激光加气道内支架在气道完全闭塞治疗中的应用

The application of laser therapy plus endobronchial stenting in treatment of complete airway obstruction

目的 探讨气道内激光加内置支架在气道完全闭塞治疗中的应用价值。方法 对 17例气道完全闭塞患者应用掺钕钇铝石榴石激光加气道内置支架治疗 ,并定期随访 2～ 2 0个月。结果 17例患者经激光治疗后气道均有扩大 ,平均扩大 (5 82± 1 0 1)mm ;气促分级减少 ,除 1例患者无变化外 ,减少 1级 4例 ,2级减少 11例 ,3级减少 1例 ;1秒钟用力呼气容积 (FEV1)增加 (0 49± 0 18)L。14例患者经激光治疗后行气道内支架置入术 ,术后患者的气道直径平均又增大 (3 5 0± 0 94)mm ;气促分级又进一步减少 ,除 2例患者无变化外 ,有 8例减少 1级 ,4例减少 2级 ;FEV1平均又增加 (0 41± 0 2 0 )L。在激光治疗过程中有 15例患者出现低氧血症 ,2例患者出现出血 ,有 3例患者术后早期出现呼吸困难 ;支架置入后出现反复肺部感染者 4例 ,支架网眼内肉芽组织或肿瘤组织生长形成阻塞 5例 ,支架出现移位 1例 ,经处理后气道均保持通畅。结论 激光治疗加气道内置支架在气道完全闭塞患者的治疗中是行之有效的。

Objective To assess the efficacy of laser therapy plus endobronchial stenting in the treatment of complete airway obstruction . Methods 17 cases with complete airway obstruction were treated with Nd:YAG laser and endobronchial stenting from April 1998 to November 2000.The patients′ dyspnea, airway gauage, pulmonary function and complications were observed. Results The airways were all restructured following a single or multiple laser treatment; the airway gauage enlarged and the average diameter increased (5.82±1.01)mm. Immediate relief of dyspnea was achieved in sixteen patients and dyspnea index lessened one grade in 4 patients, 2 grades in 11 and 3 grades in one. Obvious improvement of forced expiratory volume in one second (FEV 1 )was noted in all patients;the improvement averaged (0.49±0.18) L. Endobronchial stents were placed for 14 patients after laser treatment. After stent placement, the airway was further opened and the average airway gauage increased (3.50±0.94)mm further in diameter. Patients′ dyspnea and FEV 1 were further improved; dyspnea index lowered one grade in eight patients and 2 grades in two patients. FEV 1 improved further(0.41±0 20)L in average. Complications after laser therapy included hypoxemia in 15 patients, hemorrhage in 2 and postoperative dyspnea in 3.Follow up duration ranged from 2～20 months. Complications after stenting included recurrent pneumonia in 4 patients, airway obstruction due to granuloma or tumour growth in 5 and stent migration in 1 . Conclusion Laser therapy and endobronchial stent placement were effective in the treatment of patients with totally occluded airway. Nd:YAG laser can be first chosen to restructure the occluded airway , then endobronchial stent must be used to further enlarge the airway and maintain the therapeutic effect.