摘要
目的探讨支气管镜下覆膜支架封堵治疗气管支气管瘘的疗效及安全性。方法 7例气管支气管瘘患者,所有患者均行覆膜支架封堵治疗,探讨其治疗效果及安全性。结果 7例患者中,瘘口共9个;瘘口口径最小0.10 cm,最大2.50 cm,平均瘘口口径(0.90±0.88)cm,共置入气管覆膜金属支架8枚。7例患者术后支架均张开良好,完全覆盖瘘口。临床完全缓解(cCR)有5例;临床部分缓解(cPR)有2例。气管覆膜支架封堵治疗术后临床症状缓解率为100%。7例患者术后气促评分为(1.57±0.98)分,低于术前的(3.14±1.07)分,差异具有统计学意义(t=2.86, P<0.05)。7例患者术后卡氏功能状态评分标准(KPS)评分为(82.86±17.99)分,高于术前的(58.57±17.72)分,差异具有统计学意义(t=2.55, P<0.05)。7例患者术后72 h内支架均张开良好,无大咯血。1例(14.29%)因大咯血死亡,发生时间为术后4 d;其余6例(85.71%)1个月内均无吸入性肺炎新发,饮水进食呛咳消失,可进半流食或软食,体重有所增加。结论支气管镜下置入覆膜支架能够有效封堵气管支气管瘘,改善临床症状。
Objective To discuss the efficacy and safety of bronchoscopic covered stent occlusion in the treatment of tracheobronchial fistula. Methods 7 patients with tracheobronchial fistula were treated with covered stent occlusion, and the treatment effect and safety were discussed. Results Among the 7 patients, there were 9 fistulas; the smallest caliber of the fistula was 0.10 cm, the maximum was 2.50 cm, and the average caliber was(0.90±0.88) cm. A total of 8 tracheal-coated metal stents were placed. The postoperative stents were wellopened in 7 patients and completely covered the fistula. There were 5 cases of clinical complete response(cCR) and 2 cases of clinical partial response(cPR). The remission rate of clinical symptoms after tracheal covered stent occlusion was 100%. 7 patients had lower dyspnea score after operation as(1.57±0.98) points than(3.14± 1.07) points before operation, nad the difference was statistically significant(t=2.86, P<0.05). 7 patients had higher Karnofsky performance status(KPS) score as(82.86±17.99) points after operation than(58.57±17.72) points before operation, and the difference was statistically significant(t=2.55, P<0.05). The stents were well opened within 72 hours after operation in 7 patients without massive hemoptysis. 1 patient(14.29%) died of massive hemoptysis 4 days after operation. The remaining 6 cases(85.71%) had no new aspiration pneumonia within 1 month. Drinking water and eating cough disappeared. They could eat semi-liquid or soft food and their body weight increased. Conclusion Bronchoscopic covered stent placement can effectively block tracheobronchial fistula and improve clinical symptoms.
引文
[1]Blackmon SH, Santora R, Schwarz P, et al. Utility of removableesophageal covered self-expanding metal stents for leak and fistulamanagement. Annals of Thoracic Surgery, 2010, 89(3):931-937.
[2]Shin JH, Song HY, Ko GY, et al. Esophagorespiratory fistula:long-term results of palliative treatment with covered expandable metallicstents in 61 patients. Radiology, 2004, 232(1):252-259.
[3]StulbargRC,AdamsL.Textbookofrespiratorymedicine.Philadelphia:Saunders, 1994:511-512.
[4]苏铎华,汤春梅,张言斌,等.气管-支气管淋巴结瘘型结核的临床特征及经支气管镜介入治疗的研究.实用医学杂志,2014(13):2111-2114.
[5]Yen-Hao C, Shau-Hsuan L, Yi-Chun C, et al. Comparativestudy of esophageal stent and feeding gastrostomy/jejunostomy fortracheoesophageal fistula caused by esophageal squamous cellcarcinoma. PLoS ONE, 2012, 7(8):e42766.
[6]Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest SurgeryClinics of North America, 2003, 13(2):271-289.
[7]Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratory fistulasof tumorous origin. Non-operative management of 264 cases in a20-year period. European Journal of Cardio-Thoracic Surgery,2008, 34(5):1103-1107.
