Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

Double tracheal stents reduce side effects of progression of malignant tracheoesophageal fistula treated with immunotherapy: A case report

BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.

Development and Mechanical Properties of a Novel Woven Artificial Tracheal Stent

In this paper, the development of existing artificial tracheal stents was briefly introduced. Their structures, strengths and weaknesses were analyzed. A new woven artificial tracheal stent that used leno-based construction was designed and fabricated at last. Additionally, a preliminary mechanical study was carried out on the new artificial tracheal stent, such as the radial supporting force and the elastic restoring force, making foundation for application of the new artificial tracheal stent.

Preparation and Research of a Bionic Woven Tracheal Stent with Horizontal Pipeline

The paper designed a bionic woven tracheal stent and the stent was a multi-layer tubular structure with a transverse pipeline.Polydioxanone( PDO) monofilament and β-hydroxybutyrate and β-hydroxyvalerate copolymers/polylactic( PHBV/PLA) multifilament were chosen as the tissue engineering tracheal stent materials,and chitosan was chosen as the coating material. This study selected appropriate basic fabric structures and prepared the tracheal stent by setting reasonable weaving parameters,then treated the sample with coating and heat setting. Radical compression performances of the horizontal pipeline and longitudinal pipeline of this tracheal stent were investigated,and the experimental results showed that the stent had good performance on radial supporting force and elastic recovery,which meant it could supply adequate supports for cell growth and tissue regeneration of tracheal lesions; the horizontal pipeline could provide a good experimental foundation for reconstruction of the cartilage ring.

Tracheal Stenosis Caused by Thoracic Malignancy: Correlation between CT-Based Tracheal Measurement and Spirometric Values before and after Tracheal Stenting

Background: The correlation between computed tomography (CT)-based tracheal size and spirometry values is unknown in patients with tracheal stenosis by thoracic malignancy, which is often treated by tracheal stenting. Objectives: To evaluate the correlation between the tracheal cross-sectional area (CSA) and spirometric values before and after tracheal stenting, and to confirm that greater improvement in tracheal CSA leads to a larger improvement in spirometry values. Methods: A total of 32 patients with malignant tracheal stenosis underwent tracheal stenting. Before (n = 32) and after (n = 27) treatment, patients underwent chest CT, measuring mean and minimum tracheal CSA values, and spirometry. The correlation between tracheal CSA and each spirometric value was evaluated using Spearman rank correlation analysis. Differences in the pre- and posttreatment tracheal CSA and spirometric values were evaluated using the Wilcoxon matched-pairs test. Results: Significant improvement in the minimum tracheal CSA and in spirometric values was observed after stenting (P P P Conclusions: The tracheal size measured on chest CT correlates with patients’ spirometric values, particularly at the prestenting examination, in patients with malignant tracheal stenosis. The increase in the minimum tracheal CSA after stenting on CT is a predictor for improved spirometric values, which is first demonstrated by this study.

Preparation and characterization of paclitaxel-loaded poly lactic acid-co-glycolic acid coating tracheal stent

Background In-stent restenosis caused by airway granulation poses a challenge due to the high incidence of recurrence after treatment.Weekly applications of anti-proliferative drugs have potential value in delaying the recurrence of airway obstruction.However,it is not practical to subject patients to repeated bronchoscopy and topical drug applications.We fabricated novel pacilitaxel-eluting tracheal stents with sustained and slow pacilitaxel release,which could inhibit the formation of granulation tissue.And we assessed the quality and drug release behaviors of drug-eluting stents （DESs） in vitro.Methods Stents were dipped vertically into a coating solution prepared by dissolving 0.5 g （2％ w/v） of poly lactic acid-coglycolic acid （PLGA） and 0.025 g （0.1％ w/v） of pacilitaxel in 25 ml of dichloromethane.DES morphology was examined by scanning electron microscopy （SEM）.Pacilitaxel release kinetics from these DESs was investigated in vitro by shaking in PBS buffer followed by high performance liquid chromatography （HPLC）.Results Using an orthogonal experimental design,we fabricated numerous pacilitaxel/PLGA eluting tracheal stents to assess optimum coating proportions.The optimum coating proportion was 0.1％ （w/v） pacilitaxel and 2％ （w/v） PLGA,which resulted in total pacilitaxel loading of （16.380 6±0.002 1） mg/stent.By SEM the coating was very smooth and uniform.Pacilitaxel released from DES was at （0.376 3±0.003 8） mg/d,which is a therapeutic level.There was a prolonged,sustained release of pacilitaxel of ＞40 days.Conclusions Paclitaxel-loaded PLGA coating tracheal stents were successfully developed and evaluated.Quality assessments demonstrated favorable surface morphology as well as sustained and effective drug release behavior,which provides an experimental reference for clinical practitioners.

Design of 4D printed shape-changing tracheal stent and remote controlling actuation

has a good application prospect.The biodegradable stent can effectively reduce the damage to patients and improve the therapeutic performance of stents.In this work,a series of shape memory polylactic acid(Fe_(3)O_(4))composite tracheal stents were manufactured by 4D printing.The composite tracheal stents with different structures were designed.Moreover,with the addition of magnetic particles Fe3 O4,the shape memory PLA/Fe_(3)O_(4)composite tracheal stent has a magnetic driving effect.Under the magnetic field,the shape recovery process is completed within 40 s,and the shape recovery rate is more than 99%.Moreover,the 4D printed tracheal stent was also triggered by the irradiation of infrared lamp to realize the remote controlling recovery.The research on the structure design and driving method of 4D printing tracheal stent expands the application scope of shape memory polymer composites in biomedical field,provides a new way for personalized implantable medical devices and minimally invasive surgery.It is of great significance for better precision medical treatment.

Paclitaxel Drug-eluting Tracheal Stent Could Reduce Granulation Tissue Formation in a Canine Model

Background：Currently available silicone and metallic stents for tracheal stenosis are associated with many problems.Granulation proliferation is one of the main complications.The present study aimed to evaluate the efficacy of paclitaxel drug-eluting tracheal stent in reducing granulation tissue formation in a canine model,as well as the pharmacokinetic features and safety profiles of the coated drug.Methods：Eight beagles were randomly divided into a control group （bare-metal stent group,n =4） and an experimental group （paclitaxel-eluting stent group,n =4）.The observation period was 5 months.One beagle in both groups was sacrificed at the end of the 1st and 3rd months,respectively.The last two beagles in both groups were sacrificed at the end of 5th month.The proliferation of granulation tissue and changes in tracheal mucosa were compared between the two groups.Blood routine and liver and kidney function were monitored to evaluate the safety of the paclitaxel-eluting stent.The elution method and high-performance liquid chromatography were used to characterize the rate of in vivo release of paclitaxel from the stent.Results：Compared with the control group,the proliferation of granulation tissue in the experimental group was significantly reduced.The drug release of paclitaxel-eluting stent was the fastest in the 1st month after implantation （up to 70.9%）.Then,the release slowed down gradually.By the 54 month,the release reached up to 98.5%.During the observation period,a high concentration of the drug in the trachea （in the stented and adjacent unstented areas） and lung tissue was not noted,and the blood test showed no side effect.Conclusions：The paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo,suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

Self-Expanding Nitinol Stent for Treatment of Tracheal Stenosis Caused by Pulmonary Hypertension:1 case report

A 38 year-old man was admitted because of half a year of recurrent bouts of eough and shortness of breath and 20 days of hemoptysis. He had been apparently healthy until the illness. In the recent 6 months, the dyspnea and fatigue gradually onset and became more severe, the hemoptysis being 100-200 mL per day. Spells of chest pain are associated with coughing. Despite accepting antibiotic and antispasmodic therapy in a hospital, there was no obvious improvement and he was transferred to our hospital. Physical examination on admission: He was in acute distress and anemic face With P 110/min., R 30/min., T36. 8oC and Bp 100/60 mmHg. There were Wheezes, medium and fine

球囊扩张引导术在恶性复杂气道狭窄Y型硅酮支架置入困难时的应用

目的探讨球囊扩张引导术在恶性复杂气道狭窄Y型硅酮支架置入困难治疗中的有效性及安全性。方法本文为观察性研究。回顾性选取2021年8月至2022年3月在济宁市第一人民医院呼吸介入诊疗中心诊断为重度气道狭窄经常规方法置入硅酮支架失败的患者6例。其中男4例,女2例,年龄(62±7)岁;单侧支气管狭窄伴隆突增宽3例,双侧主支气管狭窄伴隆突增宽3例;4例患者为肺部恶性肿瘤,2例患者为食管癌侵犯气道。在恶性复杂气道狭窄Y型硅酮支架置入过程中联合球囊扩张引导术。观察Y型硅酮支架置入成功率、术中及术后并发症等指标。结果6例患者均成功置入Y型硅酮支架,术中、术后均无并发症发生,无操作相关死亡病例。术后患者气道狭窄均解除,呼吸困难均明显缓解,呼吸困难分级由Ⅲ~Ⅳ级改善为0~Ⅱ级。结论球囊扩张引导术在恶性复杂气道狭窄Y型硅酮支架置入困难时应用安全、有效。

PDO机织气管支架在体外有菌环境下的降解性能

人体气道环境是一个有菌的动态环境,植入气管中的聚二恶烷酮(PDO)支架在降解过程中易受细菌环境的干扰。探讨了体外有菌环境下PDO机织气管支架的降解性能,分析了细菌对PDO机织气管支架降解行为的影响。试验结果显示,细菌的存在对气管支架的降解有积极作用,它在降解前期能够缓冲溶液pH值的变化,减小支架的降解速率,使支架保持足够的径向支撑力,在降解后期能够加速支架的降解,使支架尽快被吸收;不同菌株对支架的侵蚀程度存在差异;机织结构的交织点会导致成品支架的降解形态呈现出不均匀性。研究可为PDO机织气管支架的进一步开发应用提供参考。

A novel wavy non-uniform ligament chiral stent with J-shaped stress-strain behavior to mimic the native trachea

Tracheal stents are an important form of treatment for benign or malignant central airway obstruction.However,the mechanical behavior of current tracheal stents is significantly different from that of the native trachea,which leads to a variety of serious complications.In this study,inspired by the structure of the native trachea,a wavy non-uniform ligament chiral tracheal stent is proposed,in which J-shaped stress-strain behavior and negative Poisson's ratio response are achieved by replacing the tangential ligament of tetrachiral and anti-tetrachiral hybrid structure with a wavy non-uniform ligament.Through the combination of theoretical analysis,finite element analysis and experimental tests,a wide range of desired J-shaped stress-strain curves are explored to mimic the native porcine trachea by tailoring the stent geometry.Besides,the negative Poisson’s ratio and auxetic diameter curves versus axial strain of the stent are also studied in detail,thus contributing to the enhancement of cross-section ventilation and reducing the migration of the stent.This novel tracheal stent with a unique microstructure shows a potential to perfectly match the physiological activities of the native trachea and thereby reduce potential complications.

Iatrogenic esophago-tracheal fistula:Challenges in diagnosis and management

Esophageo-tracheal fistula is a rare condition,and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation.A case where a wrapped tablet produced a fistula between the esophagus and trachea is described.The patient is a male born in 1938 who swallowed a tablet without unwrapping it.The patient was treated with selfexpanding metal stents(SEMS),but closure of the fistula was not achieved.Different examinations and treatment options are discussed.Surgical treatment for this condition has demonstrated considerable mortality and morbidity.In some cases closure of the fistula can be achieved by use of SEMS.Although we advise treatment of such cases with SEMS,in some cases treatment with stents will prove troublesome and the risk/benefit analysis will have to be reevaluated.

硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌致中央气道狭窄的临床疗效

目的 探讨硬质支气管镜联合电子支气管镜直视下置入金属或硅酮气管支架治疗食管癌侵犯气管致中央气道狭窄的临床应用价值。方法 回顾性分析该院呼吸与危重症医学科2019年10月-2021年7月诊治的13例食管癌侵犯气管致中央气道中重度狭窄患者的临床资料,所有患者均在全身麻醉肌松下插入硬质支气管镜,在电子支气管镜实时引导下行金属支架或硅酮支架置入治疗,观察其临床效果。结果 13例患者成功置入金属支架7枚,硅酮支架6枚(1枚直筒型,5枚Y型)。支架置入后,患者卡氏功能状态(KPS)评分、经皮动脉血氧分压(PaO_(2))和经皮动脉血氧饱和度(SpO_(2))明显高于支架置入前(P <0.05);气管狭窄程度较支架置入前明显改善,气促分级、呼吸困难博格评分和二氧化碳分压(PCO_(2))明显低于支架置入前(P <0.05);金属支架组和硅酮支架组术后近期并发症、远期并发症、3个月生存率和6个月生存率比较,差异均无统计学意义(P> 0.05)。结论 在硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌所致的中央气道狭窄,安全可行,能迅速解除气管狭窄,近期效果显著,为患者后续治疗提供了保障。

Different Approaches on Various Cases of Tracheal Stenosis

Narrowing of the airway caused by different diseases is a serious condition manifesting varying signs and symptoms. Immediate attention and treatment must be performed as this is a life-threatening condition. In the past decade, there has been massive advancement on the management of airway stenosis. Some of these are stent placement, tracheal reconstruction and tumor debulking. This article focuses on 5 different cases with distinct strategies in conducting treatment and management of airway stenosis.

“哑铃”形人工气管支架的设计、制备与性能研究

植入气管支架是重建气管与修复气管缺损的一种重要手段。针对现有的封堵用人工气管支架存在植入后塌陷、位移等问题,从气管支架的形状和结构出发,以机织透孔组织为基础组织,根据临床治疗的要求,设计了一种两端直径大、中间直径小,形似“哑铃”的人工气管支架。通过合理设置织物管幅、经纬密度等相关工艺参数,制备出的“哑铃”形变直径人工气管支架的平均表面孔径为0.34 mm,平均径向支撑应力为41.82 kPa,远大于国产镍钛合金支架的径向支撑应力7.85 kPa,抽拔力比直管状人工气管支架提高了76%,说明“哑铃”形人工气管支架的设计为支架的抗塌陷和抗位移性提供了可能。

气管支架植入术后继发肺炎的危险因素及病原学分析

目的:探讨气管支架植入术后继发肺炎的危险因素及病原学特征。方法:选取2015年4月-2022年11月于宜昌市中心人民医院确诊为气管、支气管狭窄并行支架植入的421例患者,根据是否术后继发肺炎分组,其中术后继发肺炎的为病例组(n=96),术后未继发肺炎的为对照组(n=325),收集两组患者相关资料进行Logistics回归分析。结果:多因素分析显示,恶性气道狭窄及患有慢性阻塞性肺疾病(COPD)是气管支架植入术后继发肺炎的独立危险因素。96例肺炎患者中有71例(73.96%)共培养出83株致病菌,其中以革兰氏阴性杆菌中的铜绿假单胞菌为主。结论:恶性气道狭窄及COPD可增加气管支架植入术后继发肺炎的发生风险,其致病菌以铜绿假单胞菌为主。

1例犬气管塌陷外固定支架的病例报告

气管塌陷是造成气管狭窄的原因之一,是一种进行性且不可恢复的上呼吸道疾病,常见于小型犬成年期或老年期,临床中常采用气管内支架治疗。1只气管塌陷患犬呼吸困难,有喘鸣音,采用保守治疗未见好转,综合临床检查、血液检测、超声及X射线检查结果判定为Ⅲ级气管塌陷;采取在颈段与胸腔入口处植入气管外支架的治疗方案,5 d后临床症状消失,复诊气管形态正常,未发现气管塌陷处异常,预后良好。结果表明,该方法治疗效果良好,手术方案切实可行,减少了因气管内支架而发生并发症的二次损伤,可广泛推广应用于宠物临床,但胸段气管狭窄仍建议使用气管内支架。

气管支架置入术治疗肿瘤引起的急性气道狭窄

背景与目的:肿瘤引起的急性气道狭窄,情况危急,对于此类患者实行金属气管支架置入术,有助解除患者呼吸困难,为进一步治疗争取时间。本研究旨在探讨其临床应用效果及并发症处理。方法:52例由肿瘤引起的急性气道狭窄患者在纤维支气管镜引导下,置入镍钛合金(Ni-Ti)支架。结果:52例患者支架放置成功,患者呼吸困难明显改善,术前PaO2、PaCO2、KPS值分别为(7.74±0.99)kPa、(5.37±0.39)kPa、68.85±8.08,术后PaO2、PaCO2、KPS值分别为(11.12±0.61)kPa、(4.58±0.30)kPa、84.62±5.03(P<0.01);术后并发症经对症处理后,均取得较好的疗效。结论:气管支架置入术对于肿瘤局部压迫、侵犯大气道而引起的急性呼吸困难是一种较好的姑息性治疗手段,可以挽救患者的生命,提高晚期肿瘤患者生活质量,为肿瘤患者进一步治疗创造机会。

气管内支架置入抢救气管重度狭窄性急性呼吸困难

目的对晚期肿瘤造成气管狭窄患者突发重度呼吸困难时,紧急采取简便的雾化吸入麻醉联合喉镜直视下行气管内支架置入术的疗效及评价。方法 55例因晚期肿瘤导致气管狭窄突发呼吸困难加重患者,急症气管内支架置入术,其中食管癌32例,肺癌10例,纵隔肿瘤5例,甲状腺癌3例,气管癌3例,软腭癌1例,胃癌1例。抢救后通过症状、体征、影像学改变等观察评价疗效。结果 55例患者抢救均成功,重度呼吸困难即刻改善,并获得继续治疗机会。结论急症采用雾化吸入麻醉联合喉镜直视下气管内支架植入方法简便、迅速、可靠,值得推广。