Y型金属气道支架置入治疗复合气道病变

目的初步探讨一体化Y型金属气道支架置入治疗气管下段、气管隆突和双主支气管复合病变(狭窄或瘘)的可行性和疗效。方法根据气道复合狭窄和食管/胸腔胃-隆突瘘的特殊解剖结构,设计气道Y型一体化自膨胀式金属内支架。在纤维支气管镜指导及X线监视下,对10例气道复合病变患者置入气道Y型一体化自膨胀式金属内支架10枚。结果 Y型内支架均一次性置入成功,10例患者置入内支架后症状均缓解。呼吸困难分级由Ⅲ～Ⅳ级改善为0～Ⅱ级,脉搏血氧饱和度(SpO2)由高流量吸氧时的75%～92%平均为(85±5)%]提高至自然呼吸时的90%～99%平均为(95±3)%],与术前比较差异有统计学意义(t=-7.352,P0.05)。其中2例气管食管瘘患者带膜支架置入后气促缓解,禁食24h后进食未出现呛咳。结论气道Y型一体化自膨胀式金属内支架置入能有效解除气道复合病变,技术可行,操作简单、安全,近期疗效可靠,值得进一步推广应用。

Y-Shaped Metal Airway Stent Placement for Complex Airway Diseases

Objective To investigate the feasibility and therapeutic efficacy of inverted Y-shaped self-expandable metal airway stent for complex airway diseases （stenosis or fistula）.Methods According to the particular anatomic structure and the pathological changes of complex airway diseases,the inverted Y-shaped self-expandable metal airway stent was designed.10 stents were implanted in 10 cases of airway complex diseases under the guidance of interventional fibroscopy and fluoroscopy.Results The inverted Y-shaped stents were placed successfully with immediate relief of the symptoms.100% of the patients were able to be weaned from oxygen therapy completely.Dyspnea grade improved significantly from Ⅲ-Ⅳ to 0-Ⅱ,and oxygen saturation elevated from （85±5）% in inspiring high concentration oxygen to （95±3）% in breathing ambient air （t=-7.352,P0.05）.Breathlessness in 2 cases with tracheoesophageal fistula was relieved after inserting covered airway stent without bucking while foodintaking after fasting 24 hours.Conclusion The placement of inverted Y-shaped self-expandable metal airway stent is a feasible and safe treatment for complex airway disease such as stenosis or fistula.