气管球囊扩张联合镍钛合金气管支架置入治疗良性气管狭窄
摘要
目的探讨应用气管球囊扩张联合气管镍钛合金支架置入治疗良性气管狭窄的疗效和安全性。
方法在局麻或药物静脉麻醉下,12例外伤、气管切开、插管或气管、支气管结核导致的气管狭窄者,在纤维支气管镜监测下应用气管球囊扩张气管狭窄部,然后采用纤维支气管镜定位法放置镍钛合金气管支架。
结果经气管球囊扩张后,12例气管狭窄患者的镍钛合金支架均一次性放置成功,支架扩张良好。术后拔除气管套管或插管后呼吸困难症状立即缓解,原丧失语言功能的患者术后能马上恢复语言功能。无局部严重损伤及病情恶化。术后有一定的并发症,但易于控制。
结论气管球囊扩张可以简单、安全和快速的扩张狭窄气管,建立适宜气管腔,为支架置入及支架完全扩张提供条件。镍钛合金支架对治疗良性气管狭窄有立竿见影的效果,是解决良性气管狭窄较安全有效的方法之一。
Objectives To investigate the efficacy and safety of balloon dilatation and nitinol stent implantation in the treatment for benign tracheobronchial stenosis.
Methods Twelve patients with benign tracheobronchial stenosis caused by traffic accident or tracheotomy underwent balloon dilation through bronchofibroscope under general or local anesthesia . Nitinol stents were placed to the stenosis airway by bronchofibroscope location.
Results 12 stents were successfully placed and resulted in sufficient dilation for tracheal stenosis segment ,dyspnea was rapidly improved and patients could speak immediately again.
Conclusions Balloon dilation can provide a simple and effective way for stent implantation. Nitinol stent implantation is an effective and safety treatment for benign tracheobronchial stenosis.
方法在局麻或药物静脉麻醉下,12例外伤、气管切开、插管或气管、支气管结核导致的气管狭窄者,在纤维支气管镜监测下应用气管球囊扩张气管狭窄部,然后采用纤维支气管镜定位法放置镍钛合金气管支架。
结果经气管球囊扩张后,12例气管狭窄患者的镍钛合金支架均一次性放置成功,支架扩张良好。术后拔除气管套管或插管后呼吸困难症状立即缓解,原丧失语言功能的患者术后能马上恢复语言功能。无局部严重损伤及病情恶化。术后有一定的并发症,但易于控制。
结论气管球囊扩张可以简单、安全和快速的扩张狭窄气管,建立适宜气管腔,为支架置入及支架完全扩张提供条件。镍钛合金支架对治疗良性气管狭窄有立竿见影的效果,是解决良性气管狭窄较安全有效的方法之一。
Objectives To investigate the efficacy and safety of balloon dilatation and nitinol stent implantation in the treatment for benign tracheobronchial stenosis.
Methods Twelve patients with benign tracheobronchial stenosis caused by traffic accident or tracheotomy underwent balloon dilation through bronchofibroscope under general or local anesthesia . Nitinol stents were placed to the stenosis airway by bronchofibroscope location.
Results 12 stents were successfully placed and resulted in sufficient dilation for tracheal stenosis segment ,dyspnea was rapidly improved and patients could speak immediately again.
Conclusions Balloon dilation can provide a simple and effective way for stent implantation. Nitinol stent implantation is an effective and safety treatment for benign tracheobronchial stenosis.
引文
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[9] 苏红,柳广南,张建全,等.三种气管内镍钛合金气管支架定位和置入法的比较.中华内科杂志,2005,44:625-626.
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[13] Schmidt B,Olze H,Borges AC,et al. Endobronchial ballon dilatation and stent implantation in benign stenoses.A nn Thorac Surg,2001,71: 1630-1634.
[14] Wan IY, Lee TW, Lam HC, et al. Tracheobronchial stenting for tuberculous airway stenosis.Chest,2002,122:370-374.
[15] Lehman JD,Gordon RL, Kerlan RK ,et al. Expandable metallic stents in benign tracheobronchial obstruction. J Thorc Imaging, 1998,13:105-115.
[16] Tojo T, Iioka S,Kitamura S,et al. Management of malignant tracheo- bronchial stenosis with metal stents and dumon stents.Ann Thorac Surg,1996,61:1074-1078.
[17] 李强.气管及支气管支架的临床应用.中华结核和呼吸杂志,2003,26,393.
[18] Nashef SA,Dromer C,Velly JF,et al. Expanding wire stents in benign tracheobronchial disease: Indications and complications. Ann Thorac surg,1992,54:937-940.
[19] Wallace MJ, Chamsangave JC, Ogawa K, et al.Tracheobronchail tree: expandable metallic stents used in experimental and clinical applications Work in progress.Radiology,1986,158:309-312.
[20] Ferretti G,Jouvan FB,Thony F,et al. Benign noninflammatory bronchial stenosis:treatment with balloon dilation.Radiol,1995,196: 831-834.
[21] 张伟,陈正贤,郭红全,等.气管内支架长期放置致大咯血 1 例 .中华结核和呼吸杂志,2001,24:354.
[22] 张红,王广发.纤维支气管镜下球囊扩张术治疗中心气管狭窄.中国医刊,2004,39:22-24.
[23] Lee KW,Im JG,Han JK,et al.Tuberculous stenosis of left main bronchus:results of treatment with balloons and metallic stents. J Vasc Interv Radiol,1999,10:352-358.
[24] Dumon JF,Cavaliere S,Diaz-Jimenez JP, et al. Seven-years experience with the dumon prosthesis. J Bronchology , 1996,3:6-10.
[25] 郭启勇,棠钢,刘兆玉,等.气管内留置螺旋状金属支架的基础研究 .中华放射学杂志,1995,29,484.
[1] Bond CJ. Note on the treatment of tracheal stenosis by a new T-shaped tracheotomy tube. Lancet,1891,1:539.
[2] Harkins WB. An endotracheal metallic prosthesis in the treatment of stenosis of the trachea. Ann Otol Rhinol Laryngol,1952,61:932-935.
[3] Susanto I,Peters JI,Levine Sm,et al.Use of Balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation. Chest,1998,114:1330-1335.
[4] Becker HD. Stenting the central airways. J Bronchol,1995,2:98-106.
[5] 冯起效,李七郎,谭戈峰,等.经内镜置放国产镍钛记忆支架治疗气管狭窄的临床应用.综合临床医学,1998,14:318-320.
[6] Tan BS,Watkinson AF,Dussek JE, et al. Metallic endoprostheses for malignant tracheobronchial obstruction: initial experience. Cardiovase Intervent Radiol,1996,19:91-96.
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