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。

Temporary bare metal stent in the treatment of advanced lung cancer with central airway stenosis

Objective To observe the clinical efficacy and safety of temporary bare NT stent placement in the treatment of advanced lung cancer with central airway stenosis by flexible bronchoscopy.Methods 38 advanced lung cancer patients with trachea and bronchus stenosis because of outside pressure were treated with temporary bare NT stents after diagnosis,whose quality of life Karnofsky score was 42 ± 13（x ± s） and respiratory difficulty index was 2.9 ± 0.7 before stents placement.Results Each patient was implanted a stent successfully at one time.The narrow lumen became large rapidly after stents placement.The second day after placement,respiratory difficulty index and Karnofsky score were improved significantly,compared with that before implantation（P〈0.01）.All patients received radiotherapy or / and chemotherapy after stents placement.1 to 3 months after implantation,stents were removed.No severe complication associated with stent placement and removal was observed.Conclusions Temporary bare metal stent in the treatment of advanced lung cancer with central airway stenosis was an effective method.It could create opportunities for the following radiotherapy and chemotherapy,also avoid complications because of long-term stent placement.The method of stent placement and removal was simple and safe.So It was worthy of clinical application.