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.     

食管内支架留置术治疗恶性食管-支气管瘘

目的：评价用带膜食管支架治疗恶性食管－支气管瘘的临床应用价值。材料与方法：共３例食管－支气管瘘病人，其中食管癌所致２例，另外１例为肺癌所致。所用２个支架均为金属自膨式Ｚ型支架，直径１８ｍｍ，长度１０－１２ｃｍ，支架置入术在Ｘ监视下进行。结果：２个支架植入均获成功。术后立即食管吞钡造影显示瘘口被有效封闭，进食再无呛咳出现，随访时间最长１例已达６个月。随访期间，患均进食正常，部分体重增加，未出现瘘口     

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     

金属内支架治疗恶性气道狭窄和胸腔胃-支气管瘘及支气管残端瘘

目的 探讨不同规格的金属内支架治疗严重气管狭窄和胸腔胃-气道瘘及肺叶切除术后支气管残端瘘的疗效.方法 根据影像资料显示气管、支气管狭窄段位置、长度,瘘口位置、大小、范围及程度,设计镍钛记忆合金丝编织型管状裸支架或覆膜支架,治疗气管狭窄26例;气管-支气管分叉状裸支架治疗气管-支气管复合狭窄8例;气管-支气管分叉状覆膜支架治疗胸腔胃-右支气管瘘5例,支气管残端瘘4例.支架均在DSA监视下经口腔置入病变部位.结果 43例共用镍钛记忆合金网状管状裸支架24枚,覆膜支架7枚(5例支架置入后再狭窄,重新置入覆膜支架).17枚气管-支气管分叉型支架,其中9枚覆膜.支架置入后呼吸困难、憋喘及呛咳等症状即刻缓解,碘水造影显示瘘口完全封堵,无对比剂溢出.症状改善率为100%.结论 依据影像资料选择记忆合金网状内支架治疗严重气管狭窄、胸腔胃-气道瘘、支气管残端瘘,能迅即解除呼吸困难和封堵瘘口,疗效可靠,值得临床推广应用.     

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.     

乙状结肠残端瘘误诊1例

<正>病人,女,28岁。两年前因肠扭转并全小肠坏死,在外院行"全小肠及部分结肠切除"术。术后对症治疗,病情逐渐平稳后转入我院普外科,在全麻下行"同种异体小肠移植"术,术后出现严重排斥反应,抑制失败,给予取出坏死肠段,病情平稳后持续行肠外营养支持治疗。10 d前出现左下腹部疼痛不适,腹部超声及CT检查提示左下腹腔包裹性积液(图1)。临床给予对症治疗后,左下腹部疼痛无     

应用国产带膜金属内支架治疗食管瘘的初步研究

评价国产带膜金属内支架治疗食管瘘的临床效果。材料与方法,本组３６例,其中食管气管瘘２１例,食管纵隔瘘７例,食管胃吻合口瘘８例,选用国产自膨胀式“Ｚ”型支架与镍钛热记忆合金支架。支架置入在Ｘ线电视监视下进行１６例,在胃镜下进行２０例,术后给予抗生素与止血药,静有药,１６例患者术后行放,化疗。     

食管胸腔胃吻合口内支架并发食管气管瘘的内支架再置入治疗

目的 探讨食管癌术后食管胸腔胃吻合口狭窄行支架置入后形成食管-气管瘘,再次采取支架置入治疗的疗效.方法 6例食管胸腔胃吻合口狭窄支架置入后并发食管气管瘘.X线监视下,取出原食管支架,再次置入1枚较长的食管覆膜支架,消除食管与支架成角现象.结果 本组原支架取出顺利,未出现严重并发症.均再次置入较原支架长20 ～ 40 mm的支架,支架置入后均出现不同程度咽部疼痛不适,患者能够耐受,进食顺利.结论 食管胃吻合口狭窄支架置入后并发食管-气管瘘,可以置换稍长支架进行补救.     

支气管胸膜瘘介入治疗及研究进展

支气管胸膜瘘是肺切除术后严重威胁患者生命的并发症。随着介入放射学的发展,支气管胸膜瘘的介入治疗方法也逐渐多样。本文就支气管胸膜瘘的介入治疗及研究进展进行综述。     

食管带膜内支架置入术治疗食管支气管瘘1例

患者男，49岁，三个月前无诱因出现吞咽食物后偶有胸骨后异物感，且逐渐出现进行性吞咽困难．十天前病人突然出现呛咳，逐渐有脓痰咳出．体重明显下降。检查：1．体检体温37．5℃～38．5℃之间，右肺触觉语颤减弱，右肺叩之浊音。2．实验室WBC21．1×10’／L，痰涂片少量G＋球菌，散在或成对排列。3．食管造影食管中段不规则狭窄，粘膜中断、破坏，病变累及范围13cm，病变中段右侧与右肺上叶支气管产生瘘道，使右上肺部分支气管显影，瘘道外下方1．5cm处见不规则厚壁空洞，洞周炎性浸润。4．胸片古肺门旁见大小约6cm×4．5cm厚壁空洞。5.…     

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     

镍钛合金支架治疗食管良、恶性狭窄(附10例报道)

目的;研究镍钛合金支架在食管良,恶性狭窄治疗中的应用,方法;本组１０例患者,食管癌９例,贲门失弛缓症１例,均采用镍钛合金支架,在Ｘ线监视下,经口腔进行置入术。结果：全组支架均一次置入成功,支架入后,患者吞咽困难明显改善,总有效率为１００％,追踪观察,有３例食管癌患者,肿瘤分别突向支架腔内及支架上,下端生长,再次引起狭窄,其中１例又加置一个支架,使食管狭窄再次开通。结论：采用镍钛合金支架治疗食管良,     

食管癌性重度狭窄并食管-气道瘘的内支架置入治疗

目的探讨食管癌性重度狭窄合并食管-气道瘘的内支架置入效果。方法透视下,27例食管重度癌性狭窄合并食管-气道瘘患者置入食管覆膜内支架。结果支架全部一次性置入成功,瘘口完全封堵,患者恢复正常进食,肺部感染得以控制。结论内支架置入治疗食管癌性狭窄并食管-气道瘘损伤小、操作简单安全、并发症少、成功率高,控制呛咳具有立竿见影的效果。     

暂时性蘑菇状内支架与经鼻经食管脓腔引流管置入治疗食管-胃吻合口瘘

目的探讨暂时性蘑菇状覆膜内支架与经鼻经食管脓腔引流管置入治疗食管-胃吻合口瘘的疗效。方法对8例食管-胃吻合口瘘患者透视下,经鼻腔和食管向脓腔内置入引流管,负压抽吸脓液,再经食管置入蘑菇状覆膜内支架封堵瘘口。定时经引流管冲洗脓腔,适时复查脓腔造影,及时调整后退引流管的位置,直至引流管完全拔出;在置入术后1个月左右(约在引流管拔出后1周)取出支架。结果8例蘑菇状覆膜内支架和引流管置入技术操作全部成功,放置位置合适。经鼻经食管脓腔引流14～21d,脓腔消失,引流管完全拔出。置入术后1个月内以介入技术顺利取出支架,复查造影瘘口均愈合,脓腔消失。结论暂时性蘑菇状覆膜内支架与经鼻腔经食管脓腔引流管置入治疗食管-胃吻合口瘘,操作简单安全、无严重并发症、花费低、创伤小,是一项值得推广的新技术。     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Hemolytic effect of deformed intra-arterial stents and stent grafts in vitro

Our objective was to evaluate the hemolytic effect of stents and stent grafts in an in vitro flow model. The model consisted of silicone tubings. Pulsatile flow was delivered at 1170 ml/min. Diluted packed erythrocytes were used (hematocrit of 33%). The Palmaz, MegaLink stents or Passager, Hemobahn stent grafts were placed in the middle portion of the model; control experiments contained no implant (n=10 each). Concentric stenosis of the implant was achieved by constricting the implant to 25, 50, or 70% (area, n=10 each). Samples were drawn at minute 1, 2, 4, 6, 8, 10, 15, and every 10 min up to 1 h. Hemolytic parameters were evaluated. All implants produced hemolysis, increasing in the course of time. Without deformation (0%) the Hemobahn stent causes less hemolysis compared with the other prostheses. At 25% no significant difference could be shown between all devices. At 50% constriction the Palmaz stent caused more hemolysis than the other grafts, and at 70% stenosis the Palmaz and Hemobahn caused more hemolysis than Passager or Megalink. A hemolytic effect was evaluable, probably due to mechanical stress and sheer forces, induced by turbulences in the proximity of the deformed stent. The stent grafts did not perform better than the stents. Differences in the design of a prosthesis and in the degree of stent deformation seem to have an influence on the hemolysis caused. Electronic Publication