国产镍钛支架治疗恶性气管支气管狭窄

Treatment of Malignant Tracheobronchial Stenosis by Home made Nitinol Stents

目的 :评价国产镍钛支架治疗恶性肿瘤引起的气管支气管狭窄的可行性和疗效。方法 :2 0例肺癌、食管癌等恶性肿瘤压迫或侵犯气管、支气管 ,引起气道狭窄和呼吸困难 ,安放支架术在X线透视下由纤支镜配合进行 ,分别经口 (3例 )或经鼻 (17例 )植入国产镍钛自扩型支架。 7例患者进行了后续的支气管动脉灌注化疗或放疗。结果 :12例狭窄位于主气管 ,置入支架 12个 ;8例狭窄位于气管 支气管 (4例 )或支气管 (4例 )置入支架 13个。所有患者呼吸困难得到立即缓解。 1例术后 6 0天死于严重肺部感染 ;1例术后 4 5天死于支架移位、再狭窄。 3例失访。 8例未进行后续抗肿瘤治疗者生存时间 6 0～ 90天 ,平均 73天。 7例术后进行全身化疗或支气管动脉灌注化疗者生存时间 110天～ 1年 6个月 ,平均 12个月。结论 :在X线透视下由纤支镜配合行气道支架放置术优越性较多。国产气管支气管支架能缓解晚期恶性肿瘤引起的呼吸困难 ,改善生活质量。需结合后续的抗肿瘤治疗才能延长生存时间。

Objective:To appraise the feasibility and efficacy of home made nitinol stent in the treatment of malignant tracheobronchial stenosis. Methods:Twenty patients with lung cancer and esophageal cancer underwent placement of nitinol endotracheal and/or bronchial stents for respiratory distress caused by tracheobronchial stenosis. Among them 7 patients underwent additional therapy. Results:The stenosed sites located in trachea, tracheobronchi or main bronchus in 12, 4 and 4 cases, respectively. Twenty five stents had been successively placed through oral cavity (3 cases) or nasal cavity (17 cases) under x-ray guidance with fibertracheobronchoscopy with dyspnea rapidly improved. One patient died 60 days after stenting with severe pulmonary infection and another died 45 days after stenting due to the migration of stent and restenosis. Three patients were lost follow-up. Eight patients without additional therapy lived from 60 to 90 days (mean survival: 73 days) after stent placement. Seven patients with additional anti-cancer therapy lived from 110 days to 1 year and 6 months (mean survival: 12 months) after stenting. Conclusion:It is an practicable method to place airway stent under x-ray guidance with fibertracheobronchoscopy. Although nitinol stents are useful for relieving respiratory distress and improving life quality in patients with malignant tracheobronchial stenosis, additional anti-cancer therapy should be considered.