自扩金属支架治疗气管支气管恶性狭窄

Treatment of malignant tracheobrochial stenosis by self－expandable metsllic stems

目的：观察和评价Gianturco气管支气管自扩金属支架治疗气管支气管恶性狭窄的疗效及并发症。材料和方法：在X光及支纤镜指引下应用Gianturco气管支气管自扩金属支架13个治疗气管支气管恶性狭窄10例，狭窄原因：食管鳞癌直接侵犯或纵隔淋巴结转移压迫气道6例，气管鳞癌2例，右主支气管肺鳞癌1例，纵隔肿瘤（恶性胸腺瘤）1例。狭窄部位：气管6例，右主支气管3例，左主支气管1例。结果：全部支架均成功进入预定位置，支架扩张满意。呼吸困难症状明显改善，气管支气管最小直径从术前0．37t0．18cm扩大到1．60±0．45cm（P＝0．000）；血氧分压、皮氧饱和度、生活质量明显提高。严重的并发症有咯血1例、肿瘤支架内生长2例、放化疗中出现食管气管瘘2例。7例已死亡，平均生存5．1月；3例仍生存，分别存活3、6、7月。结论：外压性肿瘤引起的气管支气管狭窄是自扩金属支架的最佳适应征，对于不能手术治疗的气管支气管恶性肿瘤是一种维持气道通畅行之有效的姑息治疗方法，为有效的抗肿瘤治疗创造时机。

Purpose : To evaluate the therapeutic effects and complications of self－expandable metalic stems(SEMS) in the treatment of malignant tracheobrochial stenosis. Material and Methods: Ten patients with malignant tracheobrochial stenosis were treated with 13 self－expandable metallic stems. Of them, the stenosed sites were located in trachea in 6, right main－stem Of bronchus in 2, left main－stem of bronchus in one. The strictures were caused by advanced esophagus cancer in 6 patients, by squmous cell tracheobrochial carcinoma in 3, by malignant thymoma in 1. ResultS: All stems were successfully dePOted in the desired POsitions and showed sufficient expansion with immediate relief of respiratory symptoms in all patients and improvement of PO2 and SO2. The quality of life was significant increase. No migration of the SEMS occurred. In the follow－up Period, tumor inpowth was found in 2 patients, esophagotracheal fistulas in 2, hemoptysis in one. Seven patients had died with mean survival time of 5. 1 months, three of 10 patients were still alive with a survival time Of 3, 6, 7months, respectively. Conclusion: An SEMS was the most suitable indication for tracheobrochial stenosis due to extrinsic tumor compression, and it is a good way to maintain the patency of airway for the stenosis due to intraluminal tumor invasion of unresectable tracheobrochial tumor.