摘要
目的探讨应用新型 Y 形气道覆膜金属支架输送释放系统,治疗气管分叉区域(包括气管下端、气管隆突和左、右主支气管)狭窄的可行性及临床效果。方法 15例气管分叉区域多发狭窄患者,在 X 线透视下,用新型 Y 形气道覆膜金属支架输送释放系统治疗。所用新型 Y 形支架输送释放系统由外到内主要由外鞘管、输送导管和内部并行排列的4根空芯管组成。4根空芯管中,2根为走行导丝的长管、2根为走行支架捆绑线的短管。2根捆绑线分别将 Y 形支架左右主支气管部捆绑成释放前的压缩状并固定于2根长管头端的外表面,然后捆绑线经支架气管部分别走行入2短管至短管尾端外。结果 15例患者使用新型 Y 形气道覆膜金属支架输送释放系统,支架置入均一次性成功,术后所有患者呼吸困难即刻缓解,未出现与手术有关的并发症;生活质量评分由术前26%～45%上升到术后1周的72%～95%。术后临床随访3～58周,中位数22周,所有患者支架置入后全身一般状况得到明显改善;5例患者分别于术后3～42周死亡,但未发生气管分叉部再狭窄;10例继续进行后续治疗者无呼吸困难。结论用新型 Y 形气道覆膜金属支架输送释放系统,治疗气管分叉区域狭窄,技术操作简单安全,并且临床短期疗效较好。
Objective To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina. Methods The Y-shaped metallic stent delivery system consisted of threetier structure. The inner-tier was composed of four parallel guiding tubes, which was used for two guidewires and two threads passing through, the middle-tier was delivery catheter, which contained the four guiding tubes, and the outer-tier was introducer sheath. Under the fluoroscopic guidance, 15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents. Results Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement, and SaO2 was increased form preoperative 75%-89% to postoperative 96%-99%. During follow-up a period of 3-58 weeks （M 22 weeks）, all stenosis were resolved without stent-related complications, and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding. Karnofsky performance status （KPS） was improved from preoperative 26%-45% to postoperative 72%-95%. Five patients died of the following causes unrelated to stent insertion, multiple organ failure （ n = 3 ）, cachexia （n = 1 ） and pulmonary infection caused by gastrobronchial fistula （n = 1 ） , and the remaining 10 patients were alive with no evidence . of dyspnea at the time of this report. Conclusion Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal carina was a simple and safe procedure and with a good short-term clinical efficacy.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第9期965-969,共5页
Chinese Journal of Radiology
关键词
气管狭窄
肿瘤转移
支架
放射学
介入性
Tracheal stenosis
Neoplasm metastasis
Stents
Radiology interventional
