球囊扩张及支架置入治疗瘢痕性气道狭窄26例

Balloon dilatation and stenting for scarred airway stenosis

目的 探讨球囊扩张及支架置人在瘢痕性气道狭窄治疗中的作用及安全性。方法 对26例不同原因引起的气管、主支气管瘢痕性狭窄或闭塞在支气管镜直视下施行了球囊扩张及镍钛记忆合金支架置人，观察了气促指数、血氧饱和度及肺部影像的变化，并随访了3—56个月。结果 26例瘢痕性气道狭窄患者均施行了球囊扩张，共置人气道支架27个，球囊扩张及支架置人后气道内径由（3．2±1．7）mm扩大至（11．5±1．8）mm，（P〈0．01）呼吸困难立即缓解，气促指数由（2．8±0．6）下降至（0．6±0．5），（P〈0．01），血氧饱和度由（88±2）％提高至（92±1）％，（P〈0．01）。术后气道肉芽组织增生4例（15．4％），经高频电凝后未再反复出现肉芽组织增生。瘢痕导致再狭窄1例（3．8％），需反复球囊扩张；并发气胸1例（3．8％），支架断裂1例（3．8％）。结论 支气管镜直视下球囊扩张及支架置人对瘢痕性气道狭窄治疗效果确切，并发症少。

Objective To evaluate the efficacy and complications of balloon dilatation and stenting for the treatment of scarred airway stenosis. Methods Balloon dilatations and airway stenting were performed in 26 patients with scarred tracheobronchial stenosis under direct view of bronchoscope. These patients were followed up for 3 -56 months. The efficacy and complications of balloon dilatation and stenting were investigated. Results Twenty-seven nickel-titanium alloy stents were placed into airways of 26 patients with scarred tracheobronchial stenosis after balloon dilatations. The diameters of airway increased from （3.2 ± 1.7 ） mm to （ 11.5 ± 1.8） mm （P 〈0. 01 ）. Dyspnea was relieved in all patients immediately after dilatations and stenting. The dyspnea index decreased from （2.8±0.6） to （0.6±0.5） （P 〈0. 01 ）. Oxygen saturation increased from （88 ± 2） % to （92 ± 1 ） % （ P 〈 0. 01 ）. Granulomas occurred in 4 patients （ 15.4% ）. Pneumothorax, broken stent and relapsed scarred stenosis developed respectively in 3 patient. Conclusion Endoscopic balloon dilatation and placement of nickel-titanium alloy stents are quite effective for the treatment of scarred airway stenosis,with less complications and easy management.