硅酮支架与覆膜金属支架并发症的对比观察

目的对照观察硅酮支架与Z型不锈钢覆膜金属支架置入后的并发症,为临床支架的选择提供参考。方法 2014年4月至2015年2月因气道狭窄或气道瘘65例患者置入硅酮支架,77例患者置入覆膜金属支架,术后定期支气管镜检查,观察2个月内两组病例的主要并发症。结果硅酮支架组置入分叉型支架45例、沙漏状支架7例、直筒型支架13例;覆膜支架组置入分叉型支架70例、直筒型支架7例。两组并发症比较:痰液潴留硅酮支架50例(76.9%)、覆膜支架61例(79.2%),相差不显著(P0.05);肉芽增生硅酮支架39例(60.0%)、覆膜支架69例(89.6%),相差显著(P0.01);支架移位:分叉型及沙漏状支架均无移位,直筒型支架移位硅酮支架2例(15.3%)、覆膜支架6例(85.7%),相差显著(P0.01);顽固性咳嗽硅酮支架4例(6.1%)、覆膜支架7例(9.0%),相差不显著(P0.05)。因肉芽增生明显经处理效果差,9例覆膜支架取出支架,硅酮支架未因肉芽增生取出支架。结论硅酮支架与覆膜支架比较,硅酮致肉芽增生较轻,其直筒型移位较少,建议对需长期放置支架的患者,优先考虑硅酮支架。

Comparative study of implantation complications by silicon stent and covered metal stent

Objective To compare the implantation complications by silicon stent and covered metal stent , in order to provide references for clinical treatment .Methods 142 patients suffered from airway narrowing or airway fistula were placed by stent from April 2014 to February 2015, wherein, 65 patients were placed by silicon stent and the others were placed by covered metal stent .The next two months , major complications of these two groups were ob-served by regular bronchoscopy .Results In the group of silicon stent , there were 45 cases with bifurcated stent , 7 with hourglass-shape type and 13 with straight one .In contrast of the covered metal stent group , bifurcated stent had 70 cases and straight one had 7 cases.The silicon stent group included 50 cases (76.9%) with sputum retention and covered metal stent had 61 cases (79.2%) (P>0.05).Hyperplasia of granulation tissue happened in 39 cases in the silicon stent group (60.0%) and 69 cases in the covered metal stent group (89.6%) (P<0.01).There was no stent migration happened in the case of bifurcated and hourglass-shape type, as straight type of the silicon stent group was only 2 cases (15.3%), against the covered group had 6 cases (85.7%) (P<0.01).Stubborn cough showed no significant difference between the two groups (P>0.05).The silicon stent group had no case to remove stent be-cause of hyperplasia of granulation tissue , however , the other group had 9 cases to remove them since hyperplasia ob-viously treated poorly .Conclusion Compared with covered metal stent , silicon stent leads to less hyperplasia of granulation tissue, and its straight-type shifts less movement, therefore, for long-term implantation, silicon stent is priority.