摘要目的 观察硬质支气管镜在中心气道狭窄治疗中的有效性和安全性.方法 回顾性分析2008年12月至2014年12月北京大学第一医院接受硬质支气管镜检查和治疗的所有中心气道狭窄患者资料,比较其硬质支气管镜治疗前后气道狭窄程度百分比、肺功能、生活质量的变化,探讨硬质支气管镜手术缓解中心气道狭窄的作用,以及硬质支气管镜手术中的并发症.结果 共有132例严重中心气道狭窄的患者接受了209例次硬质支气管镜检查和治疗.患者年龄9～85岁(中位年龄59岁),男性占65％(86/132),恶性肿瘤占68％(90/132).首次经硬质支气管镜治疗后受累气道狭窄程度明显减轻,气管狭窄程度术前为(63.3±22.4)％,术后为(17.8±16.0)％;左主支气管术前为(71.1±23.9)％,术后为(27.0±24.0)％,右主支气管术前为(73.0±26.2)％,术后为(34.9±29.8)％,差异有统计学意义(t值分别为21.9、12.3和11.2,均P＜0.01).肺功能检查结果显示,流速相关指标FEV1术前为(1.6±0.8)L,术后为(2.0 ±0.8)L,差异有统计学意义(t=3.84,P＜0.01).除扩张狭窄的气道外,本组还在硬质支气管镜下进行了支架置入、毁损支架取出、碎石等可弯曲镜下难以完成的操作.所有病例均没有出现危及生命的并发症.结论 硬质支气管镜可以快速开通气道,并在保证通气的前提下进行腔内复杂操作,可用于伴有呼吸衰竭的中心气道狭窄患者.

abstractsObjective Rigid bronchoscopy has expanded for therapeutic purposes lately.It has a large diameter working channel,the ability to maintain proper ventilation during operation,and the capacity to deal with massive bleeding and other complications.Our purpose was to describe the effectiveness and safety of rigid bronchoscopy in central airway stenosis.Methods We retrospectively analyzed all patients who had received rigid bronchoscopy for central airway obstruction in our respiratory department of this teaching hospital between December of 2008 and December of 2014.The advantages and limitations of the operations were analyzed through observing the changes of the degree of stenosis,pulmonary function,and Karnofsky performance status scale.Complications were also recorded.Results Totally 209 rigid bronchoscopic procedures were performed in 132 patients with central airway stenosis (86 men;median age,59 years;range,9 to 85 years),of them 68％ was malignancy.The rigid bronchoscopy provided immediate relief of central airway obstruction.Tracheal obstruction was (63.3 ± 22.4) ％ before and (17.8 ± 16.0) ％ after the procedures;obstruction in the left main bronchus was (71.1 ± 23.9)％ before and (27.0 ± 24.0) ％ after the procedures;and the right main bronchus was (73.0 ± 26.2) ％ before and (34.9 ± 29.8) ％ after the procedures,(t =21.85,12.27,11.17 separately,P ＜ 0.0l).Spirometry revealed that FEV1 improved significantly from (1.6 ± 0.8) L before to (2.0 ± 0.8) L after the procedures.Besides,many sophisticated procedures,such as stent implantation,corrupted metal stent removing and lithotripsy were performed under rigid bronchoscopy.There were no fatal complications.Conclusions Rigid bronchoscopy provides immediate relief of central airway obstruction and maintains proper ventilation during sophisticated intraluminal operations.It provides better visualization for advanced procedures and is an optimal selection for securing the airway in severe central airway obstruction even with respiratory failure.