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.

Epinephrine use during chemotherapy to treat severe tracheal stenosis secondary to advanced esophageal cancer:A case report and review of the literature

Dyspnea from tracheal stenosis due to compression by a tumor is an emergency that complicates therapy in oncology.We report a case of advanced esophageal cancer in a 56-year-old male who developed severe dyspnea due to airway compression by mediastinal lymph node enlargement.We used epinephrine by subcutaneous injection and aerosol inhalation to temporarily relieve dyspnea while the patient received bevacizumab and chemotherapy.The dyspnea had subsided considerably after 5 days,and the mediastinal lymph nodes were significantly reduced after 2 cycles of chemotherapy.However,the patient died of massive tracheal hemorrhage 2 months later.

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.

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.

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

Review of(acquired) incidental, rare and difficult tracheoesophageal fistula management

Acquired benign tracheoesophageal fistula is a rare condition and a difficult problem. The rarity and unpredictable presentation of this condition makes the design and setting of randomized prospective trials impossible. Guidelines on this matter are also difficult to establish. Based on a comprehensive evaluation of published literature and their experience, the authors review the etiology and best options for treatment, either surgical and non surgical, according to present knowledge.

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。

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。

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。

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.

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。

气管支架置入术治疗重症气道狭窄的疗效与经验

目的总结气管支架置入术治疗重症气道狭窄的疗效和经验。方法各种原因引起的气管和主支气管狭窄患者13例。术前常规行高千伏胸部X线摄片和CT检查以了解气道狭窄的部位、形态和范围。狭窄段位于气管10例、右侧主支气管1例、左主支气管2例。在透视下将多功能导管配合超滑导丝经过声门进入气管,随后更换金属加强导丝并随导管越过狭窄段,将导丝留置于狭窄段远端,撤除导管,将装有支架的置入器沿导丝送至狭窄段,释放支架。结果全部支架均成功置入,技术成功率100%。术后所有患者呼吸困难症状明显改善,恶性肿瘤患者平均存活时间为6.2个月,1例良性气管狭窄患者随访5年仍无再狭窄。结论气管支架置入术是治疗重症气道狭窄的有效方法。

全麻下自膨式金属支架治疗恶性气管狭窄的临床应用

目的评价全麻及透视下气管内自膨式镍钛合金支架治疗恶性气管狭窄的安全性和疗效。方法全麻下金属支架治疗气管恶性狭窄患者10例,均在透视定位下释放气管金属支架。结果10例患者气管支架释放均获成功,其中1例病变累及气管隆突,置入Y型气管支架。气管支架置入后,10例患者术前呼吸困难、气喘等症状均明显改善。结论全麻及透视下置入气管支架是一种安全、有效的治疗方法,能迅速缓解恶性气管狭窄的一系列症状,明显改善患者的生活质量,具有较高的临床应用价值。

气管支架置入术治疗气管恶性狭窄的并发症分析

目的探讨应用气管支架治疗气管恶性狭窄的并发症。方法回顾性分析1999年11月—2011年6月在局麻和数字减影血管造影机下应用气管支架治疗气管恶性狭窄的25例患者资料,其中6例置入Z型不锈钢支架,19例置入镍钛记忆合金支架,观察支架相关并发症。结果置入Z型不锈钢支架的6例患者中,所有支架置入后即刻完全扩张,2例出现支架移位,随访期中支架再狭窄3例,其中肿瘤增生性狭窄1例,黏稠痰液阻塞性狭窄1例,支架断裂伴肉芽增生性狭窄1例;置入镍钛记忆合金支架的19例患者中,术中无支架移位,2例即刻完全扩张,17例术后3天～3个月扩张完全,随访期内支架再狭窄2例,其中肿瘤增生性狭窄1例,肉芽增生性狭窄1例。所有患者术后呼吸困难即刻明显改善。结论应用气管支架治疗气管恶性狭窄有一定并发症,但仍是一种作用迅速、效果显著的治疗措施。

内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床应用价值

目的探讨内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床价值及食管支架置入术并发症的防治。方法回顾性分析163例晚期食管癌患者内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床资料,其中7例患者为食管癌性狭窄并食管-支气管瘘伴双下肺感染,19例患者为食管癌术后复发吻合口狭窄置入镍钛记忆合金覆膜支架。102例患者由于食管过于狭窄先行食管扩张,再进行内镜下放置食管支架,35例患者直接内镜下置入食管支架。结果 163例患者先后放置174个支架,均一次性置入成功,成功率为100%。163例患者均有不同程度胸痛不适,有32例支架再狭窄,其中19例单纯行支架内球囊扩张,11例于原支架上端内部分重叠再放置一支架,有26例行氩气刀再通治疗。7例患者出现支架移位,有2例支架进入食管瘘管内于次日在内镜下取出支架重新放置。所有病例均未出现食管破裂、食管血肿或出血等严重并发症,术后患者进食能力提高,食管气管瘘闭合。结论内镜下覆膜食管支架置入术是中晚期食管癌性狭窄简单、安全、有效的姑息治疗方法,能提高患者的生活质量,延长患者的生存期。

纤维支气管镜下带囊支架置入术治疗儿童气管狭窄2例

目的通过纤维支气管镜下带囊支架置入术治疗儿童气管狭窄,观察近期疗效和并发症。方法例1,女,4月龄,因＂发现心脏杂音3个月余,咳嗽10 d渐加重,伴发热、喘息3 d＂入院,诊断为膜周部＋肌部室间隔缺损,房间隔缺损（继发孔型）,肺动脉高压,主气道下段及左右主支气管变形狭窄。行肺动脉环缩术,房间隔、室间隔缺损修补术＋主动脉悬吊术成功后,术后2个月内3次撤离呼吸机均未成功。例2,女,1岁10个月,因＂咳嗽1个月余＂入院,诊断为左主支气管狭窄,EBV相关性噬血细胞淋巴组织细胞增生症。左侧支气管狭窄致使排痰困难,肺部反复感染,左肺气肿。2例患儿家长在充分了解纤维支气管镜下带囊支架置入术可能的风险后签署知情同意书。采用＂边麻边进＂方法行气道黏膜表面麻醉,例1和例2选择带囊支架长度分别为24和29 mm,直径均为4 mm（均经雷帕霉素处理）,由支架导入器送入纤维支气管镜,在纤维支气管镜直视下释放带囊支架,然后退出支架导入器。结果 2例患儿置入带囊支架后狭窄段气管扩张良好,带囊支架放置2~3个月随访,未见肉芽组织增生等并发症。结论纤维支气管镜下带囊支架置入术治疗气管狭窄近期疗效较好,远期疗效尚待观察。

金属内支架治疗恶性气道狭窄和胸腔胃——支气管瘘及支气管残端瘘

目的探讨不同规格的金属内支架治疗严重气管狭窄和胸腔胃-气道瘘及肺叶切除术后支气管残端瘘的疗效。方法根据影像资料显示气管、支气管狭窄段位置、长度,瘘口位置、大小、范围及程度,设计镍钛记忆合金丝编织型管状裸支架或覆膜支架,治疗气管狭窄26例;气管-支气管分叉状裸支架治疗气管-支气管复合狭窄8例;气管-支气管分叉状覆膜支架治疗胸腔胃-右支气管瘘5例,支气管残端瘘4例。支架均在DSA监视下经口腔置入病变部位。结果43例共用镍钛记忆合金网状管状裸支架24枚,覆膜支架7枚(5例支架置入后再狭窄,重新置入覆膜支架)。17枚气管-支气管分叉型支架,其中9枚覆膜。支架置入后呼吸困难、憋喘及呛咳等症状即刻缓解,碘水造影显示瘘口完全封堵,无对比剂溢出。症状改善率为100%。结论依据影像资料选择记忆合金网状内支架治疗严重气管狭窄、胸腔胃鄄气道瘘、支气管残端瘘,能迅即解除呼吸困难和封堵瘘口,疗效可靠,值得临床推广应用。

全身麻醉下气管支架植入术治疗恶性气管狭窄

目的评价全身麻醉下气管支架植入术治疗恶性气管狭窄的疗效。方法选择因恶性肿瘤致气管狭窄、中、重度呼吸困难患者17例,行全身麻醉及气管插管,于DSA监视下经气管套管植入镍钛记忆合金支架。结果全部病例均成功植入支架,呼吸困难症状立即得到改善。随访3～24个月,支架无移位,气管通畅,患者无明显疼痛及异物感。结论全身麻醉下气管支架植入术治疗恶性气管狭窄安全、快捷、有效,患者痛苦小,可为后续治疗提供条件。

喉罩通气全身麻醉下经纤维支气管镜辅助置入Montgomery T型硅酮支架治疗气管狭窄的临床研究

目的探讨喉罩通气全身麻醉下经纤维支气管镜辅助置入Montgomery T型硅酮支架治疗气管狭窄的疗效及安全性。方法回顾性分析10例气管切开术后良性气道狭窄拔管困难经喉罩通气全麻下经纤支镜辅助置入Montgomery T型硅酮支架治疗的患者的临床资料。比较患者T管置入前后生活质量评分、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、呼吸困难评分、嗓音综合质量评分的变化及患者并发症发生情况。结果患者术后1周生活质量评分、PaO_2较术前均明显提高(P<0.05),嗓音质量综合评分及呼吸困难评分较术前明显下降(P<0.05),无严重并发症发生。结论喉罩通气全麻下经纤支镜辅助置入Montgomery T型硅酮支架治疗气管狭窄安全有效,可作为气管插管后气道狭窄致拔管困难患者的一种选择。