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The effect of bronchoscopic argon plasma coagulation combined with cryotherapy and endobronchial isoniazid administration in the treatment of tuberculous endobronchial fistula

LUO Lin-zi;XIAO Yang-bao;XI Zhao;XIAO Jie;LUO Li;LU Zhi-bin;LUO Hai-long;DING Yan;Department of Endoscopic Diagnosis and Treatment Center,Hunan Chest Hospital;  
Objective To evaluate the therapeutic effect of argon plasma coagulation(APC) combined with cryotherapy and endobronchial isoniazid(INH) administration in patients with type Ⅵ endobronchial tuberculosis(EBTB) who developed mediastinal lymph node ulcer and fistula in bronchus.Methods A total of 65 eligible patients who received treatment in Hunan Chest Hospital from January 2013 to August 2018 were included.Thirtyone of them before January 2017,who received cryotherapy plus endobronchial local INH administration were control group;and the other 34 patients from January 2017 to August 2018,who received APC combined with cryotherapy and endobronchial local INH administration by using flexible bronchoscopy were test group.SPSS 19.0 software was used to analyzed the time to fistula recovery,efficacy,and complications after treatment.Quantitstive data were compared by t test or rank sum test,and count data were compared by χ~2 test.P0.05 was consedered statistically significant.Results Patients received endobronchial treatments 241 times(7.81+2.20 times per patient) in control group,which was significantly higher than test group(222 times(6.53 ±2.05 times per patient))(t=2.425,P=0.018).Patients received cryotherapy plus endobronchial local INH administration 3.45±0.91 times per patient in control group,and APC combined with cryotherapy and endobronchial local INH administration 2.59±0.82 times per patient in test group,the difference between two groups was statistically significant(t=3.987,P0.001).Time to fistula recovery [M(Q_1,Q_3)] was 12.0(10.0,12.0) weeks in control group,which was significantly higher than test group(10.0(8.0,12.0) weeks)(Z=-2.001,P=0.045).Twenty-nine patients had a full recovery and 2 patients had a partial recovery in control group,while,33 patients and1 patient in test group, Finally,the therapeutic efficacy were 100.00% in both two groups,and(χ~2=0.000,P=1.000).Severe complications including mediastinal bronchial fistula,fatal bleeding,and air embolism by APC did not occur during our procedures.Conclusion APC combined with cryotherapy and endobronchial INH administration is a safe and effective therapeutic approach which can reduce the times of endoscopic procedure and shorten the fistula recovery time for type VI EBEB patients with ulcer and fistula.
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