Dumon支架放置失败23例原因分析

Clinical analysis of failure implantation of Dumon stent

目的分析全麻下经硬镜放置Dumon支架失败的原因,以提高放置成功率。方法对23例经硬镜放置Dumon支架失败患者的术前准备、操作过程进行回顾性分析。结果颈后伸受限、开口狭小等致硬镜未能插入6例;主支气管严重狭窄致Y支架前推困难3例;主支气管瘘因硬镜未能插到瘘口远方以致支架推到消化道腔内4例;良性狭窄扩张不够,致支架未能放到狭窄管腔5例;严重气道软化,支架前推时气道破裂3例;因术中出现严重心血管事件而中止放置2例。结论为提高放置成功率,应注意:做好术前评估,掌握好适应证;瘢痕狭窄放置前应先充分扩张管腔;气道瘘者镜管应尽量插到瘘口远方;主支气管均严重狭窄时可边球囊扩张边前推;支架不能前推到狭窄管腔时可现场加工支架。

Objective To improve the success rate of stent implantation through analyzing the failure reason on implantation of Dumon stent. Methods The clinical data about preoperative preparation and operational process of the failure cases were retrospectively analyzed. A total of 23 cases were included, and the reasons of implantation failure were analyzed. Results Among the 23 cases, 6 cases failed to place stent for the limitation of cervical move-ment or narrow opening which resulted in rigid bronchoscopy not be inserted. Both left and right primary bronchus were severely stenosis which leaded to Y-shape stent failed to be promoted in 3 cases. The stents were promoted into alimentary canal because of the rigid bronchoscopy were unable to insert into distal end of fistula orifice in 4 cases. ？ Besides, benign stenosis was not being expanded enough in 5 cases. Rupture of airway happened in 3 several airway malacia cases. The operation was suspended because of serious cardiovascular events in 2 cases. Conclusion To improve the success rate, the following issues should be noted：preoperative assessment of conditions, mastering the indication, implanting the metal stent temporarily or using balloon to dilate the lumen in scar straitness cases, trying to insert rigid bronchoscopy into the distal end of fistula orifice in airway fistula cases, and the field processing of Du-mon stent to adapt to the special cases.