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1.
全身麻醉下气管支架植入术治疗恶性气管狭窄 总被引:2,自引:1,他引:1
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。 相似文献
2.
We have provided general anesthesia for a 53-year-old man scheduled to undergo lymph node removal for right mediastinal lymph
node metastases caused by esophageal cancer. One year prior, acute respiratory failure occurred because of stenosis of the
carinal bifurcation resulting from advanced esophageal cancer with tracheal invasion. The patient underwent placement of tracheobronchial
stents (Spiral Z Stent) in two locations (left main bronchus and trachea/right main bronchus), followed by radiotherapy and
chemotherapy. In the present case, after an 8.5-mm-ID tracheal tube was placed under bronchoscopic guidance, a 7.0 Fr. bronchial
blocker (Arndt Endobronchial Blocker; Cook, Bloomington, IN, USA) was carefully inserted into the stent in the right main
bronchus. Next, 3 ml air was injected into the blocker cuff, and left-sided one-lung ventilation was performed. After surgery
was completed, the bronchial blocker was removed under bronchoscopic guidance. We confirmed there was no tracheobronchial
injury nor stent displacement or deformation, then removed the tracheal tube. Even in patients with tracheobronchial stent
placement, one-lung ventilation can be safely and reliably performed by selecting an appropriate bronchial blocker, along
with careful insertion into the stent and frequent checking of the blocker position. 相似文献
3.
Nikolaos Charokopos Christophoros N. Foroulis Efi Rouska Maria N. Sileli Nikolaos Papadopoulos Christos Papakonstantinou 《European journal of cardio-thoracic surgery》2011,40(4):919-924
Objective: The optimal management of post-intubation tracheal stenoses is surgical reconstruction of the airway. Stenting of the trachea using silastic T-tubes or one of the various types of tracheal stents are the alternative ways to surgical reconstruction for the management of post-intubation tracheal stenoses. The early and long-term results of 11 patients with post-intubation tracheal stenosis, who underwent tracheal stenting with self-expandable metallic stents (SEMSs), are presented. Methods: Twelve patients (10 men, mean age: 47.8 ± 20.4 years) with post-intubation tracheal stenosis were referred for tracheal stenting with SEMS (2000–2004). In three cases, the upper tracheal stenosis extended within the subglottic larynx. Stenting was successful in 11 patients, while, in one patient with involvement of the subglottic larynx, the attempt to insert the stent failed. Follow-up time varied from 6 to 96 months, and it was made with virtual and fiberoptic bronchoscopy. Results: Immediate relief of obstructive symptoms was observed in all the 11 patients, where an SEMS was successfully inserted. Stent dislodgement occurred shortly after the procedure in two patients, and it was treated with insertion of a new stent in the first case and a stent-on-stent insertion in the second. Good patency of the stent was observed in three patients for 60–96 months. Three patients with good patency of the stent died from other reasons 24–48 months after stent insertion. Four patients developed obstructive granulation tissue at the ends of the stent after 12–43 months, requiring further treatment with thermal lasers and/or tracheostomy. One patient underwent stent removal and successful laryngotracheal reconstruction 6 months after stent insertion. Conclusions: The application of SEMS in post-intubation tracheal stenoses results in immediate improvement of obstructive symptoms without significant perioperative complications. SEMSs have the potential risks of migration and of granulation tissue formation at the end of the stent. SEMS should be applied only in strictly selected patients with post-intubation tracheal stenosis, who are considered unfit for surgery and/or with limited life expectancy. 相似文献
4.
Yi-Ting Yeh Chinsu Liu Hsin-Lin Tsai Fei-Yi Wu Wen-Jue Soong Yu-Sheng Lee Pei-Chen Tsao 《Journal of pediatric surgery》2019,54(12):2492-2497
BackgroundCongenital tracheobronchial stenosis (CTBS) is a rare congenital condition characterized by complete cartilage rings covering varying lengths of the major airway. In this study, we reviewed the outcomes of patients with CTBS receiving surgical tracheoplasty in our institute.MethodsWe retrospectively analyzed the outcomes of consecutive patients with CTBS operated between 2006 and 2017 when extracorporeal membrane oxygenation (ECMO) was used perioperatively.ResultsIn total, 11 patients (median follow-up period, 4.2 years; interquartile range, 1.6–5.4) were included. Seven were symptomatic in the neonatal period, 10 had cardiorespiratory anomalies, 7 required preoperative bronchoscopic balloon dilatation, and 1 required preoperative stent placement. Slide tracheoplasty (STP) was performed in 9 patients, and 2 underwent pericardial patch tracheoplasty. Seven patients required postoperative balloon dilatation, and 6 required postoperative stent placement. Early stenting provided immediate ventilatory improvement in all patients and facilitated successful extubation in a median of 4 days after stenting in 80% of the patients.ConclusionsUnder ECMO, severe CTBS could be successfully treated through a combination of tracheoplasty and bronchoscopic management. STP provided excellent results for solitary trachea stenosis with a minimum diameter of ≥ 3 mm. In selected patients, postoperative tracheobronchial stent placement was crucial in minimizing the ECMO duration and facilitating extubation.Level of EvidenceIV 相似文献
5.
Self-expanding Polyflex plastic stents in esophageal disease: various indications,complications, and outcomes 总被引:4,自引:0,他引:4
Ott C Ratiu N Endlicher E Rath HC Gelbmann CM Schölmerich J Kullmann F 《Surgical endoscopy》2007,21(6):889-896
Background Esophageal stenting has become an important technique in the treatment of different clincal problems such as malignant or
benign stenosis, anastomotic leaks after surgery, or fistulas. In this study we present our experience with the self-expanding
Polyflex plastic stent in various indications, arising complications, and patient’s outcomes.
Methods Over a three-year period, 35 patients underwent self-expanding Polyflex plastic stent placement for esophageal stenosis (n = 23) with 22 malignant, and for perforations, fistulas, or anastomotic leaks after surgery (n = 12). The short-term efficacy and long-term outcomes were analyzed.
Results In patients with stenosis, implantation was performed without any complications in 91% (21/23). In one patient perforation
occurred while passing the stenosis; in another patient the stent dislocated during the insertion procedure. Dysphagia score
improved from 3.0 to 1.0 after stenting. In all patients with perforations, fistulas, or anastomotic leaks (n = 12), stents were placed successfully without any complication. Complete sealing of the mucosal defect was proven by radiography
in 92% (n = 11) and healing was seen in 42% (n = 5). If indicated, stent removal was performed without any complications. Stent migration (n = 13; 37%) was the most common long-term complication.
Conclusions The placement of self-expanding Polyflex plastic stents is a highly sufficient and cost-effective treatment for malignant
and benign esophageal disorders. Because the long-term results were highly favorable, self-expanding plastic stent placement
could be used as the initial treatment for various conditions. 相似文献
6.
Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients 总被引:1,自引:0,他引:1
Background: To evaluate the use of esophageal stents for temporary sealing of acquired benign tracheoesophageal fistulas developed in critically ill, ventilated patients.Methods: This is a retrospective analysis (1992–2003) of the data of 12 mechanically ventilated patients — six of them after major or multiple trauma — being intubated for a median of 30 days before they develop an acquired benign tracheoesophageal fistula. Five of them were in sepsis. Two types of stents were used: the Wilson-Cook esophageal balloon plastic stent in the first four cases and the Ultraflex covered self-expandable stent in the remaining eight. The total procedure was performed at bedside in the intensive care unit, with no special need for supplementary anesthesia or fluoroscopic control.Results: Stent implantation was technically successful in all patients and fistula occlusion was achieved in every case. There was no stent migration and fistulas remained sealed until death or upon decision for removal. Nine patients died between 5 days and 2 months after stent placement, as a result of their diseases. Three patients were referred for fistula surgical repair 33, 36, and 43 days after stent placement. Before surgery the stents were easily removed under direct vision.Conclusion: Temporary closure of an acquired tracheoesophageal fistula developed in critically ill ventilated patients is an easy, bedside-applicable, safe, and effective palliative procedure, with no complications or mortality. 相似文献
7.
D. John Doyle Basem Abdelmalak Michael Machuzak Thomas R. Gildea 《Journal of clinical anesthesia》2009,21(7):529-532
The use of bronchoscopically placed self-expanding metallic stents (SEMS) and silastic stents in patients suffering from tracheobronchial stenosis or similar problems has proven to be an important clinical option. When complications occur, it may be necessary to remove the device. Removal of a SEMS is usually performed during general anesthesia with muscle relaxation and positive pressure ventilation, often using total intravenous anesthesia. Airway management depends on stent type and location. Intubating patients' tracheas with a tracheal stent requires special caution, as it risks damaging tissue and dislodging the stent distally. Potential complications with removal include tracheal disruption, retained stent pieces, mucosal tears, re-obstruction requiring new stent placement, the need for postoperative ventilation, pneumothorax, damage to the pulmonary artery, and death. 相似文献
8.
Takuma Tsukioka Makoto Takahama Ryu Nakajima Michitaka Kimura Keiko Tei Ryoji Yamamoto 《Annals of thoracic and cardiovascular surgery》2015,21(2):114-118
Purpose: Malignant airway stenosis extending from the bronchial bifurcation to the lower lobar orifice was treated with airway stenting. We herein examine the effectiveness of airway stenting for extensive malignant airway stenosis.Methods: Twelve patients with extensive malignant airway stenosis underwent placement of a silicone Dumon Y stent (Novatech, La Ciotat, France) at the tracheal bifurcation and a metallic Spiral Z-stent (Medico’s Hirata, Osaka, Japan) at either distal side of the Y stent. We retrospectively analyzed the therapeutic efficacy of the sequential placement of these silicone and metallic stents in these 12 patients.Results: The primary disease was lung cancer in eight patients, breast cancer in two patients, tracheal cancer in one patient, and thyroid cancer in one patient. The median survival period after airway stent placement was 46 days. The Hugh–Jones classification and performance status improved in nine patients after airway stenting. One patient had prolonged hemoptysis and died of respiratory tract hemorrhage 15 days after the treatment.Conclusion: Because the initial disease was advanced and aggressive, the prognosis after sequential airway stent placement was significantly poor. However, because respiratory distress decreased after the treatment in most patients, this treatment may be acceptable for selected patients with extensive malignant airway stenosis. 相似文献
9.
Nitinol stent for the treatment of tracheobronchial stenosis 总被引:6,自引:0,他引:6
Susumu Sasano Takamasa Onuki Takashi Adachi Kunihiro Oyama Toyohide Ikeda Masato Kanzaki Hiromi Kuwata Motoki Sakuraba Takako Matsumoto Sumio Nitta 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2001,49(5):311-316
OBJECTIVE: The purpose of this study was to evaluate the potential utility of implantation of a nickel-titanium alloy (nitinol) stent for the treatment of malignant or benign tracheobronchial stenosis. METHODS: We evaluated 18 patients (14 men and 4 women) who received 24 nitinol stents, between November 1997 and May 2000. All 18 patients had severe dyspnea caused by tracheobronchial stenosis. The underlying condition was malignant disease in 15 patients, and benign tracheal collapse in the other 3 patients. RESULTS: Implantation of the stent was successfully performed in all patients. Seventeen patients experienced immediate clinical improvement in respiratory symptoms. The remaining 1 patient with a bronchial fistule after lobectomy did not benefit, and died of pneumonia at 16 days after the implantation. In 15 patients, the procedure was performed using a flexible bronchoscope under local anesthesia alone, while the remaining 3 patients needed intravenous sedation. There was no complication resulting from the stent implantation. Among the 3 patients with benign tracheal collapse, 2 patients were alive at 746 and at 401 days after the stent implantation, at the time of this report. One patient with cicatricial stenosis after intubation died of heart failure due to previous myocardial infarction. Among the 15 patients with malignant disease, 4 patients have survived for 177 to 305 days to date, while the other 11 patients have died of primary malignancy with a mean survival duration of 60.2 days. CONCLUSION: The nitinol stent was effective in treating malignant or benign tracheobronchial stenosis, and had some remarkable advantages compared with other tracheobronchial stents. In stenting, most procedures can be performed using flexible bronchoscope under local anesthesia. 相似文献
10.
Hideyuki Niwa Masahide Oki Hideo Saka Atsushi Torii Arisa Yamada Fumie Shigematsu Akane Ishida Yoshihito Kogure 《Interactive Cardiovascular and Thoracic Surgery》2021,33(3):442
Open in a separate windowOBJECTIVESStent migration is a common complication of airway stent placement for upper tracheal stenosis and tracheoesophageal fistula. Although several researchers have reported that external fixation is effective in preventing stent migration, the usefulness and safety of external fixation have not been proved because their cohorts were small. We therefore investigated the efficacy and safety of external fixation during upper tracheal stenting.METHODSRecords of patients who underwent airway stent placement from May 2007 to August 2018 in a single centre were retrospectively reviewed. We included only patients whose stent had been placed in the upper trachea with external fixation to the tracheal wall. The primary endpoint of this study was the rate of stent migration.RESULTSAltogether, 51 procedures were performed in 45 patients (32 males, 13 females; median age 60 years, range 14–91 years). The median follow-up period was 9 months (range 0.3–90 months). Among the procedures, 15 were performed for benign disease and 36 for malignancy. Stents were composed of either silicone (n = 42) or metal (n = 9). Stent migration occurred in 3 (6%) patients. The stents with migration were all composed of silicone. Other sequelae were granulation tissue formation in 10 (20%) patients, sputum obstruction in 6 (12%), cellulitis in 3 (6%) and pneumonia in 1 (2%).CONCLUSIONSExternal fixation was an effective method for preventing migration of airway stents placed for upper tracheal stenosis and tracheoesophageal fistula. The complications were acceptable in terms of safety. 相似文献
11.
目的探讨局部麻醉及通气导管辅助下~(125)I粒子气管支架治疗恶性气道狭窄的疗效。方法回顾性分析于我科接受~(125)I粒子气管支架植入术治疗的恶性气道狭窄患者180例。分析~(125)I气管支架植入前、后患者气促评级、血氧饱和度(SaO2)及呼吸频率,术后随访患者的~(125)I支架情况、临床症状及生存情况。结果 180例均成功接受~(125)I粒子气管支架植入术,共植入~(125)I支架180枚,其中筒状支架132枚、"Y"型支架34枚、"L"型支架14枚。术后患者呼吸困难症状均有显著缓解。本组患者SaO2由术前的(80.60±3.87)%提高至术后的(94.31±3.40)%,差异有统计学意义(t=-30.52,P0.01);呼吸频率由术前的(29.36±3.20)次/分改善至术后的(19.29±2.19)次/分,差异有统计学意义(t=35.09,P0.01)。术后随访3~13个月,6例患者出现~(125)I支架再狭窄;患者生存期为49~401天,平均(182±94)天,患者60天生存率的估计值为0.99,180天生存率的估计值为0.65。结论局部麻醉及通气导管辅助下~(125)I气管支架植入术治疗恶性气道狭窄是安全、有效的方法。 相似文献
12.
《Transplantation proceedings》2022,54(2):454-456
BackgroundPortal vein (PV) stenosis is sometimes seen in pediatric living donor liver transplantation (LDLT). PV stents have been attempted in adults with persistent stenosis. However, long-term usefulness of PV stenting is unknown because stents do not expand with growth. We investigated the effect and long-term outcome of PV stenting for stenosis after pediatric LDLT.MethodsWe included patients aged <18 years who underwent LDLT from 1998 to 2020 and who underwent PV stenting for stenosis. We assessed age at procedure, stent complications, and long-term outcomes.ResultsFive patients underwent PV stent placement. The median age at LDLT was 10 years (range, 0.8-18.1 years). The median interval between LDLT and stent placement was 25 months. The median age at stent placement was 16 years (range, 3-20 years). The median body weight was 38 kg (range, 13-63 kg). The median stent diameter was 8 mm. The median observation period after stent placement was 8 years. On average, body weight increased 1.6 times. One complication associated with stent placement was PV thrombosis, which resulted in stent failure, but we observed no portal hypertension. In the other 4 patients, the stent has remained functioning, and there was no clinical evidence of portal hypertension.ConclusionsPV stents are effective for intractable PV stenosis in children. PV stents were successfully placed in children as young as 3 years old and weighing 13 kg. Our data suggests that a stent placed in young children does not cause portal hypertension as patients grow. 相似文献
13.
Bougienage and balloon dilation using a conventional tracheal tube for tracheobronchial stenosis before stent placement 总被引:3,自引:0,他引:3
In order to achieve urgent restoration of the airways in tracheobronchial stenosis and to make stent placement simpler and
safer, we developed a method that allows combined bougienage and balloon dilation via the use of a conventional tracheal tube.
Fifteen patients with tracheobronchial stenosis underwent bougienage and balloon dilation using a tracheal tube with a cuff
attached, inserted via a tracheostomy, before stent placement. The conventional tracheal tube was inserted via a tracheostomy,
the cuff was expanded at the stenotic site, and the tube was fixed to the tracheostomy and left in place for a few days until
sufficient dilation was achieved. This procedure was conducted on the trachea in 10 patients, the left main bronchus in three
patients, and the right main bronchus in two patients. In all patients, the procedure immediately relieved the obstructive
symptoms and dilated the stenosis sufficiently. Thereafter, Dumon stents were inserted in 10 patients, dynamic stents in four
patients, and an expandable metallic stent in one patient. The stents were introduced easily with no other dilation procedure
after a mean of 5 days from the start of the procedure. For tracheobronchial stenosis, bougienage and balloon dilation using
a tracheal tube with an integral cuff via a tracheostomy is a simple and safe method for achieving both urgent relief of airway
stenosis and dilation before stent placement.
Received: 20 May 1999/Accepted: 17 December 1999/Online publication: 25 April 2000 相似文献
14.
Respiratory management during endotracheal placement of the Dumon stent for tracheobronchial stenosis 总被引:3,自引:0,他引:3
Kono Y 《Masui. The Japanese journal of anesthesiology》2005,54(5):504-512
BACKGROUND: Endotracheal stenting at the stenotic area of the trachea or bronchus is less invasive and beneficial for patients, compared with conventional surgical treatment. METHODS: We investigated intraoperative respiratory managements for 26 patients (65+/-14 years-old) with Dumon type stent in a retrospective manner. SpO2 over 90% was an index for the intraoperative respiratory managements. RESULTS: Nine of the 26 subjects were emergency cases. Four of the 26 patients had been preoperatively under controlled respiration (CR) with an endotracheal tube, while the remaining 22 had been left under spontaneous respiration (SR). The lung cancer (10 patients) was the most frequent causative disease, followed by tracheo-broncheal invasion of the esophageal cancer (6 patients). Preoperative PaO2 in 8 of the SR group was under 70 mmHg. When SR was preserved during subsequent operation, intravenous anesthesia using propofol and fentanyl was given in combination with surface local anesthesia. I-type stent was used for 17 patients with tracheal or bronchial stenosis and Y-type stent for 9 with carina stenosis. As to the respiratory management during stenting, SR was preserved in 14 patients, CR including jet ventilation under the use of a muscle relaxant was performed in 8 patients and percutaneous cardiopulmonary support (PCPS) was used in 4 patients. In one SR patients, SR was switched to emergency PCPS on the way because of airway obstruction. In another SR patient with successful bronchial stenting, the collapsed lung was rapidly re-expanded by using jet ventilation, causing multi-embolism to the vital organs including the heart and the brain. Traumatic complications on bucking were not seen even under the condition of SR. Postoperatively, 21 of the 26 patients were transferred to ICU without endotracheal intubation. CONCLUSIONS: In a case in which severe respiratory insufficiency or airway bleeding is anticipated, PCPS on standby is necessary for safety assurance. 相似文献
15.
Lindenmann J Matzi V Porubsky C Anegg U Sankin O Gabor S Neuboeck N Maier A Smolle-Juettner FM 《The Annals of thoracic surgery》2008,85(1):354-356
From January 2003 to June 2006, 6 patients with leakage of the cervical esophagogastrostomy after esophagectomy and gastric pull-up underwent endoscopic stenting using the self-expandable covered tracheal type device. Anastomotic healing was satisfactory. Stent extraction was performed after an average interval of 91 days. Initial stent migration occurred in 2 patients and post-extraction stenosis developed in 3 patients. Insertion of a self-expandable covered metal tracheal stent represents a safe approach resulting in immediate closure and subsequent healing of cervical anastomotic leakage. 相似文献
16.
目的 评价三通喉罩气道( TLMA)在儿科经纤维支气管镜气道内支架置入术中的作用.方法 2006年3月至2010年10月,行经纤维支气管镜气道内支架置入术的患儿11例,年龄1~13岁,平均(4.8±2.7)岁,体重5~41 kg,平均(18.2±10.1 )kg.在全身麻醉下插入TLMA,在机械控制通气下经纤维支气管镜实施气道内支架置入术.术中连续监测收缩压(SP)、舒张压(DP)、心率(HR)和脉搏血氧饱和度( SpO2).记录麻醉前5 min(T0)、通气5 min(T1)、10 min( T2)、20 min( T3)和术毕(T4)时的SP、DP、HR和SpO2.记录T1~T4时点的潮气量(VT)、气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2).于T0、T2、T3和T4时采集桡动脉血行血气分析.结果 全部手术均顺利完成.TLMA通气时间22~ 55 min,平均(32± 11)min,气道内手术时间3~ 30 min,平均(9±5 )min.术中血压、HR平稳,10例(91%)维持SpO2≥95%.T1~T4时点VT、Ppeak和PETCO2差异无统计学意义(P>0.05).术中和术后PaCO2、PaO2、O2sat明显改善(P<0.05).术后无明显并发症发生.结论 TLMA用于儿科经纤维支气管镜气道内支架置入术气道管理的效果好. 相似文献
17.
BACKGROUND: Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single-stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis. METHODS: This study retrospectively reviewed 45 patients who underwent airway stenting during a 2-year period. Between June 2002 and August 2004, 45 patients underwent rigid bronchoscopy for tracheal stenosis using an Ultraflex stent (Microvasive; Boston Scientific, Boston, MA, USA), Hood stent (Hood Laboratories, Pembroke, MA, USA) and Montgomery T-tube (Boston Medical, Westborough, MA, USA). Clinical improvement, intraoperative, early and late postoperative complications were evaluated. RESULTS: Ultraflex stent was used in 14 patients, Hood stent in 9 and Montgomery T-tube in 22. The overall clinical improvement was 95.5%. Four per cent of the patients (2/45) had intraoperative complications, 8.8% (4/45) had early postoperative complications and 51% (23/45) had late postoperative complications. No significant difference was determined between stent type and complication rates. CONCLUSION: Rigid bronchoscopic insertion of airway stents for tracheal stenosis is a safe and effective procedure. No difference exists between stent type and clinical improvement, intraoperative and early and late postoperative complications. 相似文献
18.
Puma F Ragusa M Avenia N Urbani M Droghetti A Daddi N Daddi G 《The Journal of thoracic and cardiovascular surgery》2000,120(6):1064-1069
OBJECTIVE: Tracheal stenting for cicatricial stenoses is reserved for patients whose lesions are deemed inoperable for local or general reasons. The aim of our study was to verify the long-term results of silicone tracheal stents in such a clinical setting. METHODS: Clinical data of 45 patients treated by tracheal silicone stents, between 1987 and 1999, were reviewed. All patients had highly symptomatic cicatricial stenoses; they were selected for stenting rather than for surgery because of local and general conditions. This series has been divided in two groups according to the purpose of stenting: bridge to surgery or definitive treatment. Follow-up ranged between 12 and 83 months. Twenty-seven patients received a Montgomery T tube (Hood Laboratories, Pembroke, Mass), 16 a Dumon stent (Novatech, Plan de Gras, France), and 2 a Dynamic stent (Rusch, Kernen, Germany). RESULTS: No procedure-related mortality was observed. Nine patients underwent curative resection and reconstruction after a variable stenting period; one had a recurrent stenosis and was treated for palliation with a T tube. Tracheal stenting was performed for palliation as a definitive treatment in 37 patients. Among this group, 11 patients died of unrelated causes at a median of 10 months after the endoscopic treatment. The stent was permanently removed in 10 after a median interval of 32 months (range 9-70 months); in 4 others, symptomatic recurrence of the stenosis was observed within 6 weeks of stent removal. None of the patients successfully decannulated had a completely normal tracheal lumen but all remained asymptomatic because the residual stenosis was mild or well tolerated for concomitant limitation of physical activity. CONCLUSIONS: Long-term treatment with a silicone stent was safe and well tolerated in cicatricial tracheal stenoses. This procedure can be considered as a bridge to curative surgery or as a definitive treatment. The latter, generally performed for palliation, may provide satisfactory therapeutic results in selected patients, even in the presence of severe circumferential stenoses. 相似文献
19.
严重气道狭窄患者气管内治疗的麻醉管理 总被引:6,自引:3,他引:3
目的:探讨严重气道狭窄患者气管内治疗的麻醉管理方法。方法:10例不同原因气道狭窄患者分别进行狭窄气道内支架置入术、支架或异物取出术或气管造口处“T”管置入术,分别于全身麻醉下采用气管插管、喉罩及高频喷射等不同的保障气道及通气的方法。结果:经气管导管或喉罩支气管镜下定位气道内支架成功放置7例;感染气管支架或异物取出失败各1例,但均清除部分坏死组织,解除部分气道梗阻;经气管导管手控呼吸及高频喷射通气下“T”型硅胶管成功放置1例。结论:严重气道狭窄患者气管内治疗的麻醉管理关键在于保障气道内操作时的气道通畅。气管插管、喉罩及高频喷射等可灵活应用于不同的病例,其选择主要取决于气道梗阻的部位、严重程度及治疗方法,医护人员的通力协作也是成功的保障之一,经喉罩通气下行气管内操作为可行的方法之一。 相似文献
20.
目的 对内支架植入术治疗肝移植术后肝动脉狭窄的价值进行初步的探讨。方法 对34例肝移植发生肝动脉狭窄、闭塞患者行球囊扩张治疗,其中5例患者接受内支架植入治疗,3例为球囊扩张治疗无效患者,1例为球囊扩张后出现肝动脉内膜撕裂,另1例为肝动脉狭窄伴吻合口破裂出血。结果 5例患者均成功进行了内支架植入治疗,其中1例肝动脉狭窄伴吻合口破裂出血的患者植入支架后24h内发生支架内急性血栓形成,经手术行肝动脉重建治疗,其余4例术后治疗效果良好。结论 介入方法治疗肝移植术后肝动脉狭窄具有微创、安全、有效的优势,对于球囊扩张治疗无效或合并吻合口破裂出血的病例,可采用内支架植入治疗。 相似文献