经硬质支气管镜金属支架植入治疗气管-食管瘘的临床应用

Clinical Application of Metallic Stent Implantation Through Rigid Bronchoscopy in the Treatment of Patients with Tracheoesophageal Fistula

目的评估经硬质支气管镜植入金属覆膜支架对各种气管-食管瘘的治疗效果及安全性。方法选取武汉市中心医院呼吸与危重症医学科2015年4月至2018年3月期间收治的22例各类疾病所致气管-食管瘘患者,于硬质支气管镜下行气道支架植入,观察支架植入前后患者症状、日间咳嗽评分、呼吸困难指数(mMRC指数)、血气分析变化及近、远期相关并发症。结果22例患者的病因包括食管癌肺部转移17例、气管恶性肿瘤纵隔转移放疗后3例、医源性损伤2例。共植入气道支架24枚,其中直筒金属覆膜支架17枚,Y型金属覆膜支架7枚。气管支架20枚(包含Y型支架7枚),右主支气管支架1枚,左主支气管支架3枚。术后所有患者进食呛咳减轻,日间咳嗽评分、mMRC指数及动脉血氧分压明显改善;全麻手术术后均未出现严重并发症。结论经硬质支气管镜下金属支架植入是治疗气管-食管瘘的有效手段,可以明显改善患者症状,提高生存质量。

Objective To evaluate the efficacy and safety of metallic stent implantation through rigid bronchoscopy in the management of the patients with tracheoesophageal fistula(TEF).Methods We conducted a retrospective study with 22 patients suffering from tracheoesophageal fistula from April 2015 to March 2018 at Respiratory Department of Wuhan Central Hospital.All these patients underwent rigid bronchoscopy for metallic stent implantation.Clinical improvement,Cough Index,mMRC Index,arterial blood gas,early and late postoperative complications were investigated.Results The etiology of 22 patients included esophageal cancer lung metastases in 17 cases,tracheal malignant tumors mediastinal metastasis after radiotherapy in 3 cases,and iatrogenic injury in 2 cases.A total of 24 stents were implanted,including 17 straight metal stents and 7 Y-shaped metal stents.There were 20 tracheal stents(including 7 Y-shaped stents),1 right main bronchus stent and 3 left main bronchus stents.In the postoperative days,all the patients showed great improvements in Cough Index and arterial blood gas,while the mMRC Index was significantly decreased.All the patients had relief of cough after eating,and their daytime Cough Index,mMRC index and arterial oxygen partial pressure were significantly improved.Additionally,no serious complications were observed after general anesthesia.Conclusion Metallic stent implantation through rigid bronchoscopy is an effective method for the treatment of tracheoesophageal fistula,which can obviously relieve the symptoms of patients and improve the quality of life.