气道内支架治疗隆突部狭窄

The treatment of carinal stenosis with tracheal stent

目的 探讨以内支架置入的方法治疗隆突部狭窄的疗效.方法 1993-2008年上海市肺科医院收治气道内支架治疗隆突部狭窄患者33例,其中14例经气管切开置入镍钛记忆合金螺旋支架,19例在X-线透视下经纤维支气管镜置入镍钛合金网状支架（包括3例带侧孔气管主支气管支架患者）.结果 所有病例均一次性置入成功.支架置入后,患者气促、呼吸困难症状立即改善,PaO_2从置入前（70.58±23.90）mm Hg升至置入后（94.17±16.98）mm Hg（P〈0.05）,SaO_2从置入前（91.60±5.59）mm Hg升至置入后（97.20±1.87）mm Hg（P〈0.05）.恶性肿瘤患者多于2～12个月死于原发肿瘤广泛转移,支气管内膜结核狭窄患者1例因呼吸衰竭于术后10个月死亡,1例至今存活.结论 隆突部狭窄的支架治疗显著改善患者症状、提高患者生活质量.应根据隆突部狭窄的范围和部位选择合适的气管主支气管支架.

Objective To explore the efficiency of stent placement in treating carinal stenosis.Methods Thirty-three patients with carinal stenosis underwent stenting in Shanghai Pulmonary Hospital between 1993 and 2008 were recruited in the current study.NiTi spiral stents were placed with tracheotomy in 14 patients.Nitinol-alloy stents were placed in the rest 19 patients via bronchofibroscope under X-ray,including 3 treacheo-bronchial stents with lateral aperture.Results All stents were placed successfully.Patients were significantly relieved from dyspnea,and postoperative PaO_2,SaO_2 was immediately increased after stenting.Because of the primary tumor metastasis,patients with malignant tumor died in 2 to 12 months.One patients with endobronchial tuberculosis died of respiratory failure in 10 months,one still alive.Conclusions Stent treatment of carinal stenosis is beneficial in effectively relieving respiratory distress and improving life quality.Proper selection of stent type and placement according to the stenotic position and scope was recommended.