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支气管镜下氩气刀在成人气道疾病处理中的应用

Author
Francis D Sheski, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
马忠森, 主任医师，教授

引言

氩气刀(argon plasma coagulation, APC)是非接触性的电外科热消融技术，其应用氩气产生的热量来切除组织和/或止血。虽然这种技术最初主要用于外科止血和胃肠道肿瘤减瘤，但后来也用于在支气管镜下实施类似的操作。

本专题将总结支气管镜下APC处理气道疾病的适应证、禁忌证、操作技术和并发症。处理气道梗阻的其他支气管镜技术及APC处理胃肠道出血的应用将单独介绍。 (参见“中央气道阻塞的诊断与处理”和“支气管内电烙术”和“肺癌的光动力治疗”和“气道支架”和“可屈性支气管镜下气囊扩张”和“支气管内近距离治疗”和“支气管镜激光在成人气道疾病治疗中的应用”和“成人支气管镜冷冻技术”)

氩气刀的原理

与常见的误解不同，APC并不是激光。氩气(也叫作氩等离子)从探针中排出，然后高压电流从探针中通过。电流接触到氩气时使后者电离而形成单极电流，而电流在最近的目标病灶上“接地”(图片 1)[1]。热能的穿透厚度大概是2-3mm，热量可引起蛋白质变性并蒸发和细胞内外的水分，其净效应是组织破坏和凝固。

由于这些特性，APC可有效治疗表面/扁平病灶，也可用于血管富集或者出血的病灶。尽管APC的穿透深度浅于激光，导致它移除组织的能力不及后者，但APC仍可成功移除病变。与激光相比，等离子体可以在直线和切线方向上凝固病灶；因此直线走行的电离气体可凝固支气管镜下直接显示的病灶，但气体在遇到阻碍时会向侧方走行，因此可用于治疗视野中未清楚显示的褶皱或弯曲组织周围的病变。 (参见“支气管镜激光在成人气道疾病治疗中的应用”，关于‘激光切除的原则’一节)

氩气是不会燃烧的廉价气体，因此对支气管镜介入医生而言是比较廉价的支气管镜消融技术之一。

                     

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Literature review current through: 2017-07 . | This topic last updated: 2016-07-12.
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