气管-主支气管分支型部分覆膜金属内支架在胸腔胃-支气管瘘中的临床应用

Application of Covered Self-Expandable Hinged Metallic Stents in Thoracostomach Bronchial Fistula

目的探讨气管-主支气管分支型部分覆膜金属内支架置入气管治疗胸腔胃-支气管瘘的可行性及疗效。方法根据胸部多排螺旋CT﹙SCT﹚平扫结果及口服碘水食管造影显示瘘口(位于主支气管)的位置、大小、数目,设计定做气管-主支气管分支型部分覆膜金属内支架。根据测量瘘口近端距隆突距离(AB段)及瘘口远端距上叶支气管开口距离(CD段),将患者分为Ⅰ组(AB段或CD段的长度<5 mm,共4例)和Ⅱ组(AB段和CD段的长度≥5 mm,共10例)。X线透视下,14例患者14处瘘口置入15枚气管-主支气管分支型部分覆膜金属内支架。采用Fisher精确概率检验对比两组,以明确AB段及CD段对术后瘘口复发的影响。结果 14例患者内支架均置入成功,瘘口完全封闭,即刻消除呛咳症状,而4例在术后1个月内出现瘘口复发;对比分析Ⅰ组与Ⅱ组瘘口复发率,两组间瘘口复发率差异有统计学意义(P=0.04)。结论使用气管-主支气管分支型部分覆膜金属内支架能有效封堵胸腔胃-主支气管瘘,操作简单,安全有效。AB段与CD段的长度是影响支架置入后瘘口复发的重要因素。

Objective To explore the feasibility and clinical efficacy of hinge-shaped,partially covered,expandable metallic airway stent in the treatment of thoracostomach bronchial fistula.Methods Hinge-shaped,partially covered,expandable metallic airway stents were designed according to site,size and number of the fistulas（in the main bronchus） revealed by SCT and contrast agent-enhanced esophagograms.Fifteen hinge-shaped,partially covered,expandable metallic airway stent were placed in 14 patients with thoracostomach main bronchial fistula under the guidance of X-ray.These patients were divided into group I（AB 5 mm or CD 5 mm,n=4）and Ⅱgroup（AB ≥5 mm and CD ≥5 mm,n=10）,with AB defined as the distance between carina and the proximal end of the fistula and CD defined as the distance between the distal end of the fistula and the opening of superior lobar bronchus.Fisher exact probability test was employed to evaluate the associations between lengths of AB and CD and the recurrence of fistula.Results Operations of stent placement were successful in all patients,with the fistula completely sealed and the symptom of swallow choking vanished immediately.Recurrence of fistula was observed in 4 patients 1 month after the operation.Recurrence rate of fistula was correlated with the length of AB and CD（P=0.04）.Conclusion Hinge-shaped,partially covered,expandable metallic airway stents appears to be a safe and effective procedure to occlude thoracostomach bronchial fistulas.The lengths of AB and CD may play an important role in predicting the recurrence of fistula.