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207例气管切开/气管插管后良性气道狭窄的疗效分析

Effect analysis of bronchoscopic interventional therapy in 207 cases with benign tracheal stenosis of post-intubation or post-tracheostomy

摘要:

目的 分析良性气道狭窄气管切开/气管插管后发生再狭窄采用球囊导管扩张加冷冻等综合治疗措施的疗效及安全性.方法 回顾性分析2005年8月至2014年12月住煤炭总医院的207例良性气道再狭窄患者,其中气管插管83例,气管切开124例.采用球囊导管扩张、CO2冷冻等综合治疗方法.结果 83例气管插管置管时间为(12.7±1.3)d,拔管后(30.3±4.1)d发生再狭窄;124例气管切开患者分别为(100.0±23.8)d和(73.2±12.8)d.气管插管组累及气管1区(87.7%),气管切开组累及气管Ⅰ区和Ⅱ区分别为63.7%、44.4%.气管插管组以瘢痕为主(57.9%),而气管切开组发生瘢痕和肉芽肿的百分比相似.气管插管组的形态以圆形为主(57.9%),不规则形占10.5%,而气管切开组分别为29.8%和41.1%,还有6例(4.8%)完全闭塞.气管插管组的治疗次数为(8.7±1.0)次,治愈时间为(4.0±0.4)个月,治愈率为89.5%;气管切开组分别为(6.7±0.5)次、(4.7±0.4)个月和72.6%.硬质镜在气管切开组比气管插管组使用率高.冷冻在2组中使用频率最高,分别达56.9%和49.9%,球囊导管扩张在气管插管组使用率达47.2%.结论 气管镜介入治疗在气管切开/气管插管后再狭窄的治疗中可发挥重要作用,冷冻和球囊导管扩张治疗是2种重要的治疗方法.

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Objective To analyse the efficacy and safety of the combined bronchoscopic interventional therapies,including balloon dilatation and cryotherapy in the treatment of post-tracheostomy or post-intubation benign tracheal stenosis.Methods 207 cases with benign tracheal stenosis (including 83 post-intubation and 124 post-tracheostomy) were retrospectively analysed in our hospital from August 2005 to December 2014.All of the patients underwent the combined interventional therapies,including balloon dilatation and cryotherapy ect.Results The duration of intubation was (12.7 ± 1.3) d,then tracheal stenosis was developed in (30.3 ± 4.1) d after tube drawing in post-intubation group.But they were (100.0 ± 23.8) d and (73.2 ± 12.8) d respectively in post-tracheostomy group.The tracheal stenosis located in the first part of the trachea in 87.7% of post-intubation cases.In 63.7% of post-tracheostomy cases,the stenosis located in the first part and in 44.4% of cases located in the second part.The shape of tracheal stenosis were circular (57.9 %) and irregular (10.5 %) in the intubation cases.And there were 29.8% and 41.1% respectively in the tracheostomy cases,in addition six cases (4.8%) were tracheal occlusion.In post-intubation group,the treatment times,cured time and cure rate were 8.7± 1.0,(4.0 ± 0.4) months,89.5 %,respectively,but 6.7 ± 0.5,(4.7 ± 0.4) months and 72.6 % in pos~tracheostomy group,respectively.Rigid bronchoscopy was performed more frequently in post-tracheostomy group.The frequency of cryotherapy was the highest in all kinds of the interventional therapies,and balloon dilatation was second only to cryotherapy.Conclusions Bronchoscopic interventional treatment can play an important role in the treatment of post-intubation or post-tracheostomy stenosis.Both cryotherapy and balloon dilatation are the most important treatment ways.

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