支气管镜引导联合透视下气道支架置入术治疗恶性气道狭窄的临床分析

目的研究支气管镜引导联合透视下气道支架置入术治疗恶性气道狭窄的疗效。方法对2003年01月至2013年05月因恶性气道狭窄置入气道支架的患者随访12个月,评估疗效及并发症。结果80例恶性肿瘤导致的气道狭窄患者均能顺利置入气道支架,术中无患者死亡,置入后呼吸困难评级、FVC、FEV1、PEF及Pa O2等指标均明显改善(P0.05),出现远期并发症的几率为11.25%。结论支气管镜引导联合透视下气道支架置入术对恶性气道狭窄能迅速的缓解呼吸困难症状,短期疗效显著,安全性好。     

数字减影血管造影术联合气管镜支架置入治疗恶性气道狭窄临床应用

正气道金属支架置入是治疗恶性肿瘤引起的中央气道狭窄的有效方法,支架置入后呼吸困难可立即显著改善,支架再次置入对治疗支架置入后再狭窄所致呼吸困难仍然有效[1]。患者因气道狭窄、病情危重,在支架置入时操作困难。我科采用数字减影血管造影术(digital subtraction angiography,DSA)透视下联合支气管镜引导下气管镍钛合金支架置入治疗10例恶性重度气道狭窄患者取得良好疗     

气道内支架在复发性多软骨炎中的应用

目的观察气道内支架治疗累及气道的复发性多软骨炎(RP)的可行性和安全性。方法收治累及气道的RP患者6例(男1例,女5例),6例患者均存在不同程度的呼吸困难,据气道狭窄部位、程度不同,在手术室全麻下,在电子支气管镜引导下行气道内支架置入术,术后第3 d、7 d、30 d、60 d行电子支气管镜检查,了解支架的释放、位置及并发症情况。结果 6例患者共放置7个气道支架,其中I形支架4个,L形支架1个,Y形支架2个;7个支架均一次性成功置入;支架置入后患者呼吸困难症状明显改善,症状缓解。结论气道内支架置入术是治疗气道受累RP的有效方法,可改善患者症状,提高生存质量。     

支气管镜下联合介入治疗75例良性中央气道狭窄效果分析

目的 通过对支气管镜下联合介入诊疗方法治疗良性中央气道狭窄疗效及预后评估,分析优化中央气道狭窄支气管下介入诊疗方法的选择。方法 收集我院呼吸与危重症医学科2016年8月至2021年12月中央气道良性狭窄患者75例,共计行232例次支气管镜下介入诊疗,主要方法有高频电刀、氩气刀、冷冻治疗、激光消融、球囊扩张、气管支架置入等。术前对患者进行狭窄气道内径测量,评估狭窄程度及分级、Borg呼吸困难评分、术前风险评估,针对每名患者狭窄病因和部位不同制定对应支气管镜下治疗策略。结果 对于支气管结核引起的狭窄,80%以上患者可在支气管镜下介入联合治疗后得到有效治疗,能缩短抗结核治疗疗程。对于气管上段插管或气切后狭窄的患者行内镜下介入诊疗能快速缓解临床症状,但是对于气管结构性损坏或反复多种方法治疗后仍有疤痕挛缩的患者置入硅酮支架是理想选择,经过随访,1～2年后取出硅酮支架患者气道狭窄段结构稳定,黏膜完整光滑。对于气道良性肿瘤及异物引起的各段气管、支气管狭窄,支气管镜下介入诊疗能达到根治的目的。而因结构性肺病引起的气道牵拉变形狭窄治疗方法不理想。结论 中央气道良性狭窄病因多样,针对不同病因采取不同的支气...     

经纤维支气管镜置入气道支架治疗气道狭窄35例的临床分析

目的了解气道狭窄患者经纤维支气管镜置入气道支架的近期及中远期疗效。方法对35例安置气管支气管支架的气道狭窄患者随访1～12个月,评估疗效、合并症。结果 35例气道狭窄患者均能顺利置入气管支气管支架,术中无患者死亡,置入后呼吸困难、喘憋症状能即刻明显改善,肺功能各指标有明显改善(P<0.05),短期(<30 d)有效率为91.4%,12个月存活率为65.7%。并发症包括肉芽组织增生、肿瘤组织增生、支架断裂、支架移位以及气管、支气管瘘等。结论对于气道狭窄患者使用气管支气管支架置入疗效显著,能够迅速缓解症状,安全性较好,并发症主要发生于30 d之后。     

3例复发性多软骨炎气道狭窄探讨支架置入与取出时机

正复发性多软骨炎(relapsing polychondritis,RP)是临床少见病,累及气道时可出现气管支气管狭窄,除药物治疗外,气道内支架置入能迅速缓解呼吸困难症状,但因其存在并发症,所以置入与取出支架的时机需严格把握。本文就3例RP探讨气道狭窄支架置入与取出时机。病例资料病例1:54岁男性,因"间断咳嗽、咳痰伴活动后气短11月,加重1月"入院。患者11月前无明显     

支气管镜引导置入气管支气管支架治疗肺癌并气道狭窄的临床分析

目的分析经支气管镜引导置入气管支气管支架治疗肺癌并气道狭窄的经验和疗效。方法肺癌并气道严重狭窄患者,行支气管镜引导下气管支气管支架置入术。结果 15例患者均成功置入气管支气管支架,且置入后呼吸困难的症状立即缓解,PaO2、PaCO2明显被改善,咳嗽、咯血等近期并发症轻微;出现气道阻塞、支架移位等远期并发症的几率均为6.7%。结论支气管镜引导气管支气管支架置入术,对肺癌并气道狭窄患者是安全有效的,且操作简便,能明显改善患者近期生活质量。     

鼻塞式持续性气道正压通气治疗小儿重症肺炎的临床效果

目的探讨鼻塞式持续性气道正压通气(CPAP)治疗小儿重症肺炎的临床效果。方法选取2013年1月—2015年1月咸阳彩虹医院收治的重症肺炎患儿134例,按照随机数字表法分为对照组与观察组,各67例。对照组患儿予以经鼻导管高流量吸氧治疗,观察组患儿予以鼻塞式CPAP治疗,两组患儿均治疗24 h。比较两组患儿临床症状缓解时间(心率恢复正常时间、呼吸困难缓解时间、肺啰音消失时间、发绀消失时间、胸骨凹陷消失时间)、住院时间、治疗前后血气分析指标〔氧分压(Pa O2)、血氧饱和度(Sa O2)、二氧化碳分压(Pa CO2)〕、临床效果及并发症发生情况。结果观察组患儿心率恢复正常时间、呼吸困难缓解时间、肺啰音消失时间、发绀消失时间、胸骨凹陷消失时间以及住院时间短于对照组(P0.05)。治疗前两组患儿Pa O2、Sa O2、Pa CO2比较,差异无统计学意义(P0.05);治疗后观察组患儿Pa O2、Sa O2高于对照组,Pa CO2低于对照组(P0.05);两组患儿治疗后Pa O2、Sa O2高于治疗前,Pa CO2低于治疗前(P0.05)。观察组患儿临床效果优于对照组(P0.05)。两组患儿均未发生严重并发症。结论鼻塞式CPAP治疗小儿重症肺炎的临床效果确切,可有效改善患儿临床症状及血气分析指标,缩短患儿住院时间,且安全性较高。     

气管插管引导下经硬质气管镜置入硅酮支架治疗气道狭窄的疗效

目的探讨气管插管引导下置入硬质气管镜及硅酮支架治疗气道狭窄的疗效及安全性。方法选取2016年1月-2019年5月在南通市第一人民医院就诊的拟行硅酮支架置入的中心性气道狭窄患者27例,随机分为气管插管引导下插入硬镜组和直接法插入硬镜组,比较两组的硬镜插入时间,术中患者心率、血压、SPO_2情况。同时比较硅酮支架置入前、术后1周患者生活质量评分、气道狭窄程度、血气分析结果、呼吸困难缓解及并发症发生情况。结果气管插管引导下插入硬镜组术中低氧血症及心动过速的发生率明显低于直接法插入硬镜组(P均0.05),气管插管引导下插入硬镜组插入时间也明显短于直接法插入硬镜组(t=3.754,P0.05)。硅酮支架置入术后一周患者的气道狭窄程度、呼吸困难评分较术前明显下降,氧分压、生活质量评分较术前升高(P0.05)。无严重并发症发生。结论气管插管引导下硬镜置入安全、有效;硅酮支架是治疗良恶性气道狭窄的有效方法,临床值得推广。     

累及气道的复发性多软骨炎27例治疗分析

目的分析累及气道的复发性多软骨炎患者的临床特点及治疗转归。方法回顾性分析气道受累的复发性多软骨炎患者的临床资料。结果 27例累及气道的复发性多软骨炎患者,女性15例,男性12例,平均年龄52岁(14～65岁),以呼吸道症状起病的23例(85.2%),病程1个月～15年。11例管腔狭窄明显者经保守治疗无效后置入气道内支架,1例支架置入失败,置入术后第2日气促评分1.1±0.3,较治疗前明显缓解(P0.05),放置支架患者均出现不同程度的肉芽增生、气道再狭窄及呼吸道感染。3例行气管切开术,3例行气管切开及支架置入术。13例管腔狭窄轻者及1例支架置入失败者给予保守治疗,均病情稳定出院,出院时气促评分1.3±0.2,较治疗前缓解(P0.05)。结论复发性多软骨炎累及气道时,首选内科保守治疗,保守治疗无效时可行支气管镜检查评估管腔狭窄程度,管腔狭窄程度严重者可选择介入治疗,能迅速缓解症状,但并发症较多。     

经支气管镜冷冻联合氩气刀治疗支气管结核28例临床分析

目的探讨经支气管镜介入冷冻联合氩气刀治疗结核性大气道狭窄的疗效。方法对28例支气管结核患者的狭窄气道进行冷冻联合氩气刀治疗,比较治疗前后的临床表现、影像学及镜下改变等指标来进行疗效评价。结果 28例患者经过平均1.6个月和平均4.7次/人的治疗,完全有效57.1%(16/28),部分有效35.7%(10/28),轻度有效7.1%(2/28),无效0例。术中有2例出现气胸,其余的未见明显不良反应,经过1～4月的随访,4例出现再次狭窄而采取支架植入治疗,长期有效率达71.4%(20/28)。结论冷冻联合氩气刀治疗支气管结核是一项安全、有效、简便的支气管治疗方法。     

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。     

Interventional bronchoscopy for the management of airway complications following lung transplantation.

STUDY OBJECTIVES: To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation. DESIGN: Retrospective study. SETTING: Heart-lung transplant unit of a university hospital. PATIENTS: From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence. INTERVENTIONS: Dilatation, stent placement, laser or forceps excision. MEASUREMENTS AND RESULTS: Mean (+/- SE) improvement in FEV(1) in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 +/- 334 mL or 8 +/- 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV(1) was 361 +/- 179 mL or 21 +/- 9%. Patients needing stent placement after dilatation had a mean change in FEV(1) after dilatation of - 5 +/- 325 mL or 3 +/- 23%, and an improvement of 625 +/- 480 mL or 52 +/- 43% after stent insertion. Mean improvement in FEV(1) for patients treated with stent insertion for bronchomalacia was 673 +/- 30 mL or 81 +/- 24%. Complications of airway stents were migration (27%), mucous plugging (27%), granuloma formation (36%), stent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4% (1 of 41 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05). CONCLUSION: Only a small number of patients with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications.     

罗格列酮结合BiPAP呼吸机无创治疗AECOPD的临床效果观察

目的：探讨罗格列酮结合 BiPAP 呼吸机无创治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法选择2013年1月至2015年6月本院收治的AECOPD患者80例,按照随机数字法分为2组,各40例,2组患者入组后均实施对症支持治疗,对照组同时使用美国伟康BiPAP Vision型无创呼吸机支持治疗,观察组则在对照组基础上使用罗格列酮,每次4 mg,每日1次,晨起口服,连续治疗2周为1疗程,连续2个疗程为一个治疗周期。比较2组治疗前后炎症性细胞因子(TNF-α、IL-1和 hs-CRP)变化情况,治疗前后抗氧化因子(SOD和 MDA)变化情况,治疗前后血气分析(PO2和PCO2)变化情况,及肺功能结果(FEV1和 FEV1/FVC)变化情况,并统计2组使用无创呼吸机辅助治疗时间。结果治疗后2组 TNF-α、IL-1及 hs-CRP 水平均显著低于治疗前(t=280.000、37.210、57.351、115.772、4.650、26.415,P<0.05),且治疗后观察组TNF-α、IL-1及 hs-CRP水平低于治疗后对照组(t=212.132、30.679、33.527,P<0.05),治疗后观察组SOD水平高于治疗前(t=36.829,P<0.05),MDA水平低于治疗前(t=32.000,P<0.05),且治疗后观察组 SOD水平高于治疗后对照组(t =23.382,P <0.05),MDA 水平低于治疗后对照组(t =16.971,P<0.05),治疗后观察组PO2高于治疗前(t=9.609,P<0.05),PCO2低于治疗前(t=27.548,P <0.05),FEV1高于治疗前(t =41.777,P <0.05),FEV1/FVC 高于治疗前(t =33.621,P<0.05),且治疗后观察组PO2高于治疗后对照组(t=6.276,P<0.05),PCO2低于治疗后对照组(t=9.499,P<0.05),FEV1高于治疗后对照组(t=16.611,P <0.05),FEV1/FVC高于治疗后对照组(t=15.882,P<0.05)。结论罗格列酮结合 BiPAP 呼吸机无创治疗 AECOPD 患者,能有效抑制机体炎症反应,减轻氧化应激反应,提高肺通气与换气功能,缩短使用呼吸机治疗时间,值得临床重视。     

药物涂层球囊治疗冠状动脉药物洗脱支架内再狭窄临床分析

目的分析药物涂层球囊(DCB)在治疗冠状动脉药物涂层支架内再狭窄病变中的疗效。方法回顾性分析20例冠状动脉药物洗脱支架内再狭窄患者接受药物涂层球囊治疗的临床资料及随访结果。结果 20例患者共21处再狭窄病变接受DCB治疗,术中即刻成功率95.23%,1处病变在应用DCB治疗后并发夹层并出现TIMI 2级血流,然后植入药物洗脱支架(DES)治疗。所有病例术后随访至今无心绞痛再发,未发生主要心血管不良事件。其中12例患者在术后6~9个月接受冠状动脉造影复查,复查时靶病变最小管腔直径与术后即刻直径比较,按病变血管统计,差异无统计学意义(P0.05);合计统计比较差异有统计学意义(P0.05)。结论 DCB治疗DES支架内再狭窄即刻及短期疗效肯定,可以作为支架内再狭窄的一种新的治疗手段。     

无创双水平气道正压通气治疗中重症支气管哮喘的临床效果观察

目的观察无创双水平气道正压通气(BiPAP)治疗中重症支气管哮喘的临床效果。方法选取2011年4月—2014年2月江西省湘雅萍矿合作医院收治的中重症支气管哮喘患者46例,随机分为对照组和观察组,各23例。对照组采用常规综合治疗,观察组在常规综合治疗基础上加用无创Bi PAP治疗。比较治疗前和治疗72 h后两组患者肺功能指标〔第一秒用力呼气末容积占预计值百分比(FEV1%)和最大呼气流量占预计值百分比(PEF%)〕及血气分析指标(PaO2、PaCO2及SaO2)。结果两组治疗前FEV1%和PEF%比较,差异无统计学意义(P0.05);治疗后观察组FEV1%和PEF%高于对照组(P0.05)。两组治疗前PaO2、PaCO2及SaO2比较,差异无统计学意义(P0.05);观察组治疗后PaO2和SaO2高于对照组,PaCO2低于对照组(P0.05)。结论无创Bi PAP治疗中重症支气管哮喘效果确切,可有效改善患者肺通气功能,迅速纠正低氧及CO2潴留情况。     

改良型可回收金属支架治疗贲门失弛缓症疗效的初步评价

目的 初步探讨改良型可回收金属支架治疗贲门失弛缓症的疗效及安全性.方法 30例确诊为贲门失弛缓症患者随机分成两组,普通型支架(A组)和改良型支架(B组)各15例,在胃镜直视下置入支架于贲门处,2d后在X线引导下通过胃镜将支架取出.分别记录治疗前及治疗半年后患者吞咽困难、下食管括约肌(LES)静息压及食管X线表现(包括食管最扩张处直径、贲门最狭窄区宽度)的变化情况;支架置入时与2d后取出时X线下支架最狭窄处的宽度变化;治疗过程中不良反应及并发症情况.结果 30例支架置入和取出的成功率为100％,置入后A组有2例发生支架脱落,取出后重新置入,B组无一例出现移位和脱落.支架治疗半年后患者吞咽困难与治疗前相比两组均有明显改善(P＜0.05);但半年后吞咽困难复发率A组(26.7％)明显高于B组(6.67％)(P＜0.05);支架治疗前后X线下食管腔最大扩张程度两组均有明显改善(P＜0.001),贲门最狭窄区直径、支架放置后和取出时最狭窄处直径及LES静息压两组较治疗前均有明显改善,但改善程度B组显著优于A组(P＜0.05).治疗时及治疗后不良反应发生率两组无统计学差异,两组均无穿孔.结论 改良型可回收金属支架治疗贲门失弛缓症具有放置时间短、无移位脱落、症状改善明显及复发率低等优点,且安全性良好.     

结核性主支气管重度狭窄合并单侧肺不张患者支气管镜介入治疗效果分析

目的 观察支气管镜介入治疗对结核性主支气管重度狭窄或闭锁并一侧全肺不张的疗效.方法 1999年7月至2009年9月第二军医大学长海医院收治的90例结核性主支气管重度狭窄或闭锁并一侧全肺不张患者,其中男13例,女77例,年龄13～71岁,平均(31±10)岁.根据是否放置支架分为介入治疗组(53例)和支架置入组(37例),介入治疗组采用高频电凝、球囊扩张及冷冻等治疗方法,支架置入组在介入治疗的基础上置入金属支架.比较2组患者治疗前和病情稳定后影像学、支气管镜下表现及气促指数,观察治疗有效率、起效时间及再狭窄率,比较不同病程患者之间的疗效差异.2组资料比较显著性检验采用χ2检验.气促指数、病程的显著性检验采用Wilcoxon秩和检验.结果 治疗3个月后支架置入组显效率(36/37)和总有效率(37/37)均优于介入治疗组(22/53,43/53,χ2=29.595、6.060,均P<0.05),支架置入组的起效时间(0.25个月)较介入治疗组(1.60个月)明显缩短.所有患者治疗后气促指数均较前明显改善,支架置入组与介入治疗组比较差异有统计学意义(u=-2.478,P<0.05).治疗有效者中位病程为2.0个月,好转者为3.5个月,无效者为5.0个月,有效与无效者相比,差异有统计学意义(u=-3.079,P<0.01).对治疗有效者随访结果显示,再狭窄发生率达72%(26/36),显著高于介入治疗组的32%(7/22,χ2=9.090,P<0.01).发生再狭窄的中位时间介入治疗组为4个月,支架置入组为6个月.治疗有效后第12个月复查支气管镜,支架置入组的显效率(15/25,60%)及总有效率(22/25,88%)均优于介入治疗组(7/24,29%,14/24,60%,χ2=10.559,10.261,均P<0.01).支架置入组中主支气管闭锁患者的总有效率(10/11,91%)明显高于介入治疗组(7/14,50%,Fisher检验,P<0.05).组内比较主支气管重度狭窄与闭锁者的有效率无明显差异.结论 支气管镜下高频电凝、球囊扩张及冷冻等常规介入治疗及支架置入均是治疗导致肺不张的结核性主支气管重度狭窄或闭锁的有效方法.其中支架置入的疗效更好,症状改善更快.支架置入的疗效较好,但再狭窄发生率高,易发生在支架置入后6个月,应加强随访.病程对疗效有显著影响,病程长者疗效较差.因此对于出现呼吸困难,特别是肺不张的支气管结核患者,应尽早治疗.

Abstract：

Objective To observe the therapeutic efficacy of bronchoscopic interventional therapy on severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis.MethodsNinety patients with severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis, who had received bronchoscopic interventional therapy, were divided into group A and B according to whether stents had been implanted or not. Patients in group A had been treated with electrocautery, balloon dilatation and cryotherapy. Group B had been treated with metallic stent implantation on the basis of the above interventional management. In order to observe the effectiveness, the time needed for taking effect and restenosis rate were noted. The efficacy between patients with different disease courses, radiology, bronchoscopy and dyspnea index were evaluated before treatment and after the patients' conditions were stable. Results Three months after treatment, the good response rate and the total effective rate of group B were higher than those of group A, 97% vs 42% (χ2=29.595, P<0.05), 100% vs 81% (χ2=6.060,P<0.05), respectively. The time needed for taking effect in group B was significantly shorter than that in group A, 0.25 month vs 1.6 month. The dyspnea indexes of both groups were significantly improved after treatment, but the improvement of group B was more significant than that of group A(u=-2.478,P<0.05). The disease course of patients with different therapeutic efficacy was evaluated, and the median disease course was 2 months in good response efficacy patients, 3.5 months in improved patients, and 5 months in ineffective patients; the difference being significant between ineffective and good response efficacy patients (u=-3.079, P<0.01). The restenosis rate of group B was significantly higher than that of group A, 72% vs 32% (χ2=9.090,P<0.01). The median restenosis time was 4 months in group A, and 6 months in group B. Bronchoscopy follow-up 12 months after the initial effective treatment showed that the good response rate and the total effective rate of group B were better than those of group A, 60% vs 29%(χ2=10.559, P＜0.01), 88% vs 60%(χ2=10.261, P＜0.01, respectively), and the total effective rate of main bronchial atresia patients in group B was significantly higher than that in group A, 90% vs 50% (Fisher's exact test, P<0.05). There was no significant difference in effectiveness between severe stenosis and atresia patients in group A and B.Conclusion Electrocautery, balloon dilatation, cryotherapy and stent implantation were effective methods to treat severe tuberculous main bronchial stenosis or atresia complicated with unilateral atelectasis. Among them, the therapeutic efficacy was better and the symptoms improved more quickly in patients with stent implantation. The efficacy of stent implantation was better than that of conventional interventional therapy, but the incidence of restenosis was also higher. Following-up should be emphasized in this group of patients. Disease courses were associated with the therapeutic efficacy; longer disease course was related to worse therapeutic efficacy, and restenosis occurred earlier. So interventional therapy should be initiated earlier for bronchial tuberculosis with dyspnea, especially for that complicated by atelectasis.     

老年哮喘患者气道反应性测定的应用

目的　主要探讨老年哮喘气道反应性及治疗特点。　方法　老年哮喘50例(激素治疗组28例及非激素治疗组22例)、慢性阻塞性肺疾病(COPD)48例、健康老年人30例。观察肺活量(VC)、一秒率(FEV     

Stenting for in-stent restenosis.

Intravascular ultrasound studies have shown that additional stent implantation is the only percutaneous technique that allows for recovery of all the lumen area of the original implantation procedure. Despite this theoretical advantage, information on systematic additional stent implantation is still forthcoming, especially concerning the impact of new stent designs. This prospective study evaluated the efficacy of routine additional stent implantation for treatment of in-stent restenosis in 68 consecutive patients. Repeat stenting was successful in all cases, and second-generation tubular stents were used in 84% of patients. The mean additional stent length was 19.2 +/- 9.4 mm, and 15% of patients had multiple stent implantation. The postprocedure minimum lumen diameter was 3.11 +/- 0.41 mm, and the percentage residual stenosis was 2% +/- 7%. At a mean clinical follow-up of 10 +/- 8 months (follow-up rate 100%), the incidence of major adverse events was 21% (1 death, 13 target vessel revascularizations). Overall, angiographic restenosis rate was 32% (angiographic follow-up rate 79%). By multivariate analysis, the only predictors of recurrence after additional stenting were unstable angina at the second procedure (OR 8.70, 95% CI 1.50-50.33, P = 0.019), and early clinical recurrence after the first stent procedure (OR 4.83, 95% CI 1.13-20.71, P = 0.038). Additional stenting is a safe and effective treatment modality for the majority of patients with in-stent restenosis. Alternative treatments should be considered only for patients with in-stent restenosis presenting as unstable angina or early recurrence after a first stent procedure.