Clinical Research On The Treatment Of Tracheobronchial Tuberculosis

Objective: To study the efficacy and safety of airway intervention in the treatment of central airway occlusion(CAO)caused by tracheobronchial tuberculosis(TBTB),and find out the factors affecting airway recanalization in patients with CAO caused by TBTB.Methods: A total of 34 tuberculous CAO patients underwent airway interventional treatment in the First Affiliated Hospital of Chongqing Medical University from July 2013 to December 2020.We collected the clinical datas of these patients,observed the patient's symptoms,the size of the bronchial lumen after airway recanalization,the types of airway interventional techniques,and the incidence of complications related to airway interventional techniques.According to the curative effect,34 patients were divided into recanalization group and failure group.The clinical datas of the two groups were analyzed and compared to find out which may be the factors affecting the airway recanalization.Results:1.Among the 34 patients,31 were female(91.18%),the average age was(27.65±10.61)years old,the average BMI was 19.84±2.84.24 cases(70.59%)had left main bronchial occlusion.3 cases(8.82%)had right main bronchus occlusion and 7 cases(20.59%)had right middle bronchus occlusion.2.Of the 34 patients,24 cases achieved airway recanalization,of which 2 cases(5.88%)were considered cured,22 cases(64.7%)were considered effective,and 10 cases(29.41%)failed to achieve airway recanalization.The effective rate of airway recanalization was 70.59%(24/34).3.In the 24 patients who achieved airway recanalization via airway interventional treatment,the cough symptom score after treatment was significantly lower than before treatment [0.00(0.00,1.00)VS 2.00(2.00,3.00),P=0.000];m MRC score for dyspnea after treatment was significantly lower than before treatment[1.00(0.00,1.00)VS 3.00(2.00,3.00),P=0.000].4.Bleeding occurred in 33 cases(97.06%)of patients during airway intervention,of which 28 cases(82.35%)had mild bleeding,5 cases(14.71%)had moderate bleeding,and there was no severe bleeding.There was no significant difference in the incidence of bleeding between the failure group and the recanalization group(90.00% VS 100%,P=0.294).Pneumothorax,subcutaneous emphysema,and mediastinal emphysema occurred in 5 cases(14.71%).There was no significant difference in the incidence of pneumothorax,subcutaneous emphysema,and mediastinal emphysema between the two group(20% VS 12.5%,P=0.618).Among the34 patients,1 patient had a decrease in heart rate and blood pressure during the operation,and his condition was stable after rescue.5.The length from the occlusion site to the bronchial opening in the failure group was significantly longer than that in the recanalization group(2.50±0.82 VS 1.06±0.47,P=0.000).The time from the onset of dyspnea to the diagnosis of TBTB in the failure group was significantly longer than that in the recanalization group [(6.15±2.83)months vs(1.99±1.95)months,P=0.000)].The time from the onset of dyspnea to the beginning of airway intervention in the failure group was significantly longer than that in the recanalization group [(7.60±2.50)months VS(4.83±3.63)months,P=0.010)].The length from the occlusion site to the bronchial opening,the time from the onset of dyspnea to the diagnosis of TBTB,the time from the onset of dyspnea to the beginning of airway interventional treatment were negatively correlated with recanalization after airway intervention(r=-0.696,-0.632,-0.799,P values were all 0.000).Conclusions: Airway interventional treatment was an effective,minimally invasive,and relatively safe treatment for most tuberculous CAO.In those patients,the shorter the length from the occlusion site to the bronchial opening,the shorter the time from the onset of dyspnea to the diagnosis of TBTB,the shorter the time from the onset of dyspnea to the beginning of airway intervention,the easier it was to achieve the airway recanalization through airway interventional techniques.Objective: Based on the purpose and requirements of the research on the treatment of tracheobronchial tuberculosis,a multi-center scientific research cloud platform was designed and developed to realize data entry and storage,patient follow-up management and statistical analysis.Methods:A team of clinical researchers,information technology personnel,and data analysis personnel was formed to analyze the needs of the scientific research cloud platform according to the project research plan,and designed the case report form.Then the team built the cloud platform system based on functional requirements and case report forms,including setting up functional modules,building TBTB specific fields,standardizing dataa,designing a follow-up system,and setting user permissions.Then completed the cloud platform function test,re-optimized the system and put it into application.Results:The established multi-center scientific research cloud platform is running smoothly.A total of 22 sub-centers participated in the study,and a total of 327 cases of TBTB were included.The multi-center scientific research cloud platform can meet the needs of research on the treatment of tracheobronchial tuberculosis,realize multi-center data sharing,intelligent data management,and intelligent follow-up management,improve data quality,and achieve the goal of assisting multi-center clinical research.Conclusions:This scientific research cloud platform for TBTB treatment research can effectively assist multi-center clinical research,realize standardized and intelligent clinical datas management,and realize intelligent patient follow-up management,which has broad application prospects.Objective: To compare the efficacy,safety and cost of the two methods(medical treatment and medical treatment combined airway interventional treatment)for TBTB of type I,II,and explore the precise and standardized treatment for type I/II/III TBTB.researchMethods: This is a multi-center,prospective,randomized controlled study.From July 2019 to December 2020,a total of 106 patients with type I/II/III TBTB from 18 hospitals were enrolled,and they were randomly divided into two groups.Group A was the medical treatment group and received traditional anti-tuberculosis drug treatment alone.Group B was the intervention group and received both medicaiton and airway interventional treatment.All patients were followed up at 0,1,2,and 3months after enrollment to compare the efficacy,safety,and cost of the medical treatment group and the intervention group.Evaluation indicators include: severity of cough,sputum and dyspnea symptoms,6-minute walk test(6MWT),the effect seen under bronchoscopy,incidence of drug-related complications and airway interventional technology-related complications,and total costs.Results:1.A total of 106 patients were included in the analysis,with an average age of(35.49±12.88)years old,including 28 males(26.42%)and78 females(73.58%).The average BMI was 21.04±3.10,and there were 12 smoking patients.(11.32%).There were no significant differences in age,sex ratio,body mass index,smoking status,cough symptoms,sputum symptoms,hemoptysis,m MRC score,and 6-minute walk test between the medical treatment group and the intervention group(P>0.05).The datas of the two groups were comparable.2.The cough symptom score,sputum symptom score,and mMRC score of the patients in group A after 3 months of treatment were significantly lower than those before treatment(P<0.05)[(0.38±0.53 VS1.36±0.56,P=0.000),(0.35± 0.52 VS 1.20±0.65,P=0.000),(0.58±0.63 VS0.91±0.75,P=0.000)],the distance of 6MWT was significantly increased compared with before treatment [(493.29±90.59)meters VS(481.73±94.28)meters,P=0.000].After 3 months of treatment in group B,the cough symptom score,sputum symptom score,and m MRC score were significantly lower than before treatment [(0.29±0.46 VS 1.41±0.67,P=0.000),(0.22±0.42 VS 1.12±0.77),P=0.000),(0.14±0.35 VS 0.94±0.79,P=0.000)],the distance of 6MWT increased significantly compared with before treatment [(495.25±92.57)m VS(473.76±104.89)m,P=0.000)].3.The degree of improvement in the m MRC score of dyspnea and the distance increased by 6MWT in group B were significantly higher than those in group A[(0.80±0.69 VS 0.33±0.47,P=0.000),((21.49±18.84)m VS(11.56±19.35)m,P=0.009)].The effective rate under bronchoscopy in group B was higher than that in group A(92.16% VS 81.82%,P=0.031).4.There was no significant difference in the incidence of drug-related complications between group A and group B(5.45% VS 3.92%,P=1.000).The incidence of bleeding related to airway intervention in the intervention group was 13.73%(7/51),of which the incidence of mild bleeding was9.80%(5/51),and the incidence of moderate bleeding was 3.92%(2/51),No severe bleeding occurred;no pneumothorax,subcutaneous emphysema,mediastinal emphysema and other serious complications occurred.5.The total cost of treatment for 3 months in group B was significantly higher than that in group A[(28460.25±8594.64)yuan VS(16979.42±8347.81)yuan,P=0.000].Conclusions: Both medical treatment and medical treatment combined airway interventional treatment had good efficacy and safety for TBTB patients of type I,II,and III.The cost of medical treatment combined airway interventional treatment for type I,II,and III TBTB was higher than that of medical treatment alone,but it had a better effect on the improvement of patients' clinical symptoms and pulmonary function,and the curative effect of local lesions in the bronchus was better.The last but not least,the safety was good.