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目的观察喉罩通气下经电子支气管镜冷冻联合球囊扩张治疗严重良性气道狭窄的近、远期疗效和安全性。方法选取2011年1月至2013年12月严重良性中央气道狭窄的患者45例,在喉罩通气下给予冷冻联合球囊扩张治疗,比较治疗前后气道直径、一秒用力呼气容积(FEV1)、Hugh-Jones分级、血氧分压(Pa O2)和生活质量评分等指标的变化,并随访治疗的近、远期疗效和并发症。结果经过3~8个疗程治疗后,气道直径、FEV1、Hugh-Jones分级、Pa O2和生活质量评分等指标有明显改善(P<0.05)。45例患者中38例(84.4%)缓解良好,狭窄部位气管内径达到原气管内径50%以上,肺叶完全复张;7例(15.6%)缓解良好,肺叶部分复张。近期不良反应:咽痛、咳嗽11例(22.4%),出血17例(37.8%),气胸2例(4.4%);随访18个月远期效果:5例(11.1%)患者出现再狭窄(平均2.5个月),给予冷冻及球囊扩张治疗后缓解。结论喉罩通气下冷冻联合球囊扩张治疗严重良性气道狭窄效果显著、安全性高、疗效确切,值得推广。
Objective To observe the short-term and long-term efficacy and safety of laryngeal mask ventilation in the treatment of severe benign airway stenosis by electron bronchoscope combined with balloon dilatation. Methods Forty-five patients with severe benign central airway stenosis from January 2011 to December 2013 were enrolled in this study. They were treated with laryngeal mask ventilation and combined with balloon dilation. The airway diameter, forced expiratory volume in one second (FEV1 ), Hugh-Jones grading, partial pressure of oxygen (Pa O2) and quality of life scores, and follow-up treatment of short-term and long-term efficacy and complications. Results After 3 to 8 courses of treatment, the indexes of airway diameter, FEV1, Hugh-Jones grade, Pa O2 and quality of life scores were significantly improved (P <0.05). Among the 45 patients, 38 (84.4%) patients had a good response. The tracheal internal diameter of the stenosis reached more than 50% of the original diameter of the trachea and the lungs recovered completely. Seven patients (15.6%) had a good response and some of the lungs recovered. Recent side effects: sore throat, cough in 11 cases (22.4%), hemorrhage in 17 cases (37.8%) and pneumothorax in 2 patients (4.4%); 18 months follow-up effect in 5 patients (11.1% An average of 2.5 months), given after the treatment of freezing and balloon dilatation relief. Conclusions Laryngeal mask ventilation combined with balloon dilatation in the treatment of severe benign airway stenosis is significant, safe, effective and worthy of promotion.