摘要
目的探索支气管内超声(EBUS)引导下淋巴结穿刺注射给药联合冷冻治疗破溃期淋巴结瘘型(Ⅵ型)气管支气管结核(TBTB)的疗效和安全性。方法以2016年2月至2018年12月在湖南省胸科医院内镜诊疗中心接受EBUS引导下淋巴结穿刺注射给药(异烟肼0.2g,每周1次,共计53例次)联合冷冻治疗的20例破溃期Ⅵ型TBTB患者作为观察组,以2014年1月至2016年1月接受冷冻联合局部灌注给药(异烟肼0.2g,每周1次,共计198例次)治疗的21例破溃期Ⅵ型TBTB患者作为对照组。比较两组患者介入治疗次数、疗效及并发症的发生情况。采用SPSS 22.0统计软件进行数据处理,计量资料采用t检验或秩和检验,计数资料采用χ2检验,均以P<0.05为差异有统计学意义。结果观察组和对照组患者每例经支气管镜冷冻治疗次数的中位数(四分位数)[M(Q1,Q3)]分别为6.0(5.0,8.0)次和9.0(6.0,13.0)次,两组比较差异有统计学意义(Z=-2.336,P=0.019)。观察组和对照组气管或支气管瘘口处坏死物消失时间的M(Q1,Q3)为24.0(15.3,33.0)周和43.0(21.5,57.5)周,两组比较差异有统计学意义(Z=-2.572,P=0.010)。观察组和对照组瘘口愈合时间的M(Q1,Q3)为31.0(20.8,46.0)周和56.0(31.0,77.5)周,两组比较差异有统计学意义(Z=-2.688,P=0.007)。观察组支气管再通完全有效者19例,部分有效者1例;对照组支气管再通完全有效17例,部分有效4例;总有效率均为100.0%。疗程中两组患者均未出现与抗结核药品治疗相关的肝肾功能损伤及纵隔脓肿、支气管-纵隔瘘、大出血(≥100ml)等严重并发症。结论EBUS引导下淋巴结穿刺注射异烟肼联合冷冻治疗破溃期Ⅵ型TBTB,有助于加快坏死物清除、减少介入治疗次数、缩短介入治疗时间,并且安全有效。
Objective To evaluate the therapeutic effect and safety of Endobronchial Ultrasound(EBUS)-guided isoniazid administration combined with cryotherapy in patients with subtypeⅥtracheobronchial tuberculosis(TBTB).Methods A total of 41 eligible patients who received treatment in Hunan Chest Hospital from January2014 to December 2018 were included.20 patients who received EBUS-guided isoniazid administration(0.2 g,once a week,a total of 53 times)plus cryotherapy were treatment group,21 patients who received cryotherapy plus ebdobronchial isoniazid administration(0.2 g,once a week,a total of 198 times)were control group.Times of interventional therapy patients need to take,curative effects and complications of those two groups were analyzed.Results The treatment group received bronchoscopic cryotherapy for 134 times,and the median(quartile)(M(Q1,Q3))was 6.0(5.0,8.0)times/case,the control group received bronchoscopic cryotherapy for 198 times,and the median(quartile)(M(Q1,Q3))was 9.0(6.0,13.0)times/case,the difference was statistically significant(Z=-2.336,P=0.019).Comparing the median(quartile)(M(Q1,Q3))time of necrosis disappearance at the airway fistula after treatment in the treatment group(24.0(15.3,33.0)weeks)with the control group(43.0(21.5,57.5)weeks),the median time for treatment group was shorter,and the difference was statistically significant(Z=-2.572,P=0.010).The median(quartile)(M(Q1,Q3))time of fistula healing in the treatment group(31.0(20.8,46.0)weeks)was shorter than the control group(56.0(31.0,77.5)weeks)too,the difference was statistically significant(Z=-2.688,P=0.007).Airway recanalization was completely effective in 19 cases in the treatment group,and in 1 case it was partially effective,while in the control group in 17 cases completely effective,and in 4 cases partially effective.The total effective rate was 100.0%.There were no serious complications such as drug-induced hepatic and renal dysfunction,mediastinal abscess,bronchial-mediastinum fistula,or hemorrhage in both groups.Conclusion EBUS-guided isoniazid administration combined with cryotherapy for subtypeⅥ TBTB can help to clear necrosis,reduce the times of interventional therapy needed,shorten the interventional therapy time,and be safe and effective.
作者
肖阳宝
罗林紫
卢志斌
冯丹
白丽琼
罗莉
XIAO Yang-bao;LUO Lin-zi;LU Zhi-bin;FENG Dan;BAI Li-qiong;LUO Li(Hu’nan Chest Hospital,Changsha410013,China)
出处
《结核与肺部疾病杂志》
2020年第3期149-153,共5页
Journal of Tuberculosis and Lung Disease
基金
湖南省卫生与计划生育委员会科研计划(NoB-20180063)
湖南省自然科学基金青年基金(2019JJ50300)。
关键词
结核
气管支气管
支气管瘘
结核
淋巴结
冷冻疗法
投药
局部
超声检查
介入性
疗效比较研究
Tuberculosis,tracheobronchial
Bronchial fistula
Tuberculosis,lymph nodes
Cryotherapy
Administration,topical
Ultrasonography,interventiona
Comparative effectiveness research
