盛怡俊 王賽斌 涂軍偉 周韌志

[摘要] 目的 探討經(jīng)電子支氣管鏡氬等離子體凝固（argon plasma coagulation，APC）聯(lián)合高頻電刀治療氣道狹窄的臨床價(jià)值。 方法 研究對(duì)象選擇2015年6月～2017年6月我院收治的氣管、支氣管惡性狹窄患者64例，采用隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和觀察組，每組各32例。對(duì)照組患者給予高頻電刀治療，觀察組患者給予APC+高頻電刀治療。比較兩組臨床療效，同時(shí)比較兩組治療前后氣促指數(shù)、肺功能FEV1、氣道直徑、氣道橫截面積及生活質(zhì)量評(píng)分。 結(jié)果 對(duì)照組和觀察組總有效率分別為71.88%和93.75%，觀察組的總有效率顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前兩組氣促指數(shù)、肺功能FEV1差異無統(tǒng)計(jì)學(xué)意義（P>0.05），治療后兩組氣促指數(shù)均較治療前有所下降，肺功能FEV1較治療前有所上升，且觀察組氣促指數(shù)顯著低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05），肺功能FEV1顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前兩組氣道直徑、氣道橫截面積差異無統(tǒng)計(jì)學(xué)意義（P>0.05），治療后兩組氣道直徑、氣道橫截面積均較治療前有所上升，且觀察組氣道直徑、氣道橫截面積顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前兩組生活質(zhì)量評(píng)分差異無統(tǒng)計(jì)學(xué)意義（P>0.05），治療后兩組生活質(zhì)量評(píng)分均較治療前有所上升，且觀察組生活質(zhì)量評(píng)分顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 經(jīng)電子支氣管鏡氬等離子體凝固聯(lián)合高頻電刀治療氣道狹窄效果良好，可有效緩解患者氣促及呼吸困難等臨床癥狀，提高肺功能，提高生活質(zhì)量。

[關(guān)鍵詞] 電子支氣管鏡;氬等離子體凝固;氣道狹窄;高頻電刀;臨床價(jià)值

[中圖分類號(hào)] R730.5? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2019）09-0016-05

[Abstract] Objective To investigate the clinical value of argon plasma coagulation（APC） via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis. Methods 64 patients with malignant tracheal and bronchial stenosis who were admitted to our hospital from June 2015 to June 2017 were selected as the study subjects. All patients were divided into control group and observation group by random number table method， with 32 cases in each group. Patients in the control group were given high-frequency electrotome. Patients in the observation group were given APC+high-frequency electrotome. The clinical efficacy was compared between the two groups. At the same time， the dyspnea index， pulmonary function FEV1， airway diameter， airway cross-sectional area and quality of life score were compared before and after treatment in both groups. Results The total effective rate in the control group and the observation group were 71.88% and 93.75%， respectively. The total effective rate in the observation group was significantly higher than that in the control group， and the difference was statistically significant（P<0.05）. There was no statistically significant difference in the dyspnea index and FEV1 between the two groups before treatment（P>0.05）. After treatment， the dyspnea index of both groups was decreased compared with that before treatment， and the pulmonary function FEV1 was increased compared with that before treatment. The dyspnea index in the observation group was significantly lower than that in the control group， and the difference was statistically significant（P<0.05）. The pulmonary function FEV1 was significantly higher than that in the control group， and the difference was statistically significant（P<0.05）. There was no statistically significant difference in airway diameter and airway cross-sectional area between the two groups before treatment（P>0.05）. After treatment， the airway diameter and airway cross-sectional area in the two groups were increased compared with that before treatment. The airway diameter and airway cross-sectional area in the observation group were significantly higher than those in the control group， and the difference was statistically significant（P<0.05）. There was no statistically significant difference in the quality of life score between the two groups before treatment（P>0.05）. After treatment， the quality of life scores in the two groups were increased compared with those before treatment. The quality of life scores in the observation group was significantly higher than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion The argon plasma coagulation via electronic bronchoscope combined with high-frequency electrotome in the treatment of airway stenosis has a favorable effect， which can effectively alleviate clinical symptoms such as shortness of breath and dyspnea， improve lung function and improve quality of life.