单导丝联合双导丝引导技术置入一体式Y型气道支架的策略  

The strategy for implantation of integrated Y-shaped tracheal stent guided by single guidewire combined with double guidewire technique

作　　者：赵纯 向述天[1] 苏伟[1] 曾俊仁[1] 徐松[1] 毛崇文[1] ZHAO Chun;XIANG Shutian;SU Wei;ZENG Junren;XU Song;MAO Chongwen(Department of Radiology,Forth Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650032,China)

机构地区：[1]昆明医科大学第四附属医院放射科

出　　处：《介入放射学杂志》2019年第9期847-850,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基金(2017FE468-087)

摘　　要：目的探讨单导丝联合双导丝引导一体式Y型气管支架置入在治疗复杂气道病变中的可行性、安全性和有效性,并探寻一体式气道Y型支架置入的方法选择。方法回顾性分析2014年6月至2018年9月38例气管隆突或叶支气管病变患者行一体式Y型气道支架的临床资料,其中隆突区病变28例,叶支气管病变10例。所有病例均在全身麻醉后、DSA引导下,首先采用单导丝引导技术引导一体式Y型气道支架置入,单导丝引导失败则采取双导丝引导技术。结果单导丝引导置入32枚(大Y支架28枚、小Y支架4枚),双导丝引导技术置入6枚,均为小Y支架。狭窄患者的呼吸困难症状在支架置入后即刻缓解,气道瘘患者术中造影显示瘘口全部封堵良好。结论全麻下单导丝引导技术联合双导丝引导技术引导一体式Y型气管支架置入治疗复杂气道病变是简易可行的,其技术安全、疗效可靠,值得临床进一步推广应用。Objective To evaluate the feasibility,safety and efficacy of single guidewire combined with double guidewire technique in guiding the implantation of integrated Y - shaped tracheal stent for the treatment of complex airway lesions,and to discuss the selection of methods used in the implantation of integrated Y- shaped tracheal stent.Methods The clinical data of 38 patients with airway lesions located at tracheal carina (n=28) or lobar bronchus (n=10),who were treated with implantation of integrated Y- shaped tracheal stent at authors' hospital during the period from June 2014 to September 2018,were retrospectively analyzed.Under general anesthesia and guided by DSA,guiding technology with single guidewire was adopted to perform the implantation of integrated Y- shaped tracheal stent,and,if single guidewire technique failed,double guidewire technique would be employed.Results Single guidewire technique was adopted in the implantation of 32 stents,including 28 large Y - shaped stents and 4 small Y - shaped stents.Double guidewire technique was used in the implantation of 6 stents,all of which were small Y- shaped stents.The symptoms of dyspnea due to airway stenosis were immediately relieved after stent implantation.Intraoperative angiography in patients with airway fistula showed that all the fistulae were well occluded.Conclusion It is simple and feasible to guide the integrated Y- shaped tracheal stent implantation under general anesthesia with single guidewire technique and/or double guidewire technique for the treatment of complex airway diseases. The technique is safe with reliable clinical effect,and it is worthy of further promotion and application in clinical practice.

关 键 词：气道病变 Y型支架 置入方法 

分 类 号：R562[医药卫生—呼吸系统]