硅酮支架治疗三种常见良性中心气道狭窄的对照研究

A controlled study of the silicone stent for treatment of three common benign central airway stenosis

目的对比观察硅酮支架对三种常见良性中心气道狭窄的疗效及并发症,评估其安全性。方法回顾总结2019年11月-2023年10月期间因良性中心气道狭窄于我院行气道Dumon硅酮支架植入术的患者资料共40例,其中气管支气管结核(tracheobronchial tuberculosis,TBTB)性狭窄14例,气管插管后狭窄14例,气管切开后狭窄12例。术后定期复查支气管镜,分析统计三组病例的近期疗效、远期疗效及支架相关并发症。结果40例患者共成功植入硅酮支架48例次,所有患者植入硅酮支架后mMRC评分、KPS评分、血氧饱和度、气道最狭窄处直径均明显改善,术前术后比较,差异有统计学意义(P均<0.05)。3组患者间治疗效果比较TBTB组不如气管插管、气管切开两组,差异有统计学意义(P<0.05);气管插管与气管切开两组间治疗效果比较差异无统计学意义(P均>0.05)。3组患者植入硅酮支架后主要支架相关并发症为肉芽增生、痰液潴留及支架移位,3组患者间比较肉芽增生、痰液潴留的发生率TBTB组高于气管插管、气管切开两组,差异有统计学意义(P<0.05);但并发肉芽增生及痰液潴留发生率气管插管与气管切开两组之间差异无统计学意义;3组患者并发支架移位比例差异无统计学意义。结论硅酮支架治疗三种常见良性中心气道狭窄均具有良好疗效,安全性较高,治疗难治性良性气道狭窄建议优先选择硅酮支架;且TBTB组治疗效果不如气管插管组及气管切开组,但TBTB组易于并发明显肉芽增生及痰液潴留,建议对植入硅酮支架的TBTB患者实行更精细的随访管理,以避免发生严重并发症,从而影响预后。

Objective To evaluate the efficacy and safety of the silicone stent for treatment of three common benign central airway stenosis.Methods We retrospectively reviewed 40 patients with benign airway stenosis who were treated with a Dumon silicone stent at Affiliated Hospital of Guizhou Medical University between November 2019 to October 2023,including 14 cases of tracheobronchial tuberculosis(TBTB)stenosis,14 cases of stenosis after tracheal intubation,and 12 cases of stenosis after tracheotomy.The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed,for evaluating the short-term efficacy,long-term efficacy and stent-related complications.Results The 40 patients were successfully implanted of silicone stents for 48 times totally.The mMRC score,KPS score,blood oxygen saturation and the diameter of the narrowest airway were significantly improved(P<0.05)after the implantation of silicone stents in all patients.Patients in TBTB group achieved inferior efficacy than those in the other two groups(P<0.05),while there was no significant therapeutic effect between tracheal intubation and tracheotomy groups(P>0.05).The main complications after the implantation of silicone stents were granulation hyperplasia,sputum retention and stent displacement.There were higher incidence rates of granulation hyperplasia and sputum retention in the TBTB group compared with the tracheal intubation and tracheotomy groups(P<0.05),while there was no statistically significant difference in incidence rates of granulation hyperplasia and sputum retention between the last two groups.Meanwhile,there was no significant difference in the proportion of stent displacement among the three groups.Conclusions The efficacy and safety were satisfied in the treatment of the three common benign central airway stenosis,with a recommendation for the treatment of refractory benign airway stenosis.However,the treatment effect of the TBTB group is inferior to that of the tracheal intubation and tracheotomy groups,with higher rates of obvious granulation hyperplasia and sputum retention simultaneously.More detailed follow-up management was recommended for TBTB patients implanted with silicone stents to avoid the development of stentrelated minor complications into serious complications with a worse prognosis.