通气导管辅助下^(125)I支架置入术治疗恶性气道狭窄24例

Treatment of malignant airway stenosis with ^(125)I seed stent implantation assisted by airway tube:preliminary results in 24 patients

目的评估局麻下通气导管辅助下^(125)I放射性粒子支架置入治疗恶性气管、支气管狭窄的可行性和安全性。方法回顾性分析从2014年3月至2015年1月行^(125)I支架置入术治疗的恶性气管、支气管狭窄患者24例,包括气管-支气管癌6例、食管癌8例、肺癌纵隔淋巴结转移9例、纵隔恶性肿瘤1例。所有患者均出现由恶性肿瘤所致的气道狭窄并出现不同程度的气促、咳嗽等症状。气促评级2级2例,3级16例,4级6例。在介入治疗中,首先将单弯导管置于一侧主支气管作为通气导管,然后将携带有^(125)I粒子支架成功释放在病变的气管、支气管,最终撤出通气导管。重点分析^(125)I支架置入的技术成功率、手术相关并发症发生率及术中患者耐受程度。结果 24例患者均一次性成功置入^(125)I支架,未出现严重的手术相关并发症,技术成功率为100%。在通气导管辅助下,支架输送器通过气道狭窄处时患者SaO_2维持在(92.9±2.3)%,无一患者术中出现窒息、血氧饱和度显著下降的情况。术后有6例患者出现痰中带血、2例患者出现刺激性咳嗽、1例患者出现轻微胸痛,经对症处理后均好转;手术过程中未出现患者剧烈咳嗽、躁动、呼吸困难等不能配合治疗的情况。结论局麻下通气导管辅助下^(125)I支架置入术治疗恶性气道狭窄安全、可行。

Objective To evaluate the safety and feasibility of 125I seeds stent implantation with assistance of airway tube under local anesthesia in treating malignant tracheobronchial stenosis. Methods The clinical data of 24 patients with malignant tracheal and bronchial stenosis, who underwent the treatment of 125I seed stent implantation at authors＇ institute during the period from March 2014 to January 2015, were retrospectively analyzed. The primary lesions included tracheal and bronchial cancer （n=6）, esophageal carcinoma （n=8）, pulmonary cancer associated with mediastinal lymph node metastasis （n=9）, and malignant mediastinal tumor （n=1）. All patients had different degrees of shortness of breath, cough and other symptoms due to airway constriction caused by malignant tumors. Grade Ⅱ of breath shortness was seen in 2 patients, grade Ⅲ in 16 patients, and grade IV in 6 patients. First, a 4F single-curve catheter was placed into one of the main bronchi, which was used as the ventilation catheter, then implantation of 125I seed stent in the diseased trachea and bronchus was carried out, finally, after the implantation of 125I seed stent was successfully accomplished the ventilation catheter was removed. The technical success rate of 125I seed stent implantation, the procedure-related complications and the intraoperative patient tolerance were calculated and the results were analyzed. Results Successful implantation of 125I seed stent with single procedure was accomplished in all 24 patients and no severe operation-related complications occurred. The technical success rate was 100%. Under the assistance of ventilation catheter, the oxygen saturation maintained at the level around 92.9% when the stent release device was passing through the airway stenotic site. Neither intraoperative asphyxia nor severe decrease in blood oxygen saturation occurred in all patients. After the treatment, 6 patients had bloody sputum, 2 patients developed irritable cough, and one patient complained of mild chest pain, these symptoms were relieved after symptomatic treatment. During operation, no events that caused the patients unable to cooperate with the treatment, such as severe cough, dysphoria, dyspnea, etc., occurred. Conclusion For the treatment of malignant airway stenosis, 125I seed stent implantation with assistance of airway tube under local anesthesia is safe and feasible.