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支气管内电烙术

Author
Henri G Colt, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
张庆瑜, 主任医师，教授

引言

恶性或良性疾病所致的气管支气管阻塞，可引起反复的肺炎、呼吸功能不全和死亡。大多数情况下不可行治愈性切除，因而主要为姑息治疗。目前有一些支气管镜下技术可用于气管支气管树中阻塞组织的治疗，包括电烙术、激光治疗、冷冻治疗、气管内支架置入、近距离治疗，以及气囊扩张治疗[1,2]。 (参见“中央气道阻塞的诊断与处理”)

在这些治疗选择中，仅激光切除和电烙术单次治疗即可迅速破坏组织，因此适用于治疗引发急性呼吸窘迫或咯血的病变。在美国，这种情况时通常应用钕钇铝石榴石(Nd:YAG)激光，但激光设备昂贵的费用限制了在全球许多地方的使用。因为电烙术也能快速产生热破坏组织，但依赖电流作用而非激光，费用相对便宜，所以电烙术可称为“穷人的激光”[3,4]。 (参见“Basic principles of medical lasers”和“支气管镜激光在成人气道疾病治疗中的应用”)

本文将总结支气管内电烙术，这又称为电灼术、透热疗法、电凝固术(或电凝)、热凝固术或电外科。其他支气管镜下治疗技术将单独讨论。

历史背景

20世纪30年代，电烙术首次用于治疗直肠癌[5]。后来内窥镜下电烙术广泛用于治疗胃肠道病变，如结肠息肉、血管出血和胆道狭窄。

电烙术治疗气管支气管肿瘤潜在应用的最初报告也出现于20世纪30年代[6-8]，但诸如烧伤、气管穿孔和致命性咯血等并发症使人们丧失了技术的热情[9]。随着电极和其他硬件的改进，以及更先进的高频电流发生器的应用，提高了支气管镜下电烙术的有效性和安全性，并再次引起人们对该技术的兴趣。尽管如此，姑息性电烙术的相关文献报道很有限，大多数肺科医生仍不熟悉它的使用。

                      

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Literature review current through: 2017-07 . | This topic last updated: 2017-07-13.
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