硅酮支架置入治疗成人气管支气管软化症  

Silicone stent insertion for treating tracheobronchomalacia in adults

作　　者：李晓[1] 潘金兵[1] 马芸[1] 钱皓瑜[1] 张群成 汪铮[1] Li Xiao;Pan Jinbing;Ma Yun;Qian Haoyu;Zhang Quncheng;Wang Zheng(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou 450003,Henan Province,China)

机构地区：[1]河南省人民医院呼吸与危重症医学科

出　　处：《中国组织工程研究》2020年第4期549-554,共6页Chinese Journal of Tissue Engineering Research

基　　金：河南省医学科技攻关计划项目(201504046)，项目负责人：马芸~~

摘　　要：背景:硅酮支架置入可通过稳定气道缓解气管支气管软化症患者的症状,目前国内报道较少。目的:评价硅酮支架置入治疗成人气管支气管软化症的疗效。方法:选择河南省人民医院2015年9月至2018年12月收治的8例气管支气管软化症患者为研究对象。根据患者气道软化部位、程度,选取、设计合适的硅酮支架,8例患者均置入硅酮支架,其中2例为沙漏型支架,2例为直筒型支架,3例为Y型支架,1例为T型管。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。术前和术后30 d行血气分析测定血氧,并采用卡式评分评估生活质量;术后7,30,60 d行气管镜检查动态监测支架位置及管腔内分泌物、肉芽生长等情况。结果与结论:(1)7例患者成功置入硅酮气道支架,症状均即刻缓解;1例患者在置入过程中出现左主支气管膜部撕裂,置入失败;(2)7例患者术后30 d氧分压和卡式评分均高于术前(t=-8.60,-20.76,P<0.05);(3)术后定期气管镜下观察,3例出现支架移位,3例出现排痰困难和轻度肉芽组织增生,内镜下处理后好转;(4)结果表明,气管支气管软化症患者置入硅酮支架可缓解患者症状,虽然硅酮支架移位和痰液阻塞发生率较高,但仍是一种重要的治疗方法。BACKGROUND: Silicone tracheobronchial stent insertion can provide symptomatic relief through airway stabilization in patients with symptomatic tracheobronchomalacia. However, there are few studies on this method.OBJECTIVE: To evaluate the safety and efficacy of silicone stents in the treatment of tracheobronchomalacia. METHODS: Eight tracheobronchomalacia patients who underwent silicone stent implantation at Henan Provincial People’s Hospital between September 2015 and December 2018 were included in this study. According to the location and degree of airway softening, appro priate silicone stents were designed. Silicone stents were implanted in all eight patients, including hourglass stent s in 2 cases, straight tube stents in 2 patients, Y-shaped stents in 3 patients, and T-shaped stents in 1 patient. All patients provided informed consent and this study was approved by the Medical Ethics Committee of Henan Provincial People’s Hospital, China. Blood gas analysis was performed before and 30 days after surgery to measure blood oxygen level. Quality of life was assessed by card score. The position of stent, intraluminal endocrine, and granulation growth were dynamically monitored by bronchoscopy at 7, 30 and 60 days after surgery. RESULTS AND CONCLUSION: Silicone airway stents were placed successfully in seven patients. Dyspnea was relieved immediately. One patient had rupture of left main bronchial membrane during the procedure of insertion. Th e partial oxygen pressure and chi-square score of seven patients at 30 days after surgery were significantly higher than those before surgery(t=-8.60,-20.76, P<0.05). Tracheoscopy revealed that stent displacement occurred in 3 patients, difficulty in s putum expectoration and mild granulation tissue hyperplasia occurred in 3 patients, and improved after endoscopic treatment. The results suggest that silicone stent insertion in patients with trach eobronchomalacia can alleviate the symptoms of patients. Although the incidence of silicone stent displacement and sputum obs

关 键 词：气管支气管软化症 硅酮支架 T管 支架移位 支气管镜 硬质支气管镜 介入治疗 肉芽组织 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]