透视引导下气道瘘封堵覆膜金属内支架取出术的应用

Application of X-ray fluoroscopy-guided removal of covered metal stent for blocking airway fistulas

目的:总结在X线透视引导下气道瘘封堵覆膜金属内支架取出术的应用效果。方法:85例患者共放置90枚气道覆膜金属内支架用于封堵气道瘘,在X线透视引导下取出支架,其中男72例,女13例,年龄15~81(54.9±12.3)岁。回顾患者临床资料,分析支架取出的适应证。结果:85例患者90枚支架,成功取出89枚,技术成功率98.9%;仅1枚支架存在金属丝残留,经支气管镜成功取出;支架取出操作时间为(19.0±8.6)min。取出原因:常规取出46例,支架移位11例,肉芽组织过度增生10例,气道瘘复发8例,支架不耐受6例,支架断裂4例,留置时间分别为97.5(76.5,123.0)、11.0(3.0,26.0)、119.5(90.8,219.8)、24.0(10.0,64.0)、5.5(2.3,10.3)和89.5(74.0,127.5)d。支架取出术的并发症有支架金属丝残留(1例)、气道黏膜撕裂伴大咯血(2例)、因气道再狭窄需再次置入支架(1例)、需要机械通气的呼吸困难(1例)、吸氧可缓解的呼吸困难(1例)。结论:在X线透视引导下取出用于封堵气道瘘的覆膜金属内支架安全、有效;推荐支架取出的时间窗为置入后第31~90天。

Aim:To investigate the indications and complications of X-ray fluoroscopy-guided removal of covered metal stent for blocking airway fistulas.Method:A total of 85 patients(72 males and 13 females)with airway fistulas were treated with 90 covered metal stents,and the stents were removed under the guidance of X-ray fluoroscopy.The age of the patients was 15 to 81(54.9±12.3)years.The clinical data of the patients were reviewed and the indications and complications of stent removal were analyzed.Results:A total of 89 stents were successfully removed,and the technical successful rate was 98.9%.Only one stent with residual metal wires was removed by bronchoscope.The time of stent removal was(19.0±8.6)min.The reasons for removal were as follows:conventional removal in 46 cases,stent displacement in 11 cases,excessive granulation tissue hyperplasia in 10 cases,airway fistula recurrence in 8 cases,stent intolerance in 6 cases,stent rupture in 4 cases,and the retention time was 97.5(76.5,123.0),11.0(3.0,26.0),119.5(90.0,219.8),24.0(10.0,64.0),5.5(2.3,10.3)and 89.5(74.0,127.5)days,respectively.The complications of stent removal included residual metal wire(1 case),airway mucosal tear with massive hemoptysis(2 cases),re-stenting due to airway restenosis(1 case),and dyspnea requiring mechanical ventilation(1 case),dyspnea relieved by oxygen(1 case).Conclusion:X-ray fluoroscopic removal of airway stent for blocking airway fistulas is safe and effective.The recommended removal time window is 31 to 90 days after the stent implantation.