局麻下喉镜联合透视气管支架植入治疗恶性气道狭窄或瘘患者

Airway stenting with inhalation anesthesia in malignant airway stenosis or fistula under radiological guidance

目的分析雾化吸入局麻下喉镜联合透视气管内支架植入术治疗晚期肿瘤导致气管狭窄或瘘的疗效，并发症和安全性。方法收集江苏省肿瘤医院2001年6月至2010年6月74例晚期肿瘤导致气管狭窄或瘘患者（狭窄60例，瘘14例），采用德国百瑞压缩雾化吸入器行咽喉气管支气管黏膜表面麻醉，在数字减影血管成像透视下进行体表标记定位，经口喉镜明视下插入泥鳅导丝入气道，置换交换导丝，运用支架输送器释放气管内支架。结果74例患者均成功置入支架。60例气道狭窄患者中，有6例累及气管隆突，置入袖状支架，其余均为单纯金属裸支架。14例瘘患者，使用的均为覆膜支架。患者术后无明显改善2例，余72例患者术后全部气道恢复通畅，血氧饱和度接近正常。长期咽痛1例，刺激性呛咳2例，咳痰3例，痰中血块3例，痰中偶有血丝64例，气管支架移位1例，气管支架下缘气管食管瘘形成1例。结论局麻下喉镜联合透视技术行气管内支架植入可有效解除气道狭窄及堵瘘。

Objective To assess the efficacy and safety of airway stenting with inhalation anesthesia under radiological guidance in the palliation of malignant tracheobronchial stenosis. Methods Between June 2001 and August 2010, 74 consecutive patients with malignant tracheobronchial stenosis were treated by the insertion of an uhraflex self-expandable metal stent with inhalation anesthesia under fluoroscopic guidance. Results All patients achieved obvious symptomatic relief. The outcomes were as follows： dyspnea （ n = 2 ）, long-term angina （ n = 1 ）, strong irritation cough （ n = 2 ）, hard phlegm （ n = 3 ）, clotting expectoration （ n = 3 ）, blood-tinged expectoration （ n = 64 ）, airway stent displacement （ n = 1 ） and tracheoesophageal fistulas （ n = 1 ）. Conclusion Performed with inhalation anesthesia under radiological guidance, tracheobronchial recanalization with a self-expandable metal stent is a safe and effective palliative treatment for malignant stenosis.