螺旋CT后处理技术在气道支架技术中的应用价值

The application value of spiral CT postprocessing technique in airway stenting technique

目的探讨螺旋CT后处理技术在气道支架置入技术中的应用价值。方法收集2012年5月—2016年4月间因恶性气道狭窄或恶性气管食管瘘行气道支架置入治疗的患者23例,平均年龄(61.6±10.0)岁。支架置入术前后进行支气管镜检查及64层多层螺旋CT检查,同一患者术前术后分别接受2种检查,以容积再现、多平面重组(multiplanar reformation,MPR)及CT仿真内镜成像(CT virtual endoscopy,CTVE)多种方式重组,对狭窄气道或瘘口的位置、狭窄程度、瘘口大小、狭窄气道远端情况进行评估,并测量狭窄段气道的相关数据;评估支架置入术后气道的通畅程度、支架的位置和形态、邻近气道及合并症等情况。比较两者的阳性预测情况。结果所有患者根据螺旋CT气道三维重建检查提供的相关数据,成功地完成了气道支架置入。23例患者共置入支架30枚,其中柱型21个,L型3个,Y型6个。支架均保持在原位,通畅且无变形;支架置入后气道恢复通畅,瘘口封闭,饮水、进食呛咳及呼吸困难缓解。支气管镜检查和CT检查对诊断气道狭窄的阳性率均为100%(23/23)。3例(13%)患者因气道严重狭窄,无法依靠支气管镜对狭窄段气道进行测量。并发症发生情况:MPR显示在支架的两端和内部肿瘤生长导致的气道狭窄者3例,CTVE显示黏液阻塞者2例。结论 64层螺旋CT后处理技术作为一种方便、快捷、准确、无创的检查方法,在恶性气道狭窄或气管食管瘘的患者,能准确地测量瘘口及狭窄段气道的相关数据,对于气道支架置入治疗及术后疗效观察均有较高的参考价值,值得推广应用。

Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of （61.6± 10.0） years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation （MPR） and CT virtual endoscopy （CTVE） in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections was compared. Results Airway stents were placed successfully according to the data from the spiral CT airway three- dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% （23/23）. Complications： MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.