被覆金属内支架治疗食管气管瘘的随访研究

目的;探讨被覆内支架治疗食管癌病人食管气管瘘的远期疗效及并发症。方法：１５例在Ｘ线电视导上置入被覆内支架１５个,１０例门诊随访,５例电话或信访。结果：１５例均一次封闭成功,平均生存期６．４５月,其中６例联合放化疗生存期平均为９．２月,９例死于肿瘤转移,３例死于肺部感染,３例死于其它原因,１例支架滑脱入胃内,１例支架上端再狭窄,１例食物堵塞支架上端,３例有明显胃食管返流,余无明显并发症。结论：被覆     

Endovascular treatment for an iliac artery-ureteral fistula with a covered stent

Iliac artery-ureteral fistula (IAUF) is a rare entity that has a potential risk of life-threatening hemorrhage. It is difficult to diagnose and treat appropriately. Conventional treatment for the disease consists of surgical ligation and vascular reconstruction or coil embolization. Surgical treatment is usually difficult for patients with several risk factors. In recent years, endovascular stent-graft treatment for iliac artery pseudoaneurysm has been reported. The present report describes two cases in which endovascular covered stent-graft treatment was successfully applied to treat IAUF, with good clinical outcomes.     

双倒Y型气道覆膜内支架治疗胸腔胃-右主支气管瘘的疗效观察

目的：评估双倒 Y 型气道覆膜内支架置入治疗胸腔胃-右主支气管瘘的疗效。方法回顾性分析15例胸腔胃-右主支气管瘘,所有患者均因食管癌行食管切除并胸腔胃食管吻合,术后有放射治疗史,瘘口均临近右上叶支气管开口。根据患者气管支气管正常管径的直径和长度,个体化设计出大小2枚倒 Y 型气道覆膜内支架,并于 X 线透视下置入支架,观察患者瘘口封堵情况,临床症状改善情况。结果所有胸腔胃-右主支气管瘘患者行双倒 Y 型气道覆膜内支架置入治疗,操作均一次性成功,瘘口封堵完全,能顺利进食,卧位呛咳症状消失,未出现气道出血、气胸等并发症。结论双倒 Y 型气道覆膜内支架置入治疗胸腔胃-右主支气管瘘技术可行,疗效肯定。     

Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent

PURPOSE: To evaluate the safety and clinical effectiveness of a covered retrievable expandable nitinol stent for the treatment of malignant tracheobronchial stricture and/or esophagorespiratory fistula (ERF). MATERIALS AND METHODS: With fluoroscopic guidance, stents were placed in 35 symptomatic patients with malignant tracheobronchial stricture and/or ERF in most cases caused by lung or esophageal cancer. The site of stricture was most commonly at the trachea or left main bronchus. If there were complications, the stent was removed with a retrieval set. Nine patients had combined symptomatic ERF. RESULTS: A total of 47 tracheobronchial stents were placed and were technically successful and well-tolerated in all patients. Improvement of dyspnea was achieved in 92% of the patients (24 of 26 patients). Associated ERF in nine patients was effectively treated with tracheobronchial stent placement with or without esophageal stent placement. Stent migration, tumor overgrowth, symptomatic sputum retention, and hemoptysis occurred in 17% (6/35), 6% (2/35), 20% (7/35), and 17% (6/35) of patients, respectively. There were no documented cases of tumor ingrowth. Stent removal was performed easily in five patients when stent migration (n = 2), severe pain (n = 1), tumor overgrowth (n = 1), or persistent gastrobronchial fistula (n = 1) developed. All patients died 2 days to 26 weeks (mean, 9.62 weeks) after stent placement because of disease progression (n = 18), pneumonia (n = 9), hemoptysis (n = 5), or unknown cause (n = 3). CONCLUSION: Use of a covered retrievable expandable nitinol stent is a safe and effective method for relieving dyspnea. This procedure contributed to improved quality of life for patients with malignant tracheobronchial stricture and/or ERF. Stent retrievability was useful in resolving stent-related complications.     

Overcoming the delivery limitation: results of an approach to implanting an integrated self-expanding Y-shaped metallic stent in the carina

PURPOSE: To evaluate the technical success and initial clinical safety and effectiveness of the use of a Y-shaped metallic stent for complex stenoses involving the carina. MATERIALS AND METHODS: Thirty-five consecutive patients with complex tracheobronchial stenoses involving the carina were treated with an integrated self-expandable inverted Y-shaped metallic stent and delivery system. The Y-shaped metallic stents were placed in the tracheobronchial tree with fluoroscopic guidance. Technical success, clinical success, Hugh-Jones classification, and complications were assessed during follow-up. RESULTS: The delivery of the integrated self-expandable Y-shaped metallic stent in the carinal areas was technically successful and well-tolerated in all patients. Clinical success was achieved in 31 patients (89%) 1-7 days after stent placement; the procedure failed in four patients (11%). The improvement between pre- and postoperative Hugh-Jones classification grade was statistically significant (P<.001). During follow-up (mean follow-up, 192 days+/-169), all stenoses were resolved, and general physical examination of the 31 patents showed improvement with no obvious dyspnea or bleeding. Twenty-one patients were healthy without evidence of dyspnea, and the remaining 14 patients died (mean survival, 189 days+/-172) at the time of this report. The mean and median survival periods were 217 days+/-30 and 215 days+/-108, respectively. The mean and median stent patency periods were 216 days+/-30 and 215 days+/-119, respectively. CONCLUSIONS: Deployment of an integrated, self-expandable inverted Y-shaped metallic stent with the delivery system was a safe and effective procedure for the treatment of complex tracheobronchial stenoses involving the carina.     

不同类型被覆金属内支架治疗食管支气管瘘的初步研究

目的：评价不同类型被覆金属内支架治疗食管气管瘘的临床效果。方法：本组１０例,食管癌浸润或溃疡等通所致食管气管瘘６例,食管癌中段狭窄并网状金属内支架置入及放疗后致左支气管瘘１例,ＢＡＩ所致食管支气管瘘３例。选用美国ＧｉａｎｔｕｒｃｏＺ型带膜支架２例,Ｕｌｔｒａｆｌｅｘ支架２例,国产带膜网状支架６例。所有病例的支架置入均在透视下完成。结果：１０例支架置入术均１次成功,瘘口完全封闭,饮水不再呛咳,术后第     

被覆内支架治疗食管-气管瘘和食管狭窄的临床应用

目的评价应用被覆金属内支架治疗食管-气管瘘和食管狭窄病人的疗效。方法根据食管狭窄的程度、长度、瘘口部位及狮窄上缘距食管上端开口处距离，确定支架长度和支架位置。5例患者均在X线电视监视下完成操作。结果5例病人均1次成功放置被覆金属内支架，患者呛咳及吞咽困难症状消失，术后均能进普通流食。正侧位胸片检查，支架位置准确，形状为两头呈喇叭口样，中间狭窄部直径可达1．1cm～1．5cm。管瘘病人的二种很好的非创伤性姑息性治疗手段。结论X线透视下置入被覆金早内支架，是晚期食管癌合并食管-气管瘘病人的二种很好的非创伤性姑息性治疗手段。     

自膨式国产金属食管覆膜支架治疗食管-气管瘘

目的:探讨自膨式国产金属食管覆膜支架治疗各种食管瘘的方法,常见并发症的预防与处理。方法:采用自膨式国产金属食管覆膜支架,在X线监视下或胃直视下用推送器经口置入食管病变部位,共治疗食管瘘患者57例,其中食管-气管瘘18例,食管-支气管瘘25例,食管-纵隔瘘9例,食管-纵隔-支气管瘘5例。结果:57例患者均顺利完成支架置入,即时堵瘘率为100%,未出现技术问题及严重并发症。所有患者均达到了改善进食、提高生活质量的治疗效果。结论:自膨式国产食管覆膜支架适用于治疗各种食管瘘,操作简便、疗效安全,且价格低廉,是一项值得推广的技术。     

覆膜Y型单子弹头气道支架治疗左主支气管胸膜瘘12例

目的 评估应用Y型单子弹头覆膜气道支架封堵残端较短的左主支气管胸膜瘘的临床效果.方法 回顾性分析2010年8月-2013年9月收治的12例残端较短的左主支气管胸膜瘘患者,根据这类患者支气管残端较短的解剖结构特点,个体化定制Y型单子弹头覆膜气道内支架.在X线监视下,12例患者共置入12枚Y型单子弹头内支架.观察患者支架置入后瘘口愈合情况.结果 12枚支架均一次性置入成功,内支架置入后瘘口即刻完全封堵,随访3～ 17个月;6例瘘口封堵良好,支架置入后3个月取出,瘘口愈合、残腔消失;5例复查胸部多排螺旋CT(MSCT)显示支架子弹头部周围软组织较薄,残腔较前明显缩小,未取出支架,继续负压引流,带支架生存至今.1例高龄患者,支架置入前已存在重度肺部感染,支架置入后瘘口虽即刻完全封堵,但术后未能控制原有肺部感染,加之体质虚弱,术后2周死于肺部重度感染和机体衰竭.结论 应用Y型单子弹头覆膜自膨式内支架封堵残端较短的左主支气管胸膜瘘患者的瘘口,近期临床效果可靠,值得推广应用.     

气道Y型单子弹头一体化自膨式金属覆膜支架治疗右主支气管残端瘘17例分析

目的 探讨气道Y型单子弹头一体化自膨式金属覆膜支架(简称Y型单子弹头覆膜支架)置入治疗右主支气管残端瘘(也称支气管胸膜瘘)的可行性和疗效.方法 根据右主支气管残端瘘残留段支气管较短的特殊解剖结构与病变特点,设计出气道Y型单子弹头覆膜支架.X线监视下,对17例患者置入17枚Y型单子弹头覆膜支架.结果 气道支架均一次性置入成功,17例患者瘘口支架置入后均获得完全封堵,随访1 ～ 34个月.2例术后1～2周内死于顽固性肺部感染和全身衰竭;5例瘘口愈合;10例右胸膜残腔较术前明显缩小,其中2例拔出胸腔引流管,8例带胸膜腔外引流管生存至今.结论 气道Y型单子弹头覆膜支架能够完全封堵右主支气管残端瘘,技术可行,近期疗效可靠,值得进一步推广应用.     

Bronchogastric fistula successfully treated with the insertion of a covered bronchial stent

Ohne Zusammenfassung     

Treatment of ureteroarterial fistula with an endoureteral stent graft

A patient with a history of total cystectomy for bladder cancer, cutaneous ureterostomy, irradiation, and long-term indwelling urinary catheters presented with an aortoureteral fistula (UAF), which was treated with an endoureteral stent graft. The described ureteral approach using stent grafts may be considered for the management of UAFs when more traditional approaches are unavailable.     

一体化覆膜气管支架治疗支气管胸膜瘘8例

目的 评价一体化自膨式金属覆膜气管支架在支气管胸膜瘘治疗中的应用价值.方法 对8例一侧肺叶切除术后支气管胸膜瘘的患者在X线监视下行一体化自膨式金属覆膜气管支架置入术,覆膜气管支架为一体化L型或Y型一侧带膜.结果 8例支架均一次性置入成功,7例术后经胸腔冲洗后随访1年均无复发;2例脓胸行右肺全切术后支气管残端瘘支架3个月后取出,1例随访半年时支架断裂部分随咳嗽咯出,病情复发.结论 一体化自膨式金属覆膜气管支架在一侧肺叶切除术后的支气管胸膜瘘治疗中是一种简便、安全、有效的治疗方法.     

Endovascular covered stent repair of an iatrogenic subclavian artery-to-pulmonary artery fistula and pseudoaneurysm

An iatrogenic fistula and consequent pseudoaneurysm developed between the right subclavian artery and right pulmonary artery as a result of misplacement of a hemodialysis access catheter. The patient, who was considered to be at high risk for surgical repair, successfully underwent endovascular treatment that involved insertion of two nitinol stents covered with expanded polytetrafluoroethylene (stent-grafts), one into the right subclavian artery and the other into a right upper lobe pulmonary artery. Multi-detector row computed tomographic angiography played an integral role in the evaluation of the patient's vascular injury and treatment planning.     

组合式双“Y”形覆膜支架治疗右主支气管胸膜巨大瘘1例

临床资料 患者,男,46岁.病理确诊为食管中段低分化鳞状细胞癌.行食管癌切除、胃食管弓上吻合术.术后患者呼吸困难,气胸形成,诊断右主支气管胸膜瘘.术后第4天再行右主支气管漏修补+大网膜填充术.术后12 d,患者胃管、胸腔引流管持续引流出胸腔积液及气体,诊断为:再发右主支气管胸膜瘘合并食管吻合口瘘.患者已不能耐受外科手术.拟行组合式双“Y”形气管覆膜支架植入瘘口封堵术.     

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex tracheobronchial stenosis: initial clinical experience

PURPOSE

We aimed to report our preliminary results of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex lower tracheal-carinal-main bronchial complex stenosis.

MATERIALS AND METHODS

Seven consecutive patients with lower tracheal-carinal-main bronchial complex stenosis underwent Y-shaped stent insertion under local anesthesia. During the procedure, subcarinal ventilation was performed using a 4 F angiographic catheter, and stent insertion was performed under the protection of ventilation. Data on technical success, clinical outcome, and follow-up were collected and analyzed.

RESULTS

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia was technically successful in all patients without any major procedure-related complications. Seven stents were inserted in seven patients. Respiratory function improved in all patients, with the Hugh-Jones classification of respiratory status improving from grade IV–V before stenting to grade I–II after stenting. During the follow-up, one patient experienced re-stenosis of the stent. Average survival time was 185.7 days (range, 96–285 days) after the stenting procedure.

CONCLUSION

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia can be an effective, simple, and safe method for lower tracheal-carinal-main bronchial complex stenosis.Airway stenosis is usually caused by local primary lung cancer, esophageal cancer, or some other mediastinal tumors. Airway stent insertion is an effective and widely used method to manage this condition (1, 2). However, as the stent introducer sheath or bronchoscopy can aggravate hypoxia, asphyxia is the most serious procedure-related complication during airway stenting or interventional bronchoscopy. The incidence of asphyxia was reported in 1.5%–14.3% of cases undergoing airway stent insertion (2–4).To overcome this complication, Dolan et al. (5) used a thin ventilation catheter to support tracheobronchial stent insertion for three patients with tracheobronchial stenosis. Before stent insertion, the distal tip of the ventilation catheter was placed across the stenosis for ventilation, and then the stent insertion was performed under the protection of ventilation. However, there is no similar technique used for placement of Y-shaped airway stent. In this study, we reported our initial clinical experience of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for seven patients with lower tracheal-carinal-main bronchial complex stenosis.