韩氏支架封堵支气管残端瘘的治疗与护理  

The treatment and nursing experience of bronchial stump fistula with Han's stent

作　　者：石瑾[1] 韩新巍[1] 李永东[1] 吴刚[1] 

机构地区：[1]郑州大学第一附属医院放射科,河南郑州450052

出　　处：《医学影像学杂志》2006年第10期1080-1083,共4页Journal of Medical Imaging

摘　　要：目的：探讨韩氏支架封堵支气管残端瘘临床疗效及护理体会。方法：自2003年4月～2005年1月，对10例（7男，3女，年龄37-73岁，平均54．5岁）支气管残端瘘患者进行回顾性分析。经螺旋CT和支气管镜证实5例位于左支气管，5例位于右支气管。选择韩氏封堵支架在透视下行支气管残端瘘内支架封堵治疗。结果：本组中9例成功地置入了支气管残端瘘封堵内支架，成功率90．0％（9／10），未发生与手术有关的并发症，即刻造影复查9例瘘口完全封堵。1例由于术中发现支架不合适，在等待二次置入支架过程中突发心律失常并心衰而死亡。术后随访30天，7例患者瘘口闭合，临床症状减轻，脓腔缩小，引流量减少，身体逐渐恢复，3例在引流15～28天后治愈而拔除引流管。随访3—15个月，9例完全治愈，1例在支架置入4个月后由于全身化疗引发剧烈呕吐而导致支架上移而使瘘口复发，遂接受外科胸膜修补术，1例部分治愈，1例结核患者无明显改变。结论：韩氏封堵支架封堵支气管残端瘘具有简单、安全、创伤小、花费低、可重复性、疼痛小、恢复快的优点，适用于全肺切除或肺叶切除术后并发支气管残端瘘的患者，特别适用于那些外科顽固性的和难治性的支气管残端瘘患者，更适用于全身体质差、外科手术风险大和不能耐受全麻者，因而避免了侵袭性外科治疗。内支架置入是瘘口愈合的基础，精心细致的护理是瘘口愈合、脓腔消失的保证，医生和护士默契配合是瘘口痊愈的关键。Objective：To explore the clinical efficacy and nursing experience of bronchial stump fistula with Han＇s stent. Methods： Between March 2003 arid January 2005, 10 patients （7 men and 3 woman; age ranging from 37 to 73 years; mean age 54.5 years） with bronchial stump fistula were retrospectively reviewed. Spiral CT and bronchoscopy demonstrated 5 fistulae located at the left bronchial stump and 5 situated in right bronchial stump. The closure stent inserted under fluoroscopic guidance. Results： Stent placement in the bronchial stump was technically successful in 9 patients, with no direct procedure-related complications. Immediate closure of the BPF was achieved in all the 9 patients. One patient was found dead due to cardiac arrest before the stent placement. Follow-up 30 days after the procedure, 7 patients except one recovered slowly with fistula closed, symptoms relieved and drainage volmue reduced. Three chest tube were extracted 15 - 28 days later. Follow-up 3 - 15 months, permanent closure of BPF achieved in 9 patients, one patient with fistula recurred after stent placement 4 months due to severe vomiting after intravenous chemotherapy, and then required surgical repair with omental flap; one patient achieved partial cure; one patient acquired no change in fistula, symptoms and empyema. Conclusion： Closure of the bronchial fistula with metallic stent was simple, safe, mini-traumatic, reproducible, less expenditure, little pain and quick recovery, the procedure was fit for the patients with bronchial stump fistulas after pneumonectomy or lobectomy, especially fit for the patients with intractable bronchial stump fistula after surgical repair, and even fit for the patient with poor general physical condition and high operative risk under general anesthesia and may profit the patient by avoidance of aggressive surgical intervention. Insertion of the stent was the basis of fisttda cure, elaborate and inetictdous nursing guaranteed the fistula cure and obliteration of the empyema, doctor and nurse

关 键 词：支气管残端瘘 内支架 设计 介入放射学 护理 

分 类 号：R562.24[医药卫生—呼吸系统] R815[医药卫生—内科学]