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。     

Dumon支架放置失败23例原因分析

目的分析全麻下经硬镜放置Dumon支架失败的原因,以提高放置成功率。方法对23例经硬镜放置Dumon支架失败患者的术前准备、操作过程进行回顾性分析。结果颈后伸受限、开口狭小等致硬镜未能插入6例;主支气管严重狭窄致Y支架前推困难3例;主支气管瘘因硬镜未能插到瘘口远方以致支架推到消化道腔内4例;良性狭窄扩张不够,致支架未能放到狭窄管腔5例;严重气道软化,支架前推时气道破裂3例;因术中出现严重心血管事件而中止放置2例。结论为提高放置成功率,应注意:做好术前评估,掌握好适应证;瘢痕狭窄放置前应先充分扩张管腔;气道瘘者镜管应尽量插到瘘口远方;主支气管均严重狭窄时可边球囊扩张边前推;支架不能前推到狭窄管腔时可现场加工支架。     

内镜支架置入新技术治疗幽门良性狭窄的初步观察（含视频）

2017年6月—2019年9月,5例良性重度幽门狭窄患者在郑州大学第一附属医院接受了内镜下全覆膜支架置入新技术治疗,5例均成功完成幽门处全覆膜支架置入,无并发症发生,术后行上消化道造影显示支架位置良好、造影剂通过顺利。5例患者于术后1～3 d开始进流食,进食后均无呕吐、腹痛、腹泻等症状出现,随访期间均有不同程度的体重增加,营养状态获得明显改善。4例于术后3～4个月行支架取出术;余1例于术后3个月发现支架移位至胃内,取出支架后观察幽门口略狭窄,行球囊扩张术+黏膜切开术。随后5例继续随访3个月,均无症状反复及再狭窄。以上结果初步证实,内镜下全覆膜支架置入新技术治疗良性幽门狭窄安全、有效。     

气道支架置入联合球囊扩张治疗发烟罐气体吸入性损伤致气道瘢痕狭窄1例报道

正在我国,良性气道狭窄主要由于气管-支气管结核、气管插管或气管切开术后、气管外压性狭窄所致,因吸入烟雾致气道化学性损伤所致的瘢痕狭窄较为少见。气道狭窄是呼吸科、胸外科的急危症,往往需要紧急处理,气道支架置入联合球囊扩张术能迅速扩张狭窄气道,缓解呼吸困难,避免阻塞窒息,是此类病人重要的抢救手段。我科于2016年3月接诊一批某部队实战演练时误吸入发烟罐气体致化学性吸入性损伤的患者,其中1例声门下气道黏膜     

倒Y型金属气道支架置入治疗晚期恶性肿瘤隆突部狭窄

目前常使用直管形金属气道内支架治疗非隆突部位的气道阻塞[1],但病变若同时累及气管下段、气管隆突和左右主支气管导致隆突区域的多发性或复合狭窄时,不能用单枚内支架有效解除全部气道狭窄,可以同时放置多个管形金属支架、单分支状金属气道内支架、Y型硅胶管支架(Dumon支架)或用2枚自膨胀式金属支架制成的Y型支架进行治疗[2-5].     

气管镜介入并放置 Dumon 支架治疗肺癌袖状切除术后吻合口狭窄1例并文献复习

目的观察气管镜下常规介入并放置Dumon支架治疗肺癌袖状切除术后吻合口狭窄的效果。方法回顾性分析1例常规介入并放置Dumon支架治疗肺癌袖状切除术后吻合口狭窄患者的临床资料,并复习相关文献。结果患者男,57岁,1 a前因右肺上叶鳞癌行右肺上叶袖状切除术,术后3个月因咳嗽及活动后喘憋入院,行胸部CT检查示右中叶及右下叶肺不张,行电子气管镜检查诊断为右肺上叶袖状切除术后吻合口狭窄并闭锁,给予气管镜下电切、二氧化碳冷冻、球囊扩张等介入治疗并放置Dumon支架1枚,术后临床症状明显缓解,复查胸部CT示右肺复张。结论气管镜下常规介入并放置Dumon支架治疗肺叶袖状切除术后吻合口狭窄临床效果较好。     

下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓的疗效观察

目的探讨下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓的疗效和临床应用。方法入选2013年2月至2015年8月广州医科大学附属第一医院连续收治的17例下肢深静脉血栓患者,其中混合型血栓15例,中央型2例;16例血栓位于左侧深静脉,1例血栓位于右侧深静脉。所有患者均经健侧股静脉插管置入滤器后,将溶栓导管置入患侧下肢静脉进行尿激酶溶栓,期间定期复查下肢深静脉造影及下肢静脉超声。结果所有患者均一次性成功置入OptEase下腔静脉滤器并成功进行尿激酶溶栓治疗,患者临床症状在溶栓5~10 d后均明显改善及消失,其中7例溶栓后下肢静脉造影左髂总静脉狭窄大于90%;5例经球囊扩张后残余狭窄小于40%;2例球囊扩张后残余狭窄大于50%,并行支架置入术,术后残余狭窄小于20%。结论下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓安全、直接、有效,但长期疗效有待于进一步观察。     

支气管球囊扩张术治疗良性支气管狭窄的护理配合

目的评价纤维支气管镜下支气管球囊扩张术治疗良性支气管狭窄的护理配合。方法收集良性支气管狭窄患者20例,根据狭窄的部位及长度,选择不同型号的球囊扩张导管进行球囊扩张术,分别检测术前和最后1次术后当天患者支气管狭窄段的直径和气促评分,测定第1秒用力呼气量(FEV1)和用力肺活量(FVC),记录术后并发症,并定期随访所有患者。结果所有患者均接受球囊扩张成功,平均(2.1±1.5)次。行球囊扩张术后,狭窄段支气管直径明显增大,气急、胸闷等不适症状明显缓解,未出现严重并发症,具有高达100%的即刻疗效,且远期疗效较好。结论术前、术中、术后的护理配合对纤维支气管镜下球囊扩张治疗良性支气管狭窄顺利完成,具有重要作用。     

食管及贲门良、恶性狭窄的内镜下治疗169例临床观察

目的探讨内镜下扩张治疗食管及贲门的良、恶性狭窄的临床疗效。方法术前进行内镜以及食管X线造影检查,了解狭窄的位置、形态、管腔直径大小以及有无肿瘤等情况。插入球囊扩张管,对169例食管及贲门的良性及恶性狭窄行球囊扩张或者并探条扩张、支架置入、热凝治疗。结果单纯行球囊扩张治疗158例,球囊扩张并支架置入6例,球囊扩张并热凝治疗4例,球囊扩张并探条扩张治疗1例,术后均有不同程度的疗效。结论食管及贲门的良、恶性狭窄的内镜下扩张治疗是一种简单、有效的治疗方法。     

螺旋穿透微导管(Tornus)在冠状动脉慢性完全闭塞病变介入治疗中的应用

目的 评价一种新的螺旋穿透微导管(Tomus)在慢性完全闭塞病变(CTO)介入治疗中应用的效果.方法 6例CTO患者在介入治疗中,导丝成功通过病变后,球囊导管未能通过病变,采用Tomus微导管的机械作用通过闭塞病变后交换球囊,从而为球囊扩张做准备.结果 所有Tomus导管均成功通过病变部位,随后球囊也均能顺利通过闭塞病变进行扩张和置入支架,术中所有患者均未出现冠状动脉穿孔等并发症.结论 Tomus导管在治疗CTO等严重冠状动脉病变中是有效的和安全的.     

Interventional bronchoscopy in the management of airway stenosis due to tracheobronchial tuberculosis

STUDY OBJECTIVES: To assess the efficacy and complications of interventional bronchoscopic techniques in treating airway stenosis due to tracheobronchial tuberculosis. DESIGN: Case series. SETTING: Respiratory care centers at two tertiary care referral teaching hospitals in Japan, Hiroshima City Hospital and Okayama Red Cross Hospital. PATIENTS AND INTERVENTIONS: A total of 30 patients were admitted to the hospital with a diagnosis of tracheobronchial tuberculosis between January 1991 and January 2002. Of those 11 patients received interventional bronchoscopy, including stent placement, laser photoresection, argon plasma coagulation (APC), balloon dilatation, cryotherapy, and endobronchial ultrasonography (EBUS). One patient with complete bronchial obstruction underwent a left pneumonectomy. RESULTS: Six patients underwent stent placement after balloon dilatation, while the remaining five patients underwent only balloon dilatation. In six patients, Dumon stents were successfully placed to reestablish the patency of the central airways. Two patients first had Ultraflex stents implanted but had problems with granulation tissue formation and stent deterioration caused by metal fatigue due to chronic coughing. Dumon stents then were placed within the Ultraflex stents after the patient had received treatment with APC and mechanical reaming using the bevel of a rigid bronchoscope. In four patients, EBUS images demonstrated the destruction of bronchial cartilage or the thickening of the bronchial wall. The main complications of Dumon stents are migration and granulation tissue formation, necessitating stent removal, or replacement, and the application of cryotherapy to the granuloma at the edge of the stent. CONCLUSION: Interventional bronchoscopy should be considered feasible for management of tuberculous tracheobronchial stenosis. Dumon stents seem to be appropriate, since removal or replacement is always possible. Ultraflex stents should not be used in these circumstances because removal is difficult and their long-term safety is uncertain. EBUS could provide useful information in evaluating the condition of the airway wall in cases of tracheobronchial tuberculosis with potential for bronchoscopic intervention.     

Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis

STUDY OBJECTIVES: A frequent complication of the widely used Dumon silicone stent is its tendency to migrate when used in tracheal stenosis. We compared the clinical efficacy and complications (including migration) of the Dumon stent with a screw-thread stent, a device with an increased stent-to-wall contact surface and, theoretically, less tendency to migrate. DESIGN: Retrospective case analysis. SETTING: Academic hospital. MATERIALS AND METHODS: Forty-six patients with tracheal stenoses (23 benign and 23 malignant) requiring the placement of 50 stents (29 Dumon and 21 screw-thread) were studied. In 26 patients Dumon stents were used, and in 20 patients screw-thread stents were used. Both patient groups had comparable clinical and stenosis-related characteristics. RESULTS: Stent insertion and follow-up were uneventful in both the Dumon and the screw-thread insertions, respectively: 62% vs 67% (not significant). There were seven migrations in the Dumon group, compared to only one migration in the screw-thread group, respectively: 24% vs 5%. This difference did not reach statistical significance (p = 0.1). All of the migrations occurred in the benign stenosis group, and none occurred in the malignant-stenosis group, respectively: 8 of 23 vs 0 of 23, p = 0.004. Within the benign-stenosis group, the Dumon stent had a significantly increased risk for migration when compared to the screw-thread stent, respectively: 7 of 13 vs 1 of 11, p = 0.033. CONCLUSIONS: The screw-thread stent and the Dumon stent are equally effective in the management of tracheal stenosis. There is a general trend toward a decreased migration rate, and a significantly lower risk for migration in patients with benign tracheal stenosis. The (less expensive) screw-thread stent may represent an attractive alternative in the management of tracheal stenosis in general, and may be preferable to the Dumon stent in treating benign tracheal stenosis.     

Implantation of endoprostheses in aortocoronary bypass. Preliminary experience at the Thoraxcenter of Rotterdam

An intraluminal stent was implanted in 5 patients after dilatation of an aorto-coronary venous graft. In the first 4 patients the procedure was motivated by restenosis after angioplasty. In the 5th patient the stent was implanted as a first-line measure in a case of dilated venous bypass stenosis. Stent implantation carries a risk of thrombosis and requires effective anticoagulation. Thus, one of our patients had to be reoperated upon for prosthetic thrombosis facilitated by the withdrawal of anticoagulants owing to a gastrointestinal haemorrhage. After a 3-month follow-up, the results seem to be encouraging in spite of a case of restenosis located at the proximal end of the tutor. However, more time will be needed to determine precisely the effectiveness of stents in the prevention of restenosis after venous graft dilatation.     

气管与主支气管良性狭窄金属支架植入后再狭窄及处理

目的观察良性气管、主支气管狭窄金属支架植入后再狭窄的发生情况,评价球囊扩张、冷冻、高频电凝对再狭窄的疗效。方法对30例良性气管狭窄(A组)、35例支气管结核(EBTB)性主支气管狭窄(B组)者行金属支架植入术,随访观察再狭窄的发生情况,对再狭窄者行球囊扩张、冷冻和高频电凝联合治疗。评价治疗前及病情稳定后狭窄段气道内径、气促指数和肺通气功能。结果(1)A组发生再狭窄者6例,B组发生再狭窄者8例,再狭窄率分别为20%和22.86%。共植入国产支架30枚,6例发生再狭窄,再狭窄率为20%(6/30);共植入Ultraflex支架36枚,8例发生再狭窄,再狭窄率为22.2%(8/36)(P>0.05)。气管上段支架植入再狭窄率为4/9,中下段支架植入再狭窄率为9.09%(χ2=5.114,P<0.05,但χ2c=3.100,P>0.05)。纤维化期EBTB再狭窄率为16.67%,炎症反应期EBTB再狭窄率为60%(χ2=4.564,P<0.05,但χ2c=2.437,P>0.05)。(2)A组再狭窄治疗有效率为4/6,其中上段和中下段分别为2/4和2/2。B组再狭窄治疗有效率为7/8。(3)2组患者病情稳定后与治疗前相比,狭窄段内径均增加,气促指数均下降,肺活量均升高,第1秒钟用力呼气容积均上升。结论良性气管狭窄、结核性主支气管狭窄金属支架植入后有部分患者发生再狭窄。气管上段再狭窄发生率高于中下段,对这部分患者行金属支架植入术时应慎重。处于炎症反应期的EBTB再狭窄发生率高于纤维化期,应尽量避免对这部分患者行金属支架植入术。球囊扩张、冷冻和高频电凝是治疗支架植入后再狭窄的有效方法。     

Tracheobronchial stenting for tuberculous airway stenosis

We reviewed the results of the use of the Dumon silicone stents in patients experiencing tuberculous tracheobronchial stenosis since 1994, using a retrospective case review in a university teaching hospital with 1,450 beds serving a population of > 1.8 million. Between February 1994 and September 2001, seven patients with tuberculous tracheobronchial stenosis (mean age, 43 years) underwent a total of 11 dilatations with placement of 10 straight stents and 1 Y stent. Under general anesthesia, all patients underwent rigid bronchoscopy and dilatation of the stenosis with placement of a Dumon stent. There were no deaths. One patient developed a pneumothorax. Two patients experienced migration of the stent, which required reintervention for adjustment of position of the stent. The stents were left in situ for a mean period of 32 months. There was marked improvement in dyspnea in all patients after the procedure, as determined by visual analog scale. Endoscopic dilatation with placement of a silicone stent is an effective treatment for patients with tuberculous tracheobronchial stenosis.     

Treatment of Peripheral Pulmonary Stenoses

Background: Peripheral pulmonary artery stenosis is a relatively frequent anomaly responsible for right ventricular hypertension, significantly affecting the quality of life and the long-term prognosis of patients with congenital heart disease. Balloon angioplasty has been used to relieve pulmonary artery stenosis, but immediate and long-term results have not been completely satisfactory. Conversely, stent implantation seems a promising and more effective technique for the treatment of this vascular anomaly. Methods: Between April 1987 and September 1997, indication for interventional cardiac catheterization has been estabilished for 150 patients. Balloon angioplasty was performed in 120 patients (162 procedures) and stent implantation in 60 patients (79 stents). In 30 patients, both procedures have been carried out. Indication was based on the presence of right ventricular hypertension (right ventricular/systemic peak systolic pressure ratio ≥ 0.5), right ventricular dysfunction, or a markedly unbalanced pulmonary blood flow, especially after bidirectional cavopulmonary anastomosis. Criteria for technical success of balloon dilation were defined as a ≥ 50% increase in the predilation diameter, a ≥ 50% decrease in the transstenotic pressure gradient, or a ≥ 20% decrease in the right ventricular-to-aortic pressure ratio. Mean balloon/stenosis diameter ratio was 3.0 ± 0.7 (range 1.8–4.2). Time between primary surgery/balloon angioplasty and stent implantation was 18 ± 7 months (range 8–21 months). Stainless steel balloon-expandable endovascular stents were maximally dilated to 12–18 mm of diameter, and high-pressure dilations were performed to further expand the stent, if necessary. Results: After balloon angioplasty, the diameter of the stenotic segment increased from 3.1 ± 0.3 to 5.1 ± 1.4 mm (P < 0.01), the gradient across the stenotic segment dropped from 51 ± 19 to 28 ± 8 mmHg (P < 0.01), and the right ventricular/systemic peak pressure ratio decreased from 0.81 ± 0.20 to 0.65 ± 0.15 (P < 0.05). No significant difference between procedures with low-pressure and high-pressure dilation was recorded. Success rates using the above-mentioned criteria could be assessed as high as 60%. After stent implantation, the diameter of the stenotic segments increased from 3.5 ± 1.2 to 13.2 ± 3.4 mm (P < 0.01), the pressure gradient across the stenotic segment dropped from 53 ± 30 to 13 ± 10 mmHg (P < 0.01), and the mean right ventricular/systemic pressure ratio decreased from 0.84 ± 0.2 to 0.40 ± 0.15 (P < 0.01). Immediate overall success for balloon angioplasty was achieved in 73 of 120 patients compared with 58 of 60 patients submitted to stent implantation (60% vs 97%, P < 0.001). The complication rate was 6.9% (5/162 procedures) in the balloon angioplasty group and 1.2% (1/79 implants) in the stent group. Restenosis has been recorded in 25% of the balloon group patients, in respect to 2% of the stent group. Conclusions: Peripheral pulmonary stenosis (PPS) is an important factor conditioning outcome of patients with congenital heart defects. Balloon angioplasty may be technically effective, but it often fails if clinical criteria and impact on patient's outcome are considered. In our experience, the use of high-pressure balloons did not change the success rate of balloon dilation. Stent implantation seems to offer a better and more definitive approach for the relief of PPS.     

Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract - first results of long-term follow-up in interim stent application in pyloric and colonic obstructions.

The use of self-expandable metallic stents (SEMS) is an established palliative treatment of malignant stenosis in the gastrointestinal tract. There is wide experience with the palliation of malignant esophageal obstruction and fistulae, but the application of stents in benign stenosis is rarely reported and exclusively deals with obstruction of the esophagus. No data has been available for benign gastric outlet and rectosigmoid obstruction until now. For the first time we report about 4 cases, in which we temporarily implanted a SEMS (Ultraflex(R) stent, Boston Scientific Microvasive(R)) in benign stenosis of the pylorus or rectosigmoid between 09.97-07.98. The indications for stent implantation were failure of established dilatation therapy and/or refusal of surgical treatment, and/or surgical high-risk patients. Our idea was to prolong the duration of the dilatation by interim implantation (range 8 days - 12 weeks) of a SEMS. There where no peri-interventional complications or dislocations. In one case endoscopic removal was not possible, peranal surgical approach allowed the removal of the stent. During follow-up (range 34-39 months) 2 patients needed one bougienage directly after stent removal. Endoscopic examinations showed no recurrence of any stenosis in all patients.We conclude that interim application of SEMS in benign stenosis of the gastrointestinal tract may be a possible therapeutic tool in selected patients. Further trials with greater numbers of patients dealing with the questions of duration of stay of SEMS and choice of stent type are needed.     

Serial late dilatations of expanded polytetrafluoroethylene‐covered stents in porcine aorta

Background: Covered stents may be desirable for stenting of coarctations. Objectives: To evaluate the ability of Atrium expanded polytetrafluoroethylene (ePTFE)‐covered stents to be implanted and then serially dilated to the size of the adjacent aorta during a rapid growth period in swine. Methods: Eight Yorkshire pigs (7 females) with a mean weight of 18.3 ± 0.7 kg had an Atrium ePTFE‐covered stent deployed in the descending aorta. Five of these animals also had an identical Atrium bare metal stent (BMS) control deployed in the descending aorta. All swines were recatheterized with the first dilatation of the stents to 14 mm at day 100. Four of these animals were recatheterized at day 145 and euthanized, and the remaining four swine were recatheterized with a second dilatation to 18–20 mm, 195 days after initial implantation. Results: All stents were deployed without device malfunction, and both uncovered and covered stents were successfully dilated from 10 to 11 mm to the size of the adjacent aorta (16–20 mm). There was no gradient across either type of stent on recatheterization and all stents were well sized to the native aorta. Only the size of the aorta limited the degree of stent dilatation. The Atrium covered stents consistently recoiled after maximal dilatation and required higher pressures for further expansion. Gross damage to the aorta was noted in two animals in which stents were dilated to >20% the diameter of the native aorta. In stent neointimal thickness was equivalent for both types of stent. Conclusions: Atrium ePTFE‐covered stents can be implanted at 10–11 mm and serially dilated to accommodate for rapid aortic growth. High pressure balloons are required for dilatation of ePTFE‐covered stents. Atrium covered stents exhibited more recoil and foreshortening at larger diameters. © 2008 Wiley‐Liss, Inc.     

Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis

AIM： To report 13 patients with benign esophagea stenosis treated with the biodegradable stent.
METHODS： We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments.
RESULTS： Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for postendoscopic mucosal dissection （ESD） stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required.
CONCLUSION： Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.     

Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis

AIM: To report 13 patients with benign esophageal stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-l-lactic acid monofilaments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for post- endoscopic mucosal dissection (ESD) stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required. CONCLUSION: Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.