超细电子支气管镜引导下气道支架置入术治疗肿瘤性复杂气道狭窄

Ultrathin Bronchoscopy-guided Stent Implantation in the Treatment of Complex Airway Stenosis Caused by Neoplasm

目的观察超细电子支气管镜下气道支架置入术治疗肿瘤性复杂气道狭窄的近期及远期疗效。方法选择36例肿瘤性复杂气道狭窄的患者,主要为气道多处狭窄(12例)、气管扭曲(16例)、大气道狭窄部小于4mm(4例)及合并有食管气管瘘(3例)或气管纵隔瘘(1例)的患者,在超细电子支气管镜引导下置入气道支架,观察气道支架置入前后患者相关临床指标的变化,随访观察支架置入后的近期、远期疗效和并发症。结果 36例患者共置入42个气道支架,一次性成功33例(94.4%),支架置入后患者咳嗽、咳痰及肺部感染症状明显好转,PaO2、C-反应蛋白、FEV1及生活质量评分等指标较支架置入前显著改善(均P<0.01),平均生存时间中位数达到17.6月,近期、远期疗效确切。结论超细电子支气管镜下气道支架置入术对于肿瘤性复杂气道狭窄的患者安全有效,可明显改善患者生活质量,延长患者的生存时间。

Objective To observe the short-and long-term clinical efficacy of ultrathin bronchoscopy-guided stent implantation in the management of patients with complex airway stenosis caused by neoplasm. Methods A total of 36 patients with complex airway stenosis caused by neoplasm were recruited in the study. There were 12 patients with multiple stenosis, 16 with trachea twist,4 with the bronchus diameter less than 4 mm in the stenosis,3 concomitant with broncho-esophageal fistula and 1 with broncho-mediastinal fistula. All the patients underwent airway stenting under the guidance of the ultrathin broncho- scope. The changes of the relevant clinical indexes, the short-and long-term clinical efficacy and complications were evaluated be fore and after stent implantaion. Results Totally,42 stents were implanted in the 36 patients. Stenting were successfully com- pleted in 33 patients for the first time （94.4%）. The symptoms such as coughs, sputum production and inflammation-related symptoms were significantly improved after stenting. The clinical indexes such as PaO2, C-reactive protein, forced expiratory volume in 1 second （FEV 1）,and St. George＇s Respiratory Questionnaire （SGRQ） scores were improved after stent implanta- tion （P〈0.01）. The average median survival time reached 17.6 months,with the short-and long-term curative effect obtained. Conclusion Ultrathin bronchoscopy-guided stent implantation for complex airway stenosis caused by neoplasm is a safe and effective procedure, improving the life quality of patients and prolonging the survival time.