气道支架植入的并发症及其防治

目的 探讨气道支架植入并发症的防治方法。方法 对镍钛记忆合金支架气管、支气管植入123例的并发症进行观察分析。结果 窒息、出血等并发症的发生率为5．7％（7／123）,并发症的发生与低氧血症、肿瘤破碎、器械刺激有关。结论 高频快速给氧,及时止血、熟练的操作是针对并发症的防治措施。     

金属覆膜支架与金属裸支架在严重恶性气道狭窄治疗中的比较分析

目的通过比较金属覆膜支架与金属裸支架在无法手术的恶性气道狭窄治疗中的有效性和安全性,探讨金属覆膜支架在恶性气道狭窄中的应用价值。方法收集南京医科大学附属江宁医院呼吸与危重症医学科2018年03月至2020年08月应用金属支架治疗严重恶性气道狭窄的33例患者资料,分为覆膜支架组(14例),裸支架组(19例),比较两者之间疗效和并发症。结果覆膜支架组术后,中位生存时间为8个月,裸支架组术后中位生存时间为4.7个月(P=0.045);覆膜支架组肿瘤再次向气道内生长的间隔时间为(13.4±9.5)月,裸支架组间隔时间为(7.1±7.4)月(P=0.040),覆膜支架组疗效均优于裸支架组;覆膜支架组术后肺部感染发生率(13/14)高于裸支架组(11/19)(P=0.048)。结论在严重恶性气道狭窄治疗中,与裸支架比较,覆膜支架可以更好地阻止肿瘤向气道内生长,延长生存时间。     

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。     

食管金属自膨式支架涂覆硅橡胶的组织相容性实验研究

对于食管癌患者,金属自膨式支架置入能立即改善吞咽困难、有效封堵食管-气管瘘且严重并发症发生率低,近年来已成为食管恶性梗阻主要姑息治疗方法。现在应用的金属支架大部分是覆膜支架[1],国内所采用的生物膜材绝大多数是医用级有机硅橡胶,但硅橡胶如与金属粘合不良,置入     

药物抑制气道支架植入后肉芽组织增生的研究进展

气道支架植人后肉芽组织增牛导致再狭窄是影响其临床疗效的一大问题.药物涂层支架在抑制冠脉再狭窄领域做出了卓越贡献.因此,研究气道药物涂层支架是解决这一问题的尝试性探索.通过概述抑制气道支架植入后肉芽组织增生的各类药物,可以为进一步研制气道涂层支架的药物选择提供方向.     

气道内支架置入治疗的并发症及其防治

气道内支架置入过程中和置入后均可能出现各种并发症,与所选用支架种类和结构有关,也与置入时操作错误有关。硅酮类支架最常见的并发症为支架移位,金属类最常见的分泌物潴留,支架对局部刺激,以及影响气流动力学和气道黏膜上皮纤毛运动等亦可导致并发症,最严重的是引起致命性大咯血。因此支架置入过程中和置入 后必须密切观察,不定期随访,及时处理并发症,维持支架功能。     

自膨式支架治疗症状性基底动脉狭窄围手术期并发症的分析

目的探讨自膨式支架治疗基底动脉症状性粥样硬化性狭窄患者围手术期的并发症。方法回顾性分析2007年11月—2013年1月,51例接受Gateway球囊扩张+自膨式支架(Wing-span支架37例、Enterprise支架8例、Solitaire支架5例、Neuroform支架1例)置入治疗患者的临床资料。评估患者的临床表现、影像学特点及围手术期并发症发生率。结果①技术成功率为100%。基底动脉病变部位的平均狭窄率[中位数(M),范围]从术前的74(50～95)%下降至术后的26(0～48)%。4例(7.8%)患者出现了不同程度的言语不清、一侧肢体肌力减退等缺血症状,MRI检查提示桥脑新发梗死,考虑为穿支动脉闭塞引发的缺血事件。积极治疗后2例术后1个月症状缓解,2例仍有不同程度的神经功能障碍。②51例患者中有49%的狭窄部位在基底动脉下段,33.3%在中段,17.6%在上段。基底动脉上段狭窄支架置入治疗后,缺血并发症率高于基底动脉中下段(22.2%比4.8%),但因例数少,差异无统计学意义(χ2=3.115,P>0.05)。结论自膨式支架治疗基底动脉狭窄安全可行,但穿支动脉缺血事件是较常见的并发症,而且以基底动脉上段最为多见。     

Y形气道支架的研究进展

各种病变引起的气道阻塞导致呼吸困难,严重时可窒息死亡.气道支架是解决各种气道阻塞的有效手段.目前对于非隆突部位的阻塞常使用直形镍钛记忆合金气道支架,其疗效已得到公认,但对于气道隆突部位的病变,尚无有效的治疗手段,有学者尝试通过同时放置多个直形支架（2或3个）进行治疗,但手术操作复杂,术后容易产生支架移位、感染、肉芽组织增生而影响疗效.20世纪90年代以来,针对隆突病变的Y形气道支架的设计和临床应用有了很大的发展,现就Y形气道支架的种类、特点、临床适应证、置入技术、疗效及并发症等研究进展综述如下.     

可膨式金属胆道支架解除恶性胆管梗阻的中长期疗效

为总结经内镜放置可膨式金属胆道支架（ＥＭＢＥ）的中远期疗效，回顾了７６例恶性胆管梗阻接受ＥＭＢＥ治疗患者的资料，并与同期５３例次放置普通塑料支架的疗效进行对比。结果前者操作成功率９３．８％，与操作有关的并发症发生率６．６％，黄疸消除率为８７．０％，金属支架的平均通畅期为３１０天，明显高于塑料支架的８５天（Ｐ＜０．０１），患者平均存活期为２１０天。随访患者中有１６例（３４．８％）发生支架阻塞，平均发生时间１８５．５天。结果表明可膨式金属胆道支架的平均通畅性能显著优于普通塑料支架，可持久有效解除恶性肿瘤所致的肝外胆管梗阻，为提高ＥＭＢＥ的疗效必须严格掌握适应证     

Placement of two overlapping uncovered metallic stents for malignant gastric outlet and duodenal obstruction due to colon cancer

Malignant obstruction of the gastric outlet and duodenum is frequently due to extrinsic involvement by tumors from contiguous organs, in particular from pancreas and gallbladder. The treatment of malignant gastroduodenal stenoses is difficult. Many patients have advanced malignant disease and are too ill to undergo surgical approach. Surgical gastrojejunostomy has been considered the palliative treatment of choice. Metallic stents can be useful in this condition with adequate palliation obtained in most cases. We report a case in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum due to a colon cancer.     

Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time(stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.     

2种放置自膨胀金属Y型支架技术的比较

目的：对局部麻醉下经可弯曲支气管镜和全身麻醉下经硬质气管镜放置自膨胀金属 Y型支架这2种技术进行比较。方法回顾性分析了2008-2014年所有放置自膨胀金属 Y 型支架治疗气道狭窄的病例,共24例。对2种置入方法的操作时间和成功率进行比较。结果根据麻醉方式,24例患者分为局部麻醉组(n=14)和全身麻醉组(n=10)。局部麻醉组和全身麻醉组成功率分别为85.7%(12/14)和100.0%(10/10),2组间比较差异无统计学意义(χ2=1.56,P >0.05)。2组支架角度,气管、支气管各段长度及支架直径比较差异均无统计学意义。局部麻醉组操作时间为(49.57±26.95)min,全身麻醉组为(31.10±10.06)min,2组比较差异有统计学意义(t=2.35,P <0.05)。结论全身麻醉下经硬质气管镜放置自膨胀金属 Y型支架治疗累及隆突的气道狭窄较局部麻醉下经可弯曲支气管镜放置更加便捷、有效。     

Fully covered self-expandable metallic stents for malignant airway disorders

Background

Airway stenting is an established procedure for treating airway stenosis and fistulas. The AERO stent (Merit Medical Systems, South Jordan, UT, USA), a relatively new, fully covered, self-expandable metallic stent, was approved in Japan in 2014. This study evaluated the efficacy and safety of this stent for malignant airway disorders.

结直肠癌支架置入术后并发症危险因素及预防

结直肠癌患者常伴结肠梗阻症状,急诊手术多因无法行肠道准备及患者一般情况较差,死亡率及术后并发症的发病率较高。支架置入治疗可以作为手术的桥梁治疗,同时也可作为晚期转移性结直肠癌患者的姑息治疗手段,与手术治疗比较,支架置入治疗的死亡率及术后并发症发生率均较低,且可避免瘘口形成,患者住院时间短、术后恢复快。但支架置入常伴穿孔、支架移位、再梗阻等并发症,严重时危及患者生命。本文对支架置入术后相关并发症相关的危险因素及预防措施作一概述。     

永久性心脏起搏器植入术后并发症的分析

目的：比较＜70岁患者与≥70岁患者起搏器植入后并发症的发生率,评估起搏器植入术后的安全性。方法选择237例于2006年1月至2011年12月在我院行永久性心脏起搏器植入患者的临床资料,根据年龄分为＜70岁组178例,≥70岁组59例,随访2年比较两组并发症发生情况。结果发生起搏器并发症25例（10.55%）,其中囊袋出血/血肿11例,囊袋破溃/感染4例,起搏器介导心动过速5例,起搏综合征4例,电极脱位/断裂1例,两组并发症发生率差异无统计学意义。结论起搏器植入术后并发症并未随年龄增长而明显增加。     

Fully covered self-expandable metal stents for treatment of malignant and benign biliary strictures

AIM:To present a series of covered self-expandable metal stents(CSEMS) placed for different indications and to evaluate the effectiveness,complications and extractability of these devices.METHODS:We therefore retrospectively reviewed the courses of patients who received CSEMS due to malignant as well as benign biliary strictures and postsphincterotomy bleeding in our endoscopic unit between January 2010 and October 2011.RESULTS:Twenty-six patients received 28 stents due to different indications(20 stents due to malignant biliary strictures,six stents due to benign biliary strictures and two stents due to post-sphincterotomy bleeding).Biliary obstruction was relieved in all cases,regardless of the underlying cause.Hemostasis could be achieved in the two patients who received the stents for this purpose.Complications occurred in five patients(18%).Two patients(7%) developed cholecystitis,stents dislocated/migrated in other two patients(7%),and in one patient(3.6%) stent occlusion was documented during the study period.Seven stents were extracted endoscopically.Removal of stents was easily possible in all cases in which it was desired using standard forceps.Twelve patients underwent surgery with pylorus preserving duodenopancreatectomy.In all patients stents could be removed during the operation without difficulties.CONCLUSION:Despite the higher costs of these devices,fully covered self-expanding metal stents may be suitable to relief biliary obstruction due to bile duct stenosis,regardless of the underlying cause.CSEMS may also represent an effective treatment strategy of severe post-sphincterotomy bleeding,not controlled by other measures.     

丝裂霉素C及紫杉醇对人胚肺成纤维细胞增殖及凋亡的影响

目的 在体外细胞学水平观察丝裂霉素C及紫杉醇抑制人胚肺成纤维细胞增殖的量效及时效关系特点.初步探讨药物抑制细胞增殖的潜在机制,为设定药物洗脱气道支架的药物洗脱浓度提供试验参考.方法 采用噻唑兰(MTT)法分别测定10-11 mol/L至10-4 mol/L(10倍倍比稀释)的丝裂霉素C或紫杉醇持续作用24、48和72 h后对人胚肺成纤维细胞增殖的抑制率.通过AnnexinV-FITC/PI双染及流式细胞术检测5 x 10-6、10-5、5×10-5、10-4、2×10-4 mol/L的丝裂霉素C或紫杉醇持续作用48 h后的细胞凋亡百分比.并采用Hoechst 33342荧光染色法观察细胞凋亡的形态学特征.结果 MTT结果显示,各浓度丝裂霉素C或紫杉醇持续作用24、48及72 h均可在不同程度上抑制人胚肺成纤维细胞增殖.其中,当丝裂霉素C处于10-11 mol/L至10-8 mol/L的较低浓度水平时,药物对细胞增殖的抑制作用较弱.且在此浓度范围内,提高药物浓度或延长作用时间对于改善抑制率无益.而当丝裂霉素C处于10-7 mol/L至10-4 mol/L的较高浓度水平时,随作用时间延长或药物浓度提高,抑制率呈渐进式增高.10-7、10-6、10-5及10-4 mol/L的丝裂霉素C持续作用72 h,抑制率分别为53.52％、60.23％、89.81％及96.47％.紫杉醇对人胚肺成纤维细胞增殖的抑制作用存在明显的“阈浓度效应”.10-5 mol/L的紫杉醇持续作用72 h,抑制率仅为48.22％,但当浓度达到10-4 mol/L后,药物作用24 h时抑制率即可达93.38％,且随作用时间延长,抑制率可进一步升高.细胞凋亡部分的试验结果与MTT部分相吻合,即当药物对细胞增殖的抑制作用较为明显时,采用流式细胞术可检测到大量凋亡细胞,且以早期凋亡为主.此时进行Hoechst 33342荧光染色可观察到典型的凋亡细胞.结论 在体外条件下,一定浓度的丝裂霉素C或紫杉醇持续作用均可对人胚肺成纤维细胞的增殖产生抑制作用.二者在气道药物洗脱支架的制备中具有潜在应用价值,可作为备选涂层药物.为有效抑制成纤维细胞增殖,丝裂霉素C洗脱气道支架的药物洗脱浓度不应低于10-7mol/L,而紫杉醇药物洗脱气道支架的药物洗脱浓度不应低于10-5 mol/L,极限洗脱浓度均为10-4 mol/L,此时丝裂霉素C或紫杉醇持续作用72 h抑制率均可达95％以上.在此基础上进一步提高洗脱浓度对于改善抑制率而言意义不大,反而有增加系统毒性的风险.诱导细胞凋亡是丝裂霉素C及紫杉醇抑制人胚肺成纤维细胞增殖的可能机制之一.