金属支架置入在恶性气管狭窄中的应用价值

Clinical application of self-expandable metallic stent implantation through bronchoscope in the patients with malignant airway stenosis

目的 探讨电子支气管镜直视下置入金属支架对各种恶性气管狭窄的治疗效果及安全性.方法 2002年12月至2012年11月我院呼吸内科收治各类恶性肿瘤所致气管狭窄患者74例,于电子支气管镜直视下行金属支架置入,观察支架置入前后患者症状、6 min步行距离、改良英国MRC呼吸困难（mMRC）指数、血气分析变化及近远期相关并发症.结果 74例患者共置入77枚支架,其中履膜支架34枚,裸支架43枚.术后所有患者喘息症状明显缓解,6 min步行距离由术前（172±45）m增加至术后28周的（288±36）m,动脉血氧分压由术前（61.34±6.44） mmHg（1 mmHg=0.133 kPa）升高至术后28周的（72.12±6.87） mmHg,mMRC指数由术前3.56±0.44降至术后28周的1.96±0.37,差异均有统计学意义（P均＜0.01）;食管气管瘘患者呛咳症状减轻;支架置入术后患者出现发热、咳嗽、咽喉疼痛感、异物感、痰中带血丝等症状,经对症治疗均得到改善,未出现严重并发症.结论 电子支气管镜直视下金属支架置入治疗恶性肿瘤所致气管狭窄可明显改善患者症状,提高生存质量.

Objective To evaluate the short and long term efficacy of self-expandable metallic stent implantation through bronchoscope in the management of the patients with malignant airway stenosis.Methods Seventy-four hospitalized patients with malignant airway stenosis during a 10-year period were selected as our subjects from Dec.2002 to Nov.2012 in the Respiratory Department of the Central Hospital of Wuhan.All these patients underwent bronchoscope for nitinol self-expandable metallic stent implantation.Clinical improvement,6min walking distance （6MWT）,mMRC index,arterial blood gas,as well as early and late postoperative complications were investigated.Results A total of 77 stents were implanted,including 34 covered metallic stents and 43 uncovered metallic stents.All patients showed the obvious relief of dyspnea after the operation.6MWT at pre-operation was （172 ± 45）m and （288 ± 36）m at 28 week post-operation.Arterial blood gas was （61.34 ±6.44）mmHg at pre-opemtion and （72.12 ±6.87） mmHg at 28 week post-operation.mMRC was 3.56 ± 0.44 at pre-operation and 1.96 ± 0.37 at 28 week post-operation.All these differences were significant（P 〈 0.01）.The operation succeeded in releasing bucking of patients with esophago-tracheal fistula.Symptoms such as fever,cough,pharyngodynia,foreign body sensation and hemoptysis were observed,and all the above side effect could be solved while no serious complications arose.Conclusion Bronchoscopic insertion of metallic airway stents for malignant airway stenosis is a safe and effective procedure that could obviously relieve respiratory distress and improve the quality of life.