江汉大学学报(自然科学版) ›› 2023, Vol. 51 ›› Issue (4): 66-72.doi: 10.16389/j.cnki.cn42-1737/n.2023.04.008

• 医学 • 上一篇    

经支气管镜球囊扩张术严重并发症原因分析

胡智敏a ,靖秋生a ,刘 敏a ,吴鸣镝a ,陈先祥*b   

  1. 武汉市肺科医院 a. 内镜中心;b. 普外科,湖北 武汉 430030
  • 发布日期:2023-08-19
  • 通讯作者: 陈先祥
  • 作者简介:胡智敏(1978— ),女,副主任医师,硕士,研究方向:支气管肺部疾病的诊断和鉴别诊断、支气管 结核、支气管肿瘤等支气管肺疾病的气管镜下介入诊疗。

Causes Analysis of Severe Complications After Bronchoscopic Balloon Dilation

HU Zhimina ,JING Qiushenga ,LIU Mina ,WU Mingdia ,CHEN Xianxiang*b   

  1. a. Endoscopy Center;b. General Surgery,Wuhan Pulmonary Hospital,Wuhan 430030,Hubei,China
  • Published:2023-08-19
  • Contact: CHEN Xianxiang

摘要: 目 的 分析 3 例经支气管镜球囊扩张术导致严重并发症的原因,提高球囊扩张术的安 全性,减少或避免严重并发症发生。方 法 3 例严重并发症分别为气道膜部撕裂、纵隔和皮下气 肿、术中大出血。复习其操作过程和抢救经过及后续治疗方法,从中找出严重并发症发生的原 因,以及抢救或对症治疗成功的经验。结 果 武汉市肺科医院 2021 年 5 月 1 日至 2022 年 4 月 30 日 期间,结核性气道狭窄球囊扩张治疗的严重并发症发生率仅仅为 2. 6%(3/114),分别为气道膜部 撕裂、纵隔皮下气肿、术后大出血各 1 例。经过对症处理,均完全恢复。结 论 气道极重度瘢痕 狭窄或管腔闭塞需再通的患者球囊扩张术中易发生膜部撕裂、纵隔皮下气肿、大出血等严重并发 症。术前做好相关应急预案,球囊扩张前适当行瘢痕松解术,术后积极对症治疗,可最大限度减 少严重并发症的影响。

关键词: 支气管镜, 球囊扩张术, 结核性气道狭窄, 严重并发症

Abstract: Objective To analyze the causes of severe complications caused by bronchoscopic balloon dilation in three cases of Wuhan Pulmonary Hospital,to improve the safety of balloon dilation and reduce or avoid severe complications. Methods Three cases of severe complications were tracheal-bronchial membrane laceration, pneumomediastinum and subcutaneous emphysema,and intraoperative hemorrhage,respectively. The records of the operation process and the methods of rescue treatment or symptomatic treatment were reviewed to find out the causes of severe complications and successful experience of rescue or symptomatic treatment. Results From May 1,2021 to April 30,2022,the incidence of severe complications after balloon dilation for tuberculous airway stenosis was only 2. 6% (3/114)in Wuhan Pulmonary Hospital,including 1 case of airway membrane tear,1 case of mediastinal subcutaneous emphysema,and 1 case of postoperative massive bleeding. After symptomatic treatment, all recovered completely. Conclusion The severe complications of balloon dilation for tuberculous trachel-bronchial membrane laceration are mostly seen in patients with extremely severe cicatricial stenosis or central airways occlusion (CAO)requiring recanalization. For severe scar stenosis,scar release before balloon dilation can reduce the incidence of airway membrane tear and mediastinal subcutaneous emphysema. Relevant emergency plans should be made before surgery,appropriate cicatricotomy should be performed before balloon dilation,and active symptomatic treatment after surgery can minimize the impact of serious complications.

Key words: bronchoscopy, balloon dilation, tuberculous airway stenosis, severe complications

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