中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

支气管镜下治疗透壁型支气管结石症的疗效分析

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目的评价支气管镜下治疗透壁型支气管结石症的疗效及安全性。方法回顾性分析 2010 年 1 月至 2017 年 12 月兰州大学第二医院呼吸内科诊断为透壁型支气管结石症 18 例患者的临床资料、治疗方法、疗效和并发症。结果通过支气管镜共诊断 18 例患者的 22 枚结石为透壁型支气管结石,2 例行择期外科手术治疗。6 例行支气管镜下一次性钳夹取石治疗,10 例行支气管镜下分次钳夹取石治疗,其中 2 例支气管镜下一次性钳取结石过程中发生大出血,1 例在钳取结石后并发支气管瘘,此 3 例均行外科手术治疗。随访透壁型支气管结石症患者 5 个月,患者均未出现远期并发症。结论支气管镜下钳夹取石可有效治疗透壁型支气管结石,若结石导致远端肺组织严重损伤、大咯血、支气管瘘或诊断不明需探查者应行手术治疗。透壁型结石如不易完整取出,可以先摘除腔内部分,解除阻塞症状,通过反复随访,定期摘除进入管腔内的结石,就能达到理想的治疗目的,且并发症少、安全性高。

ObjectiveTo evaluate the efficacy and safety of bronchoscope in the treatment of transbronchial broncholiths.MethodsThe clinical data, treatment methods, clinical efficacy and complications of 18 patients who were diagnosed with transbronchial broncholiths were etrospectively reviewed in the Respiratory Department of the Second Hospital of Lanzhou University during January 2010 to December 2017.ResultsEighteen patients were diagnosed by bronchoscopy with a total of 22 pieces of stone for transbronchial broncholiths. An elective surgical procedure was performed in 2 cases. Six cases were treated with removing broncholiths once by foreign body forceps under bronchoscope. Repeated treatments were performed in 10 patients. Two cases underwent massive hemorrhage in the process of one-time broncholiths removal by foreign body forceps under bronchoscope, and one case suffered from bronchial fistula after the broncholiths removal, all of the above 3 patients underwent surgical treatment. All patients were followed up for 5 months without any long-term complications.ConclusionsRemoval of broncholithiasis by bronchoscopic forceps can effectively treat transbronchial broncholiths with low complication and high safety. If the broncholiths cause severe distal lung tissue injury, massive hemoptysis, bronchial fistula, or the diagnosis is unclear, surgical treatment is required. When the transbronchial broncholith is difficult to remove completely at once, batch could be chosen. First, to remove one portion which causes the obstruction of airway; and then, to remove the left part of the transbronchial broncholith by stages.

关键词: 支气管结石症; 透壁型支气管结石; 支气管镜

Key words: Broncholithiasis; Transbronchial broncholiths; Bronchoscope

引用本文: 王虹, 张丽, 万毅新. 支气管镜下治疗透壁型支气管结石症的疗效分析. 中国呼吸与危重监护杂志, 2019, 18(1): 65-69. doi: 10.7507/1671-6205.201806017 复制

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