金属支架治疗气管恶性狭窄的临床应用

The clinical value of metallic stents for malignant airway obstruction

目的:评价金属支架治疗恶性肿瘤引起的气管狭窄的可行性和疗效。方法:40例恶性肿瘤压迫或侵犯气管,引起气管狭窄和严重的呼吸困难,分别置入金属支架,23例患者进行了后续的化学治疗和放射治疗。结果:32例狭窄位于主气管,共置入支架33个;8例累及气管下段及隆突区,置入Y型支架。28例术后支架即刻100%充分扩张,12例术后即刻扩张到支架固有直径的40%～80%。1周后复查,支架100%充分展开。全部支架位置良好,没有发生支架移位情况。4例患者在术后2～4月间,出现支架上口断裂,于支架上口处再次置入1枚支架后症状好转。17例恶性肿瘤患者放置支架后未经任何治疗生存期为2～6个月,23例患者放置后配合放射治疗及化学治疗,生存期明显延长达6～15个月,单因素生存分析显示两组存在统计学差异(P=0.002)。结论:气管支架能缓解晚期恶性肿瘤引起的呼吸困难,改善生活质量。结合后续的放射治疗和化学治疗能进一步延长生存时间。

Objective： To evaluate the feasibility and efficacy of metallic stent for malignant airway obstruction.Methods： Forty patients with airway obstruction and dyspnea caused by malignant carcinoma underwent metallic stents placement.Twenty-three patients underwent additional chemotherapy and radiotherapy.Results： Stenosis of 32 patients were located in the trachea,33 metallic stents were placed.Stenosis of 8 patients were located in the inferior segment or bifurcation of trachea,Y-shaped metallic stents was placed in each of these patients.The stents expanded sufficiently in 28 patients after immediate placement,and in other 12 patients,stents expanded about 40% to 80%.All stents expanded sufficiently after a week and did not have displacement.The stent disruption happened in 4 patients after 2～4 months of placement,they underwent replacement of stent again.The survial time of 17 patients without any additional therapy was 2～6 months.For the 23 patients who had chemotherapy and radiotherapy,the life span was obviously extended as long as 6～15 months.Single-factor survival analysis of overall survival showed that there was statistical significance between the two groups（P=0.002）.Conclusion： Metallic stents are useful for relieving respiratory distress and improving life quality in patients with malignant airway obstruction,additional chemotherapy and radiotherapy can further lengthen existence.