气道支架置入术治疗恶性气道狭窄伴一侧肺通气的临床研究

Clinical research of stent placement by electronic bronchoscopy on malignant airway stenosis with one side lung ventilation

目的评价气道支架置入术在恶性气道狭窄伴一侧肺通气治疗中的价值。方法选择2011年1月至2015年2月武汉市中心医院呼吸内科收住的34例恶性气道狭窄伴一侧肺通气的患者,根据狭窄的病因、部位行支架置入术,评价近期疗效、气道开放程度和肺功能及并发症情况。结果支架置入术后34例患者呼吸困难症状明显缓解,狭窄段直径增大,气促评级改善,1秒用力呼气容积(FEV1)及动脉血氧分压(Pa O2)上升,二氧化碳分压(Pa CO2)改善,差异有统计学意义(P<0.05)。2周内不良反应:刺激性咳嗽7例(20.59%),咽痛9例(26.47%),咯血10例(29.41%);随访1个月并发症:肉芽组织增生3例(8.82%),排痰困难5例(14.71%),均给予对症处理后改善,1例(2.94%)27 d后大咯血死亡。结论电子支气管镜下气道支架置入术治疗恶性气道狭窄伴一侧肺通气的可靠性和安全性较高,值得临床推广。

Objective To evaluate the value of airway stent placement by electronic bronchoscopy on malignant airway stenosis with one side lung ventilation. Methods Thirty-four patients in the Department of Respiratory Disease of Central Hospital of Wuhan from January 2011 to February 2015 were included. Airway stent was used to evaluate the shortterm therapeutic effects,airways opening degree,pulmonary functions and complications. Results Followup for one month,the symptoms of dyspnea were relieved. Airway diameter,dyspnea score,forced expiratory volume in one second（ FEV1）,partial pressure of oxygen（ PaO2）,partial pressure of carbon dioxide（ PaCO2） were improved significantly（ P〈0. 05）. Adverse reactions in 2 weeks were cough（ 7 cases,20. 59%）,sore throat（ 9 cases,26. 47%）,and hemoptysis（ 10 cases,29. 41%）. With the follow-up for one month,airway granulation proliferation occurred in 3patients（ 8. 82%）,sputum drainage difficulty in 5 patients（ 14. 71%）,and 1 patient（ 2. 94%） died because of massive hemoptysis after 27 days. Conclusion Stent placement by electronic bronchoscopy for malignant airway stenosis with one side lung ventilation is effect and safe,worthy to be promoted clinically.