Exploring The Value Of Tracheoscopic Interventional Therapy For Scar-occlusive Bronchial Tuberculosis

Objective:To investigate the clinical efficacy,safety and complications of tracheoscopic combination of multiple interventional methods in the treatment of scar-occlusive bronchial tuberculosis.Methods:The basic data of 32 patients with central airway occlusive bronchial tuberculosis diagnosed and treated in the Department of Thoracic Surgery and Endoscopic Interventional Surgery of Jiangxi Provincial Chest Hospital from May2016～January 2022 were retrospectively analyzed,and the measured values of forced expiratory volume(FEV1),cough score,m MRC score,number of tracheoscopic interventional treatments and airway recanalization were counted for all patients before and after the last interventional treatment,and the treatment results were divided into airway recanalization group with successful treatment and airway failure group with failed treatment.The improvement of FEV1 measured value,cough score and m MRC score before and after treatment in the airway recanalization group was compared,the differences in clinical data between the airway recanalization group and the airway non-passage group were analyzed,and the clinical efficacy,safety and complications of tracheoscopic intervention in the treatment of scarring stenosis bronchial tuberculosis were evaluated.Results:Thirty-two patients with scar occlusive bronchial tuberculosis received combined interventional therapy under bronchoscopy(13±6),11(34.38%)were ineffective and interventional therapy failed.Successful interventional therapy,effective treatment(56.25%)and cure(9.28%)belonged to the airway recanalization group.The m MRC score of patients in the airway recanalization group decreased from 2(2,3)before treatment to 1(0,1)after the last interventional treatment,and the difference was statistically significant(P<0.05);the measured value of FEV1From(1.56±0.17)L before treatment to(1.88±0.16)L after the last interventional treatment,the difference was statistically significant(P<0.05);The cough score decreased from 2(1,2)before treatment to 1(0,1)after the last intervention,and there was no significant difference between before and after(P>0.05).The median distances(Q1,Q3)from the occlusion to the carina in the airway failure group and the recanalization group were 2.60(2.55,2.75)and 1.30(1.10,3.10),respectively,and the median length of the occlusion(Q1,Q3)were 1.40(1.20,1.60)and 0.90(0.80,1.10),respectively,and the median time(Q1,Q3)from the onset of dyspnea symptoms to the initiation of interventional therapy was 10.00(8.50,10.25)and 4.50(3.50,5.50),the above three aspects,the patients in the non-pass group were significantly longer than those in the recanalization group,all P-values were <0.05,and the difference was statistically significant.Complications of interventional therapy under bronchoscopy included intraoperative airway mucosal bleeding(100%),postoperative chest pain and cough(15.6%),granulation tissue hyperplasia(9.38%),pneumothorax and mediastinal emphysema(3.13%).Conclusion:Interventional surgery under bronchoscopy is an effective and reliable method for the treatment of scar-obliterative bronchial tuberculosis,but the distance from the airway occlusion to the carina,the length of occlusion,and the waiting time for treatment may be important factors for the failure of interventional treatment.