癌性气道梗阻腔内冷冻及支架治疗

目的：探讨中晚期癌灶侵犯气管、支气管导致大气道梗阻、呼吸困难的姑息性救治方法。方法：21例气管、支气管癌性梗阻伴呼吸困难患者,6例伴声音嘶哑,8例伴左或右全肺不张,21例均伴肺部感染及呼吸困难。经纤支镜插入CO2冷冻软探针冷冻摘除肿瘤和／或植入带膜钛合金网状内支架救治。结果：17例气道梗阻、呼吸困难及两肺感染患者获完全缓解;2例气道梗阻获部分缓解,呼吸困难及两肺感染减轻;1例患者于等待定做内支架过程中死亡,1例气管重度梗阻,于表面麻醉、纤支镜观察中出现窒息,经呼吸机支持24小时后死亡。结论：癌肿转移、侵入气管、支气管后于腔内生长迅速,短期即可导致气道阻塞、呼吸困难死亡。对终末期患者,经纤支镜插入CO2冷冻软探针冷冻摘除肿瘤和／或植入带膜钛合金网状内支架救治方法,虽然风险大,但仍提供了一条有效的救治途径,为继续治疗赢得了宝贵时间。     

硬质气管镜结合可弯曲性支气管镜治疗大气道内肿瘤

背景与目的 大气道内肿瘤常伴有严重呼吸困难,患者难以平卧,局麻下气管镜检查受限.硬质气管镜具有通气功能,全麻下行硬质气管镜检查、治疗比较安全.本研究旨在探讨硬质气管镜结合可弯曲性支气管镜,应用冷冻联合氩等离子体凝固(APC)治疗大气道内恶性肿瘤的效果及可行性.方法 回顾性分析两组经病理明确的气道内恶性肿瘤,分别采取两种不同的气管镜治疗模式.①A组:采取硬质气管镜结合可弯曲性电子支气管镜,应用冻取结合APC治疗大气道内肿瘤19例.全麻下经口插入硬质镜,然后结合电子支气管镜,采用冻取联合APC的方法,尽量一次性消除气道内肿瘤;②B组:单独采用电子支气管镜下单用APC治疗20例类似气道内病变患者,仅用APC烧灼肿瘤,然后用活检钳取出或冻取坏死物质,根据病人的最大耐受程度,尽量清除气道内肿瘤.结果 A组气管及支气管术前阻塞程度均明显重于B组.但A组气管和支气管首次消融范围均大于B组,两组气管和支气管消融范围均无明显差别.A组所需气管镜操作次数明显少于B组,对患者的改善程度也优于B组.两组治疗过程中均无严重并发症发生.结论 硬质气管镜结合可弯曲性支气管镜能快速冻取肿瘤,联合APC也能快速凝切肿瘤和止血,两种镜子结合应用,是严重气道阻塞快速、有效的治疗方法.单独应用电子支气管镜仅适合硬质气管镜有效治疗后的维持治疗或气道肿瘤较小、阻塞程度不重的患者.     

大气道癌性梗阻的急性救治

Objective  To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods  Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO₂ and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results  Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion  The emergency remedy using soft cryoablated probe of CO₂ and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.     

镍钛记忆合金支架置入在肿瘤性气道狭窄中的治疗应用

我院呼吸内科利用纤维支气管镜(纤支镜)直视下放置镍钛记忆合金支架(NI-TI支架；自膨胀网状气道专用支架，带导引鞘的三套管支架输送器放置支架)。治疗气管内外肿瘤造成的气道狭窄。取得了良好的疗效。总结报道如下。     

金属内支架在结直肠癌梗阻治疗中的应用

手术治疗结直肠癌梗阻危险性高 ,并发症多。通过金属内支架的植入 ,可为手术提供满意的术前准备 ,或得到满意的姑息性治疗 ,且治疗中无严重并发症。本文主要对结直肠癌梗阻金属内支架治疗的适应证、禁忌证、治疗经过、治疗经验及其不足等方面作一概述。     

原发性气管肿瘤与大气道阻塞的外科治疗

采用手术及钛镍记忆合金支架治疗恶性肿瘤大气道阻塞28例。行气管袖式切除术10例,气管肿瘤局部切除术8例,肿瘤刮除 支架5例,单纯支架治疗5例。全组病例无围手术期死亡,5、10及>10年生存率分别为53·6%(15/28)、35·7%(10/28)和10·7%(3/28)。回顾性资料分析结果表明,早期诊断、积极手术或支架置入及综合治疗是治疗原发性气管肿瘤及大气道阻塞及提高生存率的有效手段。     

镍钛记忆合金支架置入在肿瘤性气道狭窄中的治疗应用

我院呼吸内科利用纤维支气管镜 (纤支镜 )直视下放置镍钛记忆合金支架 (NI TI支架 ;自膨胀网状气道专用支架 ,带导引鞘的三套管支架输送器放置支架 ) ,治疗气管内外肿瘤造成的气道狭窄 ,取得了良好的疗效 ,总结报道如下。1　临床资料1.1　一般资料2 0 0 2年 5月～ 2 0 0 4年 6月 ,2 9例肿瘤性气道狭窄患者 ,男2 3例 ,女 6例。年龄 3 2～ 78岁 ,平均年龄 60岁 ,中位年龄 5 5岁。气管肿瘤 9例 ,肺癌支气管狭窄 12例 ,食管癌侵犯气管 6例 ,甲状腺肿瘤致气管狭窄 2例。狭窄部位 :气管 12例 ,气管及支气管 3例 ,支气管 9例 ,气管、支气管、食管…     

32例气管肿瘤的外科治疗

目的：总结32例气管肿瘤患者外科治疗经验。方法：回顾性分析我科1980～2005年收治的32例气管肿瘤患者外科治疗临床资料。结果：32例气管肿瘤患者中，23例行气管袖状切除端-端吻合术；8例行气管隆凸切除重建术；1例行气管开窗、肿瘤刮除术。术后2例死亡，另有8例发生术后并发症。结论：手术切除是治疗气管肿瘤最有效的方法。气管袖状切除端-端吻合术是治疗气管恶性肿瘤最主要的术式，良性肿瘤可以考虑保守的术式。手术治疗应该兼顾手术的根治性和安全性。     

癌性肠梗阻的外科治疗进展

癌性肠梗阻常发生于晚期腹盆腔恶性肿瘤,可引起剧烈的腹痛、恶心、呕吐、进食困难等症状,严重影响患者的生活质量,其处理方式一直以来都是临床医师感到棘手的问题.外科治疗作为其主要治疗方式之一,主要包括肠道内支架置入和手术治疗等方式,其主要目的为缓解患者梗阻症状,改善生活质量.其中,肠道内支架置入具有操作简单、创伤小等特点,同...     

带膜食管内支架置入术治疗癌性食管气管瘘4例报告

食管内支架置入术是治疗食管癌所致吞咽因难和食管、气管瘘的有效方法。自 1998年以来 ,我们采用国产记忆金属带膜支架对 4例癌性食管气管瘘的患者进行食管内支架置入术 ,取得满意的疗效 ,现报告如下。1　临床资料1.1　一般资料本组 4例中 ,男性 3例 ,女性 1例 ,年龄 5 0～ 70岁。均经病理学诊断为食管鳞状上皮细胞癌。既往放疗 2例 ,放疗加化疗1例 ,未作治疗 1例。吞咽因难、饮食刺激性咳嗽咳脓痰 4例 ,发热 3例 ,发热伴咯血痰 1例。 4例均口服 30 %泛影葡胺造影确定狭窄部位、长度及瘘口准确位置。 4例均只有 1个瘘口 ,均位于食管中段 ,食…     

食管内支架对恶性食管梗阻的疗效评价

目的：研究食管内支架在恶性食管梗阻及食管气管瘘治疗中的价值。方法：１９９５～１９９８年对７２例恶性食管梗阻且不能耐受剖胸手术的患置入食管内支架治疗。男５６例,女１６例,平均年龄７３．５岁（３８～９０岁）。食管癌５５例（并食管气管瘘３例）,胃贲门癌１３例,肺癌并气管食管瘘４例。结果：所有内支架开放良好,吞咽困难计分提高２分。７２例中,５３例（７３．６％）无并发症,最多见的并发症是胸痛,有１１例（２     

Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG laser

Fourteen patients with malignant airway obstruction have had 21 placements of a flexible nylon catheter for afterloading Iridium-192 using the flexible fiberoptic bronchoscope. Prescribed therapy was completed in 13 patients (18 courses). All patients had prior full-dose external irradiation, and no effective surgical or chemotherapeutic options remained. While many have had a trial of neodymium-YAG (yttrium-aluminum-garnet) laser therapy alone, eight patients received laser treatment one to three weeks prior to planned brachytherapy to provide immediate relief of symptoms and/or facilitate access and safe catheter placement. Most patients (64%) had recurrent squamous cell lung cancer. A dose of 3000 cGy is currently specified to 5 mm and 10 mm in the bronchus and trachea, respectively. Nine of the 13 treated patients have had follow-up bronchoscopy at approximately three months post-treatment with improvement documented in seven and progression in two patients. One patient was clinically improved without follow-up bronchoscopy, and three patients have had insufficient follow-up. A single patient treated with laser and 6000 rad at 5 mm developed a bronchoesophageal fistula. No other complication has been observed. The technique is simple and safe with the use of laser therapy when needed and appears to offer effective palliation in most patients even when standard therapy is exhausted.     

High-dose-rate endobronchial brachytherapy for recurrent airway obstruction from hyperplastic granulation tissue

PURPOSE: Benign endobronchial granulation tissue causes airway obstruction in up to 20% of patients after lung transplantation or stent placement. High-dose-rate endobronchial brachytherapy (HDR-EB) has been successful in some cases refractory to standard bronchoscopic interventions. METHODS AND MATERIALS: Between September 2004 and May 2005, 8 patients with refractory benign airway obstruction were treated with HDR-EB, using one to two fractions of Ir-192 prescribed to 7.1 Gy at a radius of 1 cm. Charts were retrospectively reviewed to evaluate subjective clinical response, forced expiratory volume in 1 second (FEV(1)), and frequency of therapeutic bronchoscopies over 6-month periods before and after HDR-EB. RESULTS: The median follow-up was 14.6 months, and median survival was 10.5 months. The mean number of bronchoscopic interventions improved from 3.1 procedures in the 6-month pretreatment period to 1.8 after HDR-EB. Mean FEV(1) improved from 36% predicted to 46% predicted. Six patients had a good-to-excellent subjective early response, but only one maintained this response beyond 6 months, and this was the only patient treated with HDR-EB within 24 h from the most recent bronchoscopic intervention. Five patients have expired from causes related to their chronic pulmonary disease, including one from hemoptysis resulting from a bronchoarterial fistula. CONCLUSION: High-dose-rate-EB may be an effective treatment for select patients with refractory hyperplastic granulation tissue causing recurrent airway stenosis. Performing HDR-EB within 24-48 h after excision of obstructive granulation tissue could further improve outcomes. Careful patient selection is important to maximize therapeutic benefit and minimize toxicity. The optimal patient population, dose, and timing of HDR-EB should be investigated prospectively.     

支气管镜下冷冻联合氩等离子电凝治疗中央气道肺癌

目的　了解支气管镜下冷冻联合氩等离子电凝治疗中央气道肺癌的效果。方法　共３５例中央气道肺癌患者接受治疗,采用局部麻醉,支气管软镜下,应用氩等离子凝固治疗仪治疗中央气道阻塞性病变。术中采用冷冻、氩等离子电凝、冻切重复进行。对于较大的病变可分次手术,全部治疗结束１周后评价疗效。评价指标包括术前、术后呼吸困难指数,支气管镜检查等。结果　３５例患者,共接受治疗７６次。术前呼吸困难指数３.１±０.４７,术后１６±０.４３,缓解率为８４.０％;复查支气管镜,完全有效１１例（３１.４％）,部分有效１５例（４２.９％）,轻度有效５例（１４.３％）,无效４例（１１.４％）。主要副作用包括：术后一过性呼吸困难加重１１例（３１.４％）,咳嗽加重１３例（３７.１％）,少量咯血１５例（４２.９％）。结论　在局麻下采用冷冻联合氩等离子电凝治疗中央气道肺癌近期疗效满意,可有效缓解症状,安全性较高。     

Management of central airway obstruction

The efficacy of interventional pulmonology for palliation of patients with central airway obstruction has been established, and its curative potential for early cancer has raised great interest in current screening programs. The success of endoscopic strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation, and stenting are techniques that can provide immediate relief, in contrast with cryotherapy, brachytherapy, and photodynamic therapy, which have delayed effects. With curative intent, intraluminal techniques that easily coagulate early-stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.     

Endoscopic stent for palliating malignant and benign biliary obstruction

Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included papliila of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4),choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1).The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%,58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively.Early complication included post-ERCP panereatitis and eholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient‘s living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.     

纤维支气管镜下大剂量腔内放疗治疗癌性支气管阻塞

目的　应用后装设备在纤维支气管镜引导下将192Ir导入支气管内进行腔内放疗,治疗癌性支气管阻塞。方法　常规纤维支气管镜检后,将施源器导管经活检孔导入病变部位,接后装机进行放疗,每次6～8Gy,每周1次,连续3周为1疗程。疗程结束后第1、4周复查。结果　胸部X线检查示:CR15例(23.08%),PR28例(43.08%),MR12例(18.46%),总有效率(CR+PR+MR)为84.62%。纤支镜检查示:CR25例(38.46%),PR28例(43.08%),MR9例(13.85%),总有效率为95.38%。结论　该方法对肺癌引起的支气管阻塞具有良好的再通效果,作用快,疗效好,副作用少。