气道内支架在复发性多软骨炎中的应用

目的观察气道内支架治疗累及气道的复发性多软骨炎(RP)的可行性和安全性。方法收治累及气道的RP患者6例(男1例,女5例),6例患者均存在不同程度的呼吸困难,据气道狭窄部位、程度不同,在手术室全麻下,在电子支气管镜引导下行气道内支架置入术,术后第3 d、7 d、30 d、60 d行电子支气管镜检查,了解支架的释放、位置及并发症情况。结果 6例患者共放置7个气道支架,其中I形支架4个,L形支架1个,Y形支架2个;7个支架均一次性成功置入;支架置入后患者呼吸困难症状明显改善,症状缓解。结论气道内支架置入术是治疗气道受累RP的有效方法,可改善患者症状,提高生存质量。     

球囊扩张术治疗结核性气道狭窄的临床价值

目的探讨经纤维支气管镜球囊扩张术治疗结核性气道狭窄的临床价值。方法对22例结核性气管和支气管狭窄患者,在内镜直视下进行球囊扩张治疗,并在术前和最后一次球囊扩张术治疗后当天评价气道开放、近期疗效和肺功能改善情况。结果 22例患者经纤维支气管镜球囊扩张后临床症状明显缓解,即刻疗效达到了95.5%,狭窄段气道直径明显增大(P0.01),气促评分明显降低,术后FEV1明显上升(P0.05)。结论纤维支气管镜下球囊扩张治疗结核性气道狭窄能较好的改善肺通气功能,缓解气促症状,尤其以纤维疤痕为主的气道狭窄疗效好,是一种简单、安全、有效的治疗方法。     

纤维支气管镜下高压球囊扩张术治疗结核性重度支气管狭窄

目的 探讨经支气管镜下高压球囊扩张术治疗重度支气管狭窄的临床疗效和安全性.方法 对28例结核性支气管重度狭患者实施高压球囊扩张气道成形术.分别于术前和最后一次球囊扩张术后,测定患者狭窄的气道直径、气促评分和第1秒钟最大呼气量（FEV1）.结果 28例患者分别接受高压球囊扩张术2～9次,平均（3.19±1.23）次/人.治疗前后,狭窄段气道直径明显扩大（P＜0.0l）,气促评分明显减低（P＜0.01）.术后FEV1较术前显著提高（P＜0.01）.近期疗效100％.随访18个月,远期疗效达92.9％.治疗过程中,有4例患者感轻微胸痛、2例痰中带血、发热1例.结论 经纤维支气管镜介导下高压球囊扩张气道成形术对重度结核性气道狭窄疗效显著,是l项安全和简便的治疗方法.     

纤维支气管镜定位和引导下国产支架介入治疗严重气道狭窄18例分析

目的探讨纤维支气管镜(纤支镜)定位和引导下国产支架介入治疗严重气道狭窄的应用价值。方法18例气道狭窄患者均采用常规咽喉部局麻和/或环甲膜注射利多卡因后经纤支镜定位和引导放置国产镍钛记忆合金支架(NT支架)。结果18例均一次性放置成功,呼吸困难症状迅速缓解。结论经纤支镜定位和引导下放置国产NT支架是治疗严重气道狭窄既经济又有效的方法。     

支气管镜引导联合透视下气道支架置入术治疗恶性气道狭窄的临床分析

目的研究支气管镜引导联合透视下气道支架置入术治疗恶性气道狭窄的疗效。方法对2003年01月至2013年05月因恶性气道狭窄置入气道支架的患者随访12个月,评估疗效及并发症。结果80例恶性肿瘤导致的气道狭窄患者均能顺利置入气道支架,术中无患者死亡,置入后呼吸困难评级、FVC、FEV1、PEF及Pa O2等指标均明显改善(P0.05),出现远期并发症的几率为11.25%。结论支气管镜引导联合透视下气道支架置入术对恶性气道狭窄能迅速的缓解呼吸困难症状,短期疗效显著,安全性好。     

数字减影血管造影术联合气管镜支架置入治疗恶性气道狭窄临床应用

正气道金属支架置入是治疗恶性肿瘤引起的中央气道狭窄的有效方法,支架置入后呼吸困难可立即显著改善,支架再次置入对治疗支架置入后再狭窄所致呼吸困难仍然有效[1]。患者因气道狭窄、病情危重,在支架置入时操作困难。我科采用数字减影血管造影术(digital subtraction angiography,DSA)透视下联合支气管镜引导下气管镍钛合金支架置入治疗10例恶性重度气道狭窄患者取得良好疗     

气道Y型覆膜内支架置入的临床应用（附2例报道）

目的初步探讨气道Y型覆膜内支架治疗气管隆突和双主支气管复合病变（狭窄或瘘）的可行性和疗效。方法根据气道复合狭窄和食道／胸腔胃－隆突瘘的特殊解剖结构，设计Y型气道覆膜内支架。在纤维支气管镜指导及X线监视下，对2例气道复合病变患者置人Y型气道覆膜内支架。结果内支架均一次性置入成功，2例患者置人内支架后均症状缓解。生活质量提高。结论Y型覆膜气道内支架置入能有效解除气道复合病变，技术可行，操作简单、安全、近期疗效可靠，值得进一步推广应用。     

支气管镜引导置入气管支气管支架治疗肺癌并气道狭窄的临床分析

目的分析经支气管镜引导置入气管支气管支架治疗肺癌并气道狭窄的经验和疗效。方法肺癌并气道严重狭窄患者,行支气管镜引导下气管支气管支架置入术。结果 15例患者均成功置入气管支气管支架,且置入后呼吸困难的症状立即缓解,PaO2、PaCO2明显被改善,咳嗽、咯血等近期并发症轻微;出现气道阻塞、支架移位等远期并发症的几率均为6.7%。结论支气管镜引导气管支气管支架置入术,对肺癌并气道狭窄患者是安全有效的,且操作简便,能明显改善患者近期生活质量。     

气管镜介入治疗对120例良性气道狭窄的疗效分析

目的探讨多种气管镜介入治疗方法对不同病变类型气道内良性狭窄的疗效。方法经气管镜治疗的良性气道狭窄患者120例,其中气道内瘢痕组55例,肉芽肿组53例,气道良性肿瘤12例。采用支气管镜下氩等离子体凝固（argon plasmacoagulation,APC）、冷冻、内支架等方法进行治疗,并从狭窄程度及气促评分等方面进行疗效分析。结果经支气管镜APC结合冷冻对气道内瘢痕、肉芽肿、良性肿瘤的处理效果相似。治疗后三组狭窄程度和气促评分较术前均有明显改善,表明APC结合冷冻对良性狭窄的治疗效果立竿见影。结论 APC可一次性大部分清除气道内良性肿瘤和肉芽组织,快速缓解气道梗阻症状。同时配合冷冻治疗,延缓复发时间,后期单用冷冻治疗,可达治愈效果。治疗过程中慎用金属支架。     

纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌气道阻塞

目的观察纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌致气道阻塞的近期疗效。方法对18例支气管肺癌所致气道阻塞患者进行纤维支气管镜下高频电刀烧灼切割术,再行气管内192Ir放疗,观察治疗前和治疗后临床指标的改善情况。结果治疗后18例支气管肺癌患者的临床气促分级、Kamofsky评分与肺功能指标均有显著好转,无明显副反应。结论纤维支气管镜下高频电刀术联合腔内放疗是治疗肿瘤性气道阻塞的有效方法,操作简便易行,值得推广。     

气管支气管支架置入术治疗气管狭窄178例临床分析

目的探讨气管支气管支架置入术治疗气管狭窄的临床疗效。方法选择我院2001年9月至2011年9月治疗的178例气管狭窄患者,在对气道状况进行综合评估的基础上,采用气管支气管支架置入术进行治疗,并对治疗效果、并发症、死亡情况进行分析。结果共放置支架192个,裸支架120个,覆膜支架72个。支架的放置于气管支架103个,右主支气管48个,左主支气管41个。患者在治疗前的气促症状评级为3～4级,治疗后显著改善(P<0.05)。体力状况也得到了明显的恢复(P<0.05)。术后发生气道感染29例,10例患者因肿瘤扩散导致气管再次堵塞,呼吸困难症状加重,重新安装支架。随访观察6个月,死亡62人,死亡原因包括呼吸衰竭、肺部感染、大咯血等,存活率为65.2%(116/178)。大部分存活患者的纤维支气管镜复查结果显示,支架可较好的上皮化,未发生脱落。结论气管支气管支架置入术治疗气管狭窄安全有效,为气管狭窄的治疗提供了一个新的选择。     

Surgical treatment and endobronchial stentplacement for tuberculous tracheobronchial strictures

MATERIALS AND RESULTS: We have seventeen cases of operation for the tuberculous tracheobronchial cicatric strictures. Ten of them were tracheobronchial reconstructions to the strictures, and other seven cases were resections of the peripheral destroyed or infected pulmonary tissues (lobectomy 1, pneumonectomy 6). In the reconstructions seven cases were of sleeve lobectomy (left 6, right 1), three were of segmental resection of left main bronchus and trachea. The results were good in 6 sleeve lobectomies and 2 segmental resections of left main bronchus. All these 8 cases had no marked tracheal strictures, and their postoperative troubles were mild. Two cases with tracheal stricture (left sleeve lobectomy and tracheal segmental resection with left pneumonectomy) suffered from postoperative major complications. In the former the tracheal stentplacement was needed for a long time, in the latter its tracheal anastomosis was disrupted and the patient died six months later. Peripheral pulmonary resections could get the good results to disappear their longstanding various symptoms and signs. We tried to do the endoscopic dilatation or stenting to three tracheal strictures. One case was treated by the endoscopic electrocauteries and baloon dilatations totally in 15 times, but its late prognosis was poor and the patient died of the ventilatory disturbance 53 months later. Another one was the case of left upper sleeve lobectomy with tracheal stricture, and already mentioned its tracheal stent. In the third case the tracheal wall was damaged so deeply and extensively that the tracheomalacia might cause to suffocate. Then the tracheal stricture had been dilated with several sized stents step by step, finally a silicon long T-tube was inserted into the trachea successfully. But 10 days later a hard mucous plug impacted inside the tube and the patient died. In recent Japanese literatures and meeting reports, there were sixty cases of endoscopic surgeries and stentplacement for tuberculous tracheobronchial strictures. In these cases about half ones were for the left main bronchus, one third for the trachea. In the former the rupture of bronchial wall happened in 6%, the dislocations of stent in 22% and restrictures came out in 26%. In the latter the complication death occurred in 14%, stent dislocations in 30% and restrictures in 46%, so it was only 30% to become to be free from tracheal stents. CONCLUSIONS: For the treatment of tuberculous cicatric tracheobronchial strictures, the reconstruction of main bronchus in cases without marked tracheal stenosis is a good indication to regain the lost pulmonary function. The resection of peripheral lung is also a good indication to reduce many symptoms and signs from them. However various endoscopic treatments involving stentplacement has not been established yet enough, especially in a point of late prognosis, so we have to be careful to do such procedures. The new apparatus with more durable and easily handled will be expected to develop in near future.     

Endobronchial stenting for severe airway obstruction in relapsing polychondritis.

Airway complications of relapsing polychondritis (RP), including tracheobronchial stenosis, can be fatal. This paper describes a life-saving technique (placement of multiple metallic endobronchial stents under conscious sedation) to prevent life-threatening airway closure in a 50-year-old woman with RP. Using fluoroscopic and bronchoscopic guidance, a tracheal stent and three endobronchial metallic stents were deployed in the central airways, with good functional outcome. There were no complications. In critical airway compromise caused by RP, the insertion of endobronchial stents can result in improved symptoms, pulmonary function, and a return to daily activities, without the use of tracheotomy and mechanical ventilation.     

Tracheobronchial stenting for tuberculous airway stenosis

We reviewed the results of the use of the Dumon silicone stents in patients experiencing tuberculous tracheobronchial stenosis since 1994, using a retrospective case review in a university teaching hospital with 1,450 beds serving a population of > 1.8 million. Between February 1994 and September 2001, seven patients with tuberculous tracheobronchial stenosis (mean age, 43 years) underwent a total of 11 dilatations with placement of 10 straight stents and 1 Y stent. Under general anesthesia, all patients underwent rigid bronchoscopy and dilatation of the stenosis with placement of a Dumon stent. There were no deaths. One patient developed a pneumothorax. Two patients experienced migration of the stent, which required reintervention for adjustment of position of the stent. The stents were left in situ for a mean period of 32 months. There was marked improvement in dyspnea in all patients after the procedure, as determined by visual analog scale. Endoscopic dilatation with placement of a silicone stent is an effective treatment for patients with tuberculous tracheobronchial stenosis.     

床边纤维支气管镜在危重病急救中的应用

目的评价床边纤维支气管镜(纤支镜)在危重病急救中的应用价值。方法回顾性分析床边纤支镜检查及治疗的163例患者的临床资料。结果纤支镜引导经鼻气管插管、换管及引导胃插管成功率高、效果好。对气道压力明显异常、血氧饱和度下降、呼吸困难、咯血、肺不张、严重肺部感染等能查找出原因,给予调整气管导管,清除呼吸道分泌物,局部止血及用抗生素并予射频消融、球囊扩张等治疗,疗效显著。结论床边纤支镜检查及治疗在及时救治重症病人中具有极高的实用价值。     

Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis

STUDY OBJECTIVES: A frequent complication of the widely used Dumon silicone stent is its tendency to migrate when used in tracheal stenosis. We compared the clinical efficacy and complications (including migration) of the Dumon stent with a screw-thread stent, a device with an increased stent-to-wall contact surface and, theoretically, less tendency to migrate. DESIGN: Retrospective case analysis. SETTING: Academic hospital. MATERIALS AND METHODS: Forty-six patients with tracheal stenoses (23 benign and 23 malignant) requiring the placement of 50 stents (29 Dumon and 21 screw-thread) were studied. In 26 patients Dumon stents were used, and in 20 patients screw-thread stents were used. Both patient groups had comparable clinical and stenosis-related characteristics. RESULTS: Stent insertion and follow-up were uneventful in both the Dumon and the screw-thread insertions, respectively: 62% vs 67% (not significant). There were seven migrations in the Dumon group, compared to only one migration in the screw-thread group, respectively: 24% vs 5%. This difference did not reach statistical significance (p = 0.1). All of the migrations occurred in the benign stenosis group, and none occurred in the malignant-stenosis group, respectively: 8 of 23 vs 0 of 23, p = 0.004. Within the benign-stenosis group, the Dumon stent had a significantly increased risk for migration when compared to the screw-thread stent, respectively: 7 of 13 vs 1 of 11, p = 0.033. CONCLUSIONS: The screw-thread stent and the Dumon stent are equally effective in the management of tracheal stenosis. There is a general trend toward a decreased migration rate, and a significantly lower risk for migration in patients with benign tracheal stenosis. The (less expensive) screw-thread stent may represent an attractive alternative in the management of tracheal stenosis in general, and may be preferable to the Dumon stent in treating benign tracheal stenosis.     

Physiologic studies of tracheobronchial stents in airway obstruction.

When airway obstruction is due to extraluminal compression and/or dynamic collapse, metal and silicone rubber prosthetic stents may stabilize the affected airway. Through a rigid bronchoscope, we inserted three metal stents in two patients and 18 silicone stents in 15 adult patients with symptomatic tracheobronchial compression and dynamic airway collapse. The underlying cause was malignancy in three patients; benign tracheobronchial malacia in three patients, two of whom refused surgical resection; and tracheobronchial stenosis that developed at the anastomotic site following lung transplantation in 11 patients. Clinical status and lung function studies were analyzed before and after stent insertion. Following stent insertion, airway diameter at least doubled and near normal patency of the affected tracheobronchial tree was achieved in every patient using stents of axial length 4 to 5 cm. The stents were well tolerated clinically, and all patients noted immediate relief of dyspnea. Following stent insertion, the forced vital capacity (FVC) increased from 64 +/- 21% predicted (mean +/- 1 SD) to 73 +/- 19% predicted, p less than 0.1; the forced expiratory volume in 1 s (FEV1) from 49 +/- 25% predicted to 72 +/- 26% predicted, p less than 0.02; the ratio of the FEV1/FVC from 59 +/- 16% to 78 +/- 15%, p less than 0.01; and the maximum flow at 50% expired FVC from 38 +/- 26% predicted to 72 +/- 31% predicted, p less than 0.01.     

支架置入治疗气管恶性狭窄

目的 探讨气管内支架留置的方法,及观察自胀式金属内支架在气管恶性狭窄中的疗效。方法 12例患者全部采用在透视下．经口、喉、气道内支架留置术。结果 患者呼吸困难在支架留置后即刻改善。l2例均获成功．没有技术上失败。结论 气管恶性狭窄的内支架留置术安全、有效．能明显提高患者的生活质量。