Methods Twenty patients with tuberculous bronchial stenosis were enrolled in this study. Patients with tuberculosis were given systemic antituberculous therapy and guided by fiberoptic bronchoscopy to observe the therapeutic effect after balloon dilatation. Results All 20 patients underwent balloon dilatation 2 to 5 times. Patients are mostly bronchus above the left upper lobe, only 2 cases of the left lower extremity bronchus. The diameter of bronchus was (6.3 ± 1.5) mm in the 20 patients after balloon dilatation, which was better than that of the diameter before dilation (2.6 ± 1.3) mm, the difference was statistically significant (P <0.01). Three of the 20 patients had mild chest pain during and after operation, and the symptoms of chest pain disappeared on their own after 1 day. Nine patients had slight hemorrhage of the bronchial wound after the balloon dilatation, but the bleeding stopped immediately after the operation. None of the 20 patients had complications. Follow-up of 20 patients with successful balloon dilation revealed a tracheal diameter of (6.2 ± 1.3) mm after 2 months and a tracheal diameter of (6.0 ± 1.4) mm after 7 months. The narrow trachea of all patients were widened to varying degrees and cough, sputum, shortness of breath and other symptoms have been significantly alleviated; 12 patients with acid-fast bacilli positive patients were negative, after bronchoscopy found bronchial lumen Always keep it open. Conclusions The treatment of tuberculous bronchial stenosis by bronchofibroscope guided balloon dilatation is a safe, effective and simple method, which can significantly alleviate the poor bronchial stenosis drainage and effectively treat the clinical symptoms of sputum acid-fast bacilli patients .