覆膜Y型单子弹头气道支架治疗左主支气管胸膜瘘12例  

Using Y-shaped single plugged airway covered stent to block left main bronchial stump fistula: initial experience in 12 cases

作　　者：李培文[1,2] 李宗明[1,2] 韩新巍[1,2] 吴刚[1,2] 路慧彬[1,2] 焦德超[1,2] 任克伟[1,2] 张全会[1,2] 

机构地区：[1]郑州大学第一附属医院介入科 [2]郑州大学介入治疗研究所,河南省介入治疗与临床研究中心

出　　处：《介入放射学杂志》2014年第11期1000-1004,共5页Journal of Interventional Radiology

摘　　要：目的评估应用Y型单子弹头覆膜气道支架封堵残端较短的左主支气管胸膜瘘的临床效果。方法回顾性分析2010年8月—2013年9月收治的12例残端较短的左主支气管胸膜瘘患者,根据这类患者支气管残端较短的解剖结构特点,个体化定制Y型单子弹头覆膜气道内支架。在X线监视下,12例患者共置入12枚Y型单子弹头内支架。观察患者支架置入后瘘口愈合情况。结果 12枚支架均一次性置入成功,内支架置入后瘘口即刻完全封堵,随访3～17个月;6例瘘口封堵良好,支架置入后3个月取出,瘘口愈合、残腔消失;5例复查胸部多排螺旋CT（MSCT）显示支架子弹头部周围软组织较薄,残腔较前明显缩小,未取出支架,继续负压引流,带支架生存至今。1例高龄患者,支架置入前已存在重度肺部感染,支架置入后瘘口虽即刻完全封堵,但术后未能控制原有肺部感染,加之体质虚弱,术后2周死于肺部重度感染和机体衰竭。结论应用Y型单子弹头覆膜自膨式内支架封堵残端较短的左主支气管胸膜瘘患者的瘘口,近期临床效果可靠,值得推广应用。Objective To evaluate the clinical efficacy of Y- shaped single plugged airway covered stent implantation in treating left main bronchial stump fistula. Methods From August 2010 to September2013, a total of 12 patients with left main bronchial stump fistula were admitted to the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University.As the left main bronchial stump was obviouslyshorter in all 12 patients, individualized Y- shaped single plugged airway covered stent was made to order according to the lesion＇s morphologic features. Under the fluoroscopic monitoring, the stents were successfully implanted in all the 12 patients with left main bronchial stump fistula. The occlusion of the fistula was evaluated after the treatment. Results A total of 12 stents were successfully implanted with single manipulation. All the fistulas were instantly and totally blocked after the treatment. The patients were followed up for 3- 17 months. Among all the 12 patients, total occlusion of the fistula was obtained in 6 and the stents were retrieved three months after the operation. Follow- up checkups with multi- row spiral CT scanning of the chest in 5 patients showed that the residual left pleural cavity was remarkably reduced in size. As the soft tissue around the stent plug was rather thin, the stent was not removed and negative pressure drainage had to be kept on. Only one patient died of pulmonary infection and cachexia, although his fistula had been completely blocked. Conclusion The implantation of Y- shaped single plugged airway covered stent can completely obstruct the left main bronchial stump fistula when the stump is shorter. The short- term clinical result is reliable. Therefore, this technique should be recommended in clinical practice.

关 键 词：支气管胸膜瘘 Y型自膨式覆膜内支架 Y型 介入放射学 

分 类 号：R561[医药卫生—呼吸系统]