镍钛合金支气管封堵器在支气管瘘封堵中的应用

Application of NiTi alloy bronchial occlusive device in bronchial fistula occlusion

目的 :评价镍钛合金支气管封堵器对支气管瘘实施封堵的疗效及安全性。方法 :选择 2例胆道支气管瘘的患者为研究对象 ,经支气管镜以及胆管造影确定瘘道部位和拟封堵的靶位支气管。局麻后在支气管镜引导下 ,将导引钢丝插入拟封堵的靶位支气管腔内 ;留置导丝撤出支气管镜 ;沿导丝将封堵器外鞘管送至拟封堵的靶位支气管 ,撤出导丝 ;通过外鞘管将携有封堵器的推送装置送至靶位支气管 ;在支气管镜以及 X线透视下释放封堵器 ,将靶位支气管完全封堵。术后 1周内每天观察咳嗽、咯痰等症状及体温变化 ,术后 1、7、30 d分别复查支气管镜及 X线胸片。术前及术后 3d预防性使用抗生素。结果 :镍钛合金支气管封堵器均一次置入成功。术后当天咯出胆汁样痰量明显减少 ,术后 7d咯胆汁样痰症状完全消失 ;术后 1、7、30 d X线胸片显示封堵器均位于靶位 ,且逐渐膨胀完全 ;支气管镜检查显示术后 1 d封堵区支气管黏膜轻度充血、水肿 ,术后 7d可见封堵器局部肉芽组织增生明显 ;术后 30 d时肉芽及上皮组织完全将封堵器覆盖。 2例患者围术期及术后随访至今 (分别为 1 0、1 4个月 ) ,均未发生封堵器移位、脱落以及与手术相关的感染。结论 :本组病例中所采用的镍钛合金支气管封堵器及其推送装置是一种置入方便。

Objective:To evaluate the effect and reliability of NiTi alloy bronchial occlusive device in bronchial fistula oc clusion.Methods:Two patients with biliary tract-bronchial fistula were examined by bronchoscopy and cholangiography to lo-cate the fistula and the target bronchus to be occluded.Under local anesthesia,guiding wire was sent into the lumen of target bronchus through bronchoscope,catheter was then sent along the guiding wire,and implanting system with the occlusive de-vice was sent into the target location through the catheter.With fluoroscopy and bronchoscope,the occlusive device was re-leased,occluding target bronchus totally.Patients' symptom and temperature were observed everyday in the first week after operation.Bronchoscopy and fluoroscopy were carried out on day1,7,30after operation.Preventive antibiotics were adminis-tered3d before and after operation.Results:All occlusive NiTi alloy devices were implanted successfully at the first time.Pa-tients produced much less bile-like sputum after operation and after7d.On day1,7,30after operation,fluoroscopy showed that the occlusive device was exactly in target location and expanded gradually.Bronchoscopy showed bronchial membrane around the occlusive device was in mild hyperemia and edema condition on day1;hyperplasia of granulation tissue was very obvious on day7;granulation and epithelia tissue covered the device totally on day30after operation.During perioperation and following up period,occlusive device didn't move or drop,and no operation-related infection happened.Conclusion:Our NiTi alloy bronchial occlusive device and its implanting system are convenient,reliable and effective in occluding bronchi,pro-viding a safe,effective,micro-invasive treatment for varied bronchial fistula.