气管内氩离子体凝固术在气道肿瘤及咯血中的应用

Objective：To evaluate the effectiveness and feasibility of argon plasma coagulation（APC) on the debulking of endoluminal tracheobronchial neoplasmas and haemorrhage through the flexible bronchoscope. Materials and Methods：All endobronchial APC (CESEL 3000,Germany)procedures were performed with a electric flexible bronchoscope (PENTAX EB-1830T,Japan) in 22 cases with bronchus carcinoma or granulomus underwent 106 procedures and 120 foci with haemorrhage.Obstruction sites were the trachea (n = 6), left bronchus (n = 9), and right bronchi (n = 9),including 4 patients with both trachea and bronchus obstruction. Results: 3.55 procedures of APC were given for every neoplastic obstructive site. More than 90% of tumor could be removed for 2 to 3 brochoscopic procedures after the initial APC treatment even though 60% of tumor was ablated for one procedure of APC. The mean size of the pretreatment obstruction was 44.0% in trachea, 95.6% in left bronchus and 88.1% in right bronchus.After APC and mechanical debulking, the obstruction decreased an average of 8.0%,32.5% and 32.5% respectively (P<0.01,）. 89% of lung eclectasis was improved after APC. KPS was significantly increased from 28.9% to 57.2(P<0.01). 7 cases were died after APC while the others have been alive for 10 months follow-up. 2 cases with granulomus have been alive for more than 10 months, but APC was needed for each month in a patient with stent. All bronchus haemorrhage was successfully stopped for one APC in 120 cases with either tumor and mucus haemorrhage after biopsy or large haemorrhage of unknown reason. Hypoxia could be improved in a short time if APC procedure stopped. There were no severe complications directly related to the procedure. Conclusion: APC is effective for the treatment of endoluminal haemorrhage and airway obstruction. APC is a progressive, minimal invasive procedure in the treatment of airway diseases.