球囊扩张及内支架成形术治疗气管良恶性狭窄的临床应用

目的 评价X线监视下内支架成形术和球囊扩张术治疗良恶性气管狭窄的临床意义.方法 回顾分析45例气道狭窄患者,其中恶性气管狭窄37例,包括纵隔淋巴结转移14例、食管癌13例、肺癌4例、支气管腺癌3例、淋巴瘤2例、喉癌1例;良性气管狭窄8例,包括支气管内膜结核6例、胸骨后甲状腺腺瘤1例、气管插管后1例.对其中38例患者行气道内支架成形术,7例患者行球囊扩张术.所有操作均在X线透视下完成.结果 38例患者共放置53枚支架,除1例死于痰液窒息外,其他患者术后临床症状均即刻缓解,随访无支架移位;4例患者发生再狭窄,分别行再次内支架成形术和球囊扩张术.7例患者共行19次球囊扩张术,术后症状明显缓解,无复发.平均随访24.5个月(0～124个月),31例因疾病死亡,无与支架或球囊扩张相关死亡病例.结论 X线透视下行内支架成形术和球囊扩张术是治疗良恶性气管狭窄的安全、快速、有效方法.

Balloon dilation and airway stenting for benign and malignant tracheal stenosis

Objective To assess the effectiveness of balloon dilation and airway stenting performed under fluoroscopic guidance for the treatment of benign and malignant tracheal stenosis. Methods Under fluoroscopic guidance,balloon dilation and airway stenting were performed in 45 patients with tracheobronchial stricture. Of the 45 patients, malignant tracheal stenosis was seen in 37, including mediastinal nodal metastases (n = 14), esophageal carcinoma (n=13), lung carcinoma (n = 4), adenocarcinoma of bronchus (n = 3), lymphoma (n = 2) and laryngocarcinoma (n = 1), and benign tracheal stenosis was seen in 8, including endobronchial tuberculosis (n = 6), retrosternal thyroid adenoma (n = 1) and endotracheal intubation (n = 1). Airway stenting with serf-expandable metal stent was employed in 38 patients and balloon dilation in 7 patients. All the procedures were performed under fluoroscopic guidance. Results A total of 53 self-expandable metal stents was implanted in 38 patients. The clinical symptoms were immediately relived after the procedure in all patients except for one patient who died from choking of sputum. No stent migration was observed. Restenosis developed in 4 patients, which was successfully treated with repeated stenting and balloon dilation. Nineteen times of balloon dilation procedure were accomplished in 7 patients. Marked remission of clinical symptoms was seen in most cases. During a follow-up period (ranged from 0 to 124 months with a mean of 24.5 months) 31 patients died. Conclusion For both benign and malignant tracheal stenosis, balloon dilation with airway stenting performed under fluoroscopic guidance is a safe and efficient therapy with instant curative effect in relieving clinical symptoms.