目的 探讨经纤维支气管镜(简称“纤支镜”)局部灌注给药治疗空洞性肺结核的临床价值.方法 选取2011年1月至2014年12月汕头市第三人民医院收治的172例确诊为初治空洞性肺结核的患者,采用随机数字表法分为对照组[采用常规抗结核(2H-R-Z-E/4H R-E)治疗方案]和观察组(在对照组治疗方案基础上加用纤支镜引导局部灌注抗结核药物进行介入治疗)各86例.观察组因1例患者皮肤试验对对比剂过敏和3例门诊治疗失联而退组,对照组因2例资料不全和2例门诊治疗失联而退组,两组最终完成疗程患者均为82例.采用x2检验比较分析两组患者治疗第1、2、6个月末的结核病灶吸收率、空洞缩小率、痰结核分枝杆菌(MTB)阴转率,以P＜0.05为差异有统计学意义.结果 治疗第1个月末,观察组与对照组的病灶吸收率、空洞缩小率、痰MTB阴转率分别为[61.0％ (50/82),43.9％(36/82)]、[36.6％(30/82),14.6％(12/82)]、[79.3％(65/82),61.0％(50/82)],差异均有统计学意义(x2=4.79,P=0.035;x2=40.71,P＜0.001;x2 =5.04,P=0.026);治疗第2个月末,观察组与对照组上述指标分别为[70.7％ (58/82),56.1％(46/82)]、[50.0％(41/82),24.4％(20/82)]、[85.4％(70/82),65.9％(54/82)],差异均有统计学意义(x2=3.85,P=0.048;x2=43.64,P＜0.001;x2=8.47,P=0.006);治疗第6个月末,观察组与对照组上述指标分别为[85.4％(70/82),70.7％(58/82)]、[74.4％(61/82),42.7％(35/82)]、[93.9％(77/82),82.9％(68/82)],差异均有统计学意义(x2=5.12,P=0.026;x2=38.31,P＜0.001;x2=4.82,P=0.027).结论 空洞性结核病辅以纤支镜局部灌注给药治疗的疗效明显优于单纯化疗,有助于病灶吸收和空洞缩小、痰菌阴转,值得在临床上应用.%Objective To explore clinical value of the adjuvant therapy of cavitary pulmonary tuberculosis by local instillation of antituberculosis drugs via bronchoscopy.Methods One hundred and seventy-two cases with new cavitary pulmonary tuberculosis admitted in the Third People's Hospital of Shantou City were randomly divided into control group with routine antituherculosis treatment regimen (2H-R-Z-E/4H-R-E) and observation group based on the basic regimen of control group plus local instillation of antituberculosis drugs via bronchoscope during Jan.2011 and Dec.2014.There were 86 cases in each group.In observation group,4 cases were withdrawn due to allergic to contrast media in one case and lost contact in 3 cases of outpatients.In control group,4 cases were with-drawn due to incomplete data in two cases and lost contact in 2 cases of outpatients.Eighty-two cases in each group were confirmed finally.The rates of focus absorption,cavity shrinking and sputum negative conversion were compared and tested by Chi-square in the first,second and sixth month.P＜0.05 was considered significant difference statistically.Results At the end of the first month,the rates of focus absorption,cavity shrinking and sputum negative conversion were 61.0％ (50/82),36.6％ (30/82) and 79.3％ (65/82) in the observation group,and 43.9％ (36/82),14.6％ (12/82) and 61.0％ (50/82) in the control group,respectively.The difference of each rate was significant difference statistically (x2 =4.79,P=0.035;x2 =40.71,P＜0.001;x2 =5.04,P=0.026).At the end of the second month,the rates of focus absorption,cavity shrinking and sputum negative conversion were 70.7％ (58/82),50.0％ (41/82) and 85.4％ (70/82) in the observation group,and 56.1％ (46/82),24.4％ (20/82) and 65.9％ (54/82) in the control group,respectively.The difference of each rate was significant difference statistically (x2 =3.85,P=0.048;x2 =43.64,P＜0.001;x2 =8.47,P=0.006).At the end of the sixth month,the rates of focus absorption,cavity shrinking and sputum negative conversion were 85.4％ (70/82),74.4％ (61/82)and 93.9％ (77/82)in the observation group,and 70.7％ (58/82),42.7％ (35/82)and 82.9％ (68/82) in the control group,respectively.The difference of each rate was significant difference statistically (x2=5.12,P=0.026;x2=38.31,P＜0.001;x2=4.82,P=0.027).Conclusion The efficacy of the adjuvant therapy of cavitary pulmonary tuberculosis by local instillation of antituberculosis drugs via bronchoscopy is better than that of chemotherapy with antituberculosis drugs only.It is worthy of clinical application due to its helpful for focus absorption,cavity shrinking and sputum negative conversion.
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