207例气管切开/气管插管后良性气道狭窄的疗效分析

目的 分析良性气道狭窄气管切开/气管插管后发生再狭窄采用球囊导管扩张加冷冻等综合治疗措施的疗效及安全性.方法 回顾性分析2005年8月至2014年12月住煤炭总医院的207例良性气道再狭窄患者,其中气管插管83例,气管切开124例.采用球囊导管扩张、CO2冷冻等综合治疗方法.结果 83例气管插管置管时间为(12.7±1.3)d,拔管后(30.3±4.1)d发生再狭窄;124例气管切开患者分别为(100.0±23.8)d和(73.2±12.8)d.气管插管组累及气管1区(87.7％),气管切开组累及气管Ⅰ区和Ⅱ区分别为63.7％、44.4％.气管插管组以瘢痕为主(57.9％),而气管切开组发生瘢痕和肉芽肿的百分比相似.气管插管组的形态以圆形为主(57.9％),不规则形占10.5％,而气管切开组分别为29.8％和41.1％,还有6例(4.8％)完全闭塞.气管插管组的治疗次数为(8.7±1.0)次,治愈时间为(4.0±0.4)个月,治愈率为89.5％;气管切开组分别为(6.7±0.5)次、(4.7±0.4)个月和72.6％.硬质镜在气管切开组比气管插管组使用率高.冷冻在2组中使用频率最高,分别达56.9％和49.9％,球囊导管扩张在气管插管组使用率达47.2％.结论 气管镜介入治疗在气管切开/气管插管后再狭窄的治疗中可发挥重要作用,冷冻和球囊导管扩张治疗是2种重要的治疗方法.     

Factors predicting outcome following airway stenting for post-tuberculosis tracheobronchial stenosis

Background and objective: Silicone airway stents are used to widen narrowed airways in patients with post‐tuberculosis tracheobronchial stenosis (PTTS). After mechanical stabilization, stents can be removed from the majority of patients leaving restored airway patency. However, in a significant minority re‐stenosis develops post‐sten removal thus necessitating surgical intervention or long‐term stenting. In this study, we sought to establish prognostic factors for successful airway intervention in PTTS. Methods: We retrospectively investigated 71 patients who underwent silicone stenting due to PTTS. After stenting, bronchoscopic toileting and/or repositioning was performed during follow up. At 6–12 months after clinical stabilization, stents were planned to be removed. Patients with patent airways were followed if no further intervention was required. If restenosis developed, patients underwent re‐stenting or operation. Clinical parameters were analysed to determine favourable prognostic factors. Results: Stents were successfully removed in 40 patients at a median 12.5 months after insertion. In 27 patients, stent re‐insertion was carried out and four patients underwent surgical management. Multivariate logistic regression analysis revealed that successful stent removal was independently associated with atelectasis <1 month before bronchoscopic intervention, and absence of complete lobar atelectasis. Conclusions: Airway intervention, including silicone stenting, can be successful in patients with PTTS, when the intervention is performed within 1 month of atelectasis and before complete lobar atelectasis.     

Y 型硅酮气管支架置入治疗恶性气管食管瘘临床体会并文献复习

目的：探讨 Y 型硅酮支架置入方法技巧及气管食管瘘(TEF)封堵的相关临床问题。方法复习我院 Y 型 Dumon 支架置入病例,分析操作准备、气管食管瘘封堵疗效及相关注意问题。结果确定气管支架直径[(横径+纵径)/2]并适形裁剪、打磨,硬质支气管镜下高频通气,支架由推送器经硬镜释放,配合可弯曲支气管镜,可成功置入,术后雾化吸入和随访复查,瘘口封堵良好,未见并发症。结论 Y 型 Dumon 支架对于隆突周围 TEF 疗效肯定、安全。充分病情评估、仔细测量瘘口大小,选择合适直径、医护密切配合是 Y 型硅酮支架置入重要环节,加强术后随访管理可一定程度上预防并发症。     

暂时性金属裸支架治疗晚期肺癌中心气道狭窄的探讨

目的观察经可弯曲支气管镜置入呼吸道暂时性镍钛合金裸支架治疗肺癌中心气道狭窄的临床疗效和安全性。方法 38例伴有气管、主支气管外压性狭窄为主的晚期肺癌患者,确诊后先予置入暂时性国产镍钛合金裸支架。置入支架前生活质量Karnofsky评分为42±13(x珋±s),气促指数为2.9±0.7。支架通过支气管镜直视下定位释放置入,通过上拉线取出法或下拉线取出法取出支架。结果 38例每例均置入1枚支架,均一次成功置入。支架置入后狭窄管腔均迅速扩大,置入后第2天气促指数、Karnofsky评分与置入前比较均有显著性差异(P<0.01)。支架置入后均行放疗或/和化疗,支架于置入后1～3个月予取出。未见与支架置入及取出相关的严重并发症。结论暂时性金属裸支架治疗晚期肺癌中心气道狭窄疗效确切,为后续的放化疗创造了条件,同时避免了支架长期放置的并发症,且支架的置入及取出操作简单安全,值得临床推广应用。     

Post-intubation pulmonary embolism and tracheal stenosis: a case report and review of the literature

Tracheal stenosis may be attributed to several conditions including trauma, infection, tumour or congenital and collagen vascular diseases. Despite improvement in the design of tracheal tubes, however, tracheal stenosis following intubation still remains an important cause for tracheal obstruction, which may be life threatening and often misdiagnosed. On the other hand, studies have exerted the impact of mechanical ventilation as a risk factor for pulmonary embolism. Here, we describe for the first time, an otherwise healthy patient who was mechanically ventilated due to a labor accident and developed acute pulmonary embolism that was further complicated with post-intubation tracheal stenosis. The patient was treated with anticoagulant therapy and oral corticosteroids and was further referred to a specialist centre for consideration for non-surgical endoscopic treatment.     

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。     

Congenital tracheal stenosis in infants and Children

Background Congenital tracheal stenosis （CTS） is a challenging airway problem. CTS in infants and children can be life-threatening. During last thirty years, a large number of studies covering the diagnosis, clinical presentation, managements, especially surgical treatments of CTS have been reported. This review aimed to conclude recognized knowledge of CTS and provide clues for managing infants and children with CTS.     

高压球囊气道成形术治疗结核性气道狭窄改善肺功能的观察

目的评价纤支镜介导下高压球囊扩张气道成形术治疗结核性气道狭窄对改善肺功能的作用。方法对24例因气管、支气管结核造成的不同部位近端气道狭窄患者,实施纤支镜介导下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的当天,对患者的气促评分和肺功能各项参数如肺活量VC(%)、用力肺活量FVC(L)、第1秒用力呼气容积FEV1(%)、第1秒用力呼气容积/用力肺活量FEV1/FVC(%)等进行测定,并对其并发症的发生情况进行评价,设18例对照组患者进行治疗前后比较。所有患者均进行了12～24个月的随访。结果24例患者分别接受高压球囊扩张2～6次,平均接受球囊扩张(3.64±1.29)次。经过高压球囊扩张气道成形术后,气促评分由术前的(1.45±1.01),减少为术后的(0.45±0.59)(P0.01)。术前平均FEV1(%)(81.47±10.07),上升为术后(96.03±10.79),差异有统计学意义(P0.01);术前平均FEV1/FVC(%)及FVC(L)由(79.56±10.77)、(4.03±0.41),上升为术后(87.16±7.55)、(4.62±0.86)差异有统计学意义(P0.05);而VC(%)由术前(77.01±19.35),上升为术后(79.24±15.15)差异无统计学意义(P0.05)。对照组患者治疗前后肺功能各参数变化差异无统计学意义,治疗组12～24个月的随访,远期疗效达91.7%(22/24)。24例接受此方法治疗的患者,除3例出现了远端支气管黏膜轻微撕裂外,未见其他严重并发症发生。结论纤支镜介导下的高压球囊扩张气道成形术是一项有效、安全和简便的治疗结核性近端气道狭窄,改善肺功能的方法。     

建立创伤性气道狭窄动物模型的研究现状与进展

良性气道狭窄是呼吸介入领域的常见疾病,创伤性因素是气道狭窄形成的主要病因之一.建立气道狭窄动物模型对深入研究其发病机制与疾病防治具有主要意义.目前已有不少通过损伤气管壁的方法建立气道狭窄动物模型的研究报道.本文从实验动物、周期、方法及展望等方面,就建立创伤性气道狭窄动物模型的现状与研究进展作一综述.     

Pseudomembranous aspergillus tracheobronchitis superimposed on post-tuberculosis tracheal stenosis

Pseudomembranous aspergillus tracheobronchitis superimposed on post-tuberculosis tracheal stenosis has not been previously reported. In the patient described in this case report, the airway obstruction was worsened by aspergillus infection which responded to antifungal therapy and debridement of pseudomembranous tissues by rigid bronchoscopic procedures. A silicone stent was successfully placed in the trachea to restore airway patency when there was no more evidence of tracheobronchial aspergillosis. This case raises the questions of whether, how and when to restore airway patency in patients with tracheal stenosis and concurrent aspergillus tracheobronchitis.     

纤支镜和透视下放置支架治疗肿瘤性重度气道狭窄

目的观察纤支镜联合透视导向下放置镍钛记忆合金支架治疗晚期肿瘤导致的气道狭窄的疗效。方法选取6例因晚期肿瘤所致气管或支气管重度狭窄的患者,在纤支镜联合透视导向下放置镍钛记忆合金支架。结果6例患者置入支架后呼吸困难立即缓解,一般情况好转,收到立竿见影的效果。3～7d复查纤支镜支架无移位,管腔通畅。结论使用镍钛记忆合金支架治疗晚期肿瘤引起的气道狭窄的疗效可即刻缓解气道狭窄和改善患者生活质量,方法简单,易行,疗效可靠。     

支气管镜下氩离子凝固术联合高频电刀及冷冻治疗气道狭窄的疗效观察

目的 探讨氩离子凝固术联合高频电刀及冷冻术(三联疗法)治疗气管狭窄的临床疗效.方法 本研究招募80名气管狭窄患者,随机分为观察组和对照组各40例.观察组患者予氩离子凝固术、高频电刀和冷冻术三联治疗,对照组患者仅行高频电刀治疗.观察两组患者气管再通的治疗效果,治疗前后的血气指标、呼吸困难严重程度、气管狭窄程度以及术后并发...     

球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效分析

目的观察和分析经支气管镜球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效。方法将30例良性气道狭窄的患者随机分为两组,球囊扩张组(A组,n=15例)和临时性金属支架置入组(B组,n=15例),疗程均为2个月,随访共6个月,观察两组治疗前后气促评分、狭窄段管腔直径等指标的变化。结果观察6个月末时,两组患者的狭窄段管腔直径均较治疗前增加,差异有统计学意义,气促指数均较治疗前降低,差异有统计学意义;临时性金属支架置入组与球囊扩张组相比,气促评分显著降低,狭窄段管腔直径显著升高,差异均有统计学意义,同时临时性金属支架置入组再狭窄发生率低于球囊扩张组。结论临时性金属支架置入治疗良性气道狭窄疗效优于球囊扩张,且术后再狭窄率较低。     

Silicon stent placement via rigid bronchoscopy for the treatment of central airway obstruction in infants: Case series

Introduction:Rigid bronchoscopy has been proven to be an excellent tool for the diagnosis and management of several causes of central airway obstruction (CAO). The invasive treatment of silicone bronchobrachial stenting has been performed in children and adults with CAO, and satisfying results were obtained in previous studies. However, there are few reports on infants with central airway obstruction treated with stenting via rigid bronchoscopy. This technique remains a challenge to pediatric thoracic surgeons, pediatric interventional pulmonologists, and otolaryngologists who struggle to treat airway obstruction disease.Patient concerns:Four patients were presented to our hospital with complaints of dyspnea for a period of time after their birthDiagnosis:Three patients were diagnosed as tracheobronchomalacia, and tracheoesophageal fistula.Interventions:Four patients were treated with silicone stenting through rigid bronchoscopy.Outcomes:Silicon stent was adequate for improving the obstruction of the tracheal tract. All the patients were followed-up longer than 6 months. Three patients could breathe normally; the stent migrated in only 1 patient.Conclusion:Invasive silicone tracheobronchial stenting via rigid bronchoscopy is a viable option for infants with CAO. Choosing an appropriate size is a critical factor for success of stenting according to our experience.     

纤维支气管镜下球囊扩张术在治疗结核性气道瘢痕狭窄中的应用

目的探讨纤维支气管镜介导下球囊扩张术在治疗结核性气道瘢痕狭窄中的应用价值。方法在局麻下,对11例结核性气管支气管患者的13处瘢痕狭窄部位实施球囊扩张术,每周1次,连续2～4次。X线胸片、CT扫描动态监测手术前后气道开放以及肺复张情况。于术前和最后一次球囊扩张后当天对狭窄气道直径、气促分数和第一秒用力呼吸容积（FEV₁）和用力肺活量（FVC）进行测定。结果11例患者平均接受球囊扩张治疗2.7次,扩张后支气管管径较前明显增大,症状显著缓解, X线胸片和CT扫描显示肺复张,即刻疗效达100％,远期90.9%。术后狭窄段支气管直径、气促评分、肺功能指标(FEV₁、FVC)均明显改善(P＜0.05)。结论球囊扩张术治疗结核性气管支气管瘢痕狭窄操作简便、安全,疗效显著,可作为临床首选治疗方法。