全麻下单导丝引导Y型气道支架置入术治疗复杂气管疾病6例  

Single wire-guided inverted Y-shaped tracheal stent implantation under general anesthesia for the treatment of complex tracheal diseases: initial experiences in 6 cases

作　　者：向述天[1] 汤秋月 曾俊仁[1] 卜林明[2] 徐松[1] 吴伦[1] 甘井泉 赵娟娟[1] 袁寿红[1] 

机构地区：[1]昆明医科大学第四附属医院放射科,昆明650032 [2]昆明医科大学第四附属医院麻醉科,昆明650032

出　　处：《介入放射学杂志》2015年第6期505-508,共4页Journal of Interventional Radiology

基　　金：云南省科技厅昆明医科大学联合专项(2008CD036)

摘　　要：目的探讨在全身麻醉下采用单导丝引导Y型气道支架置入的方法和临床应用。方法接受气道Y型支架治疗复杂气管疾病患者6例,其中气管胸膜瘘1例,食管-气管瘘2例,气道复合型狭窄3例。全身麻醉后在DSA监视下对6例患者置入气道Y型支架。结果 6例患者共置入Y型气道支架6枚,均为单导丝引导置入,其中1例支架右侧分支误入右肺上叶支气管内,余5例支架置入均一次获得成功。结论全麻下Y型气道支架置入术能有效封堵支气管残端胸膜瘘、左主支气管食管瘘,能快速有效解除气管隆突区复合性气道狭窄,近期疗效显著,手术安全、可靠,单导丝引导置入技术操作相对于双导丝引导置入技术操作简单、快速有效、值得推广应用。Objective To discuss the technical points and the clinical application of single wire-guided inverted Y-shaped tracheal stent implantation under general anesthesia in treating complex tracheal diseases. Methods During the period from January 2014 to October 2014 at authors ＇ hospital, a total of 6patients with complex tracheal diseases received inverted Y-shaped tracheal stent implantation. The diseases included trachea-pleural fistula（n=1）, trachea-esophageal fistula（n=2） and complex tracheal stenosis（n=3）.Under general anesthesia and guided by DSA, inverted Y-shaped tracheal stent implantation was carried out in all the 6 patients. The results were analyzed. Results A total of 6 Y-shaped tracheal stents were used in the 6 patients, and single wire-guided implantation technique was employed in all procedures. In one case, the right branch of the Y-shaped tracheal stent was placed in the right upper lobe bronchus by mistake, and in the remaining 5 cases the stent implantation was successfully accomplished with single manipulation.Conclusion Under general anesthesia, Y-shaped tracheal stent implantation can effectively obstruct the trachea-pleural fistula and left main bronchus-esophageal fistula, and it can also quickly and significantly relieve the complex airway stenosis located at the tracheal carina region. This treatment is safe and reliable with satisfactory short-term effect. Moreover, single wire-guided manipulation is technically simpler, easier and faster than dual wire-guided manipulation. Therefore, this technique should be recommended in the clinical practice.

关 键 词：全身麻醉 气管疾病 单导丝 Y型支架 

分 类 号：R614[医药卫生—麻醉学]