个体化金属覆膜支架治疗气道瘘的临床应用  

Clinical application of individualized metal coated stent in the treatment of airway fistulae

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 Chongiven(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12期1185-1189,共5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：目的探讨金属覆膜支架治疗良/恶性食管-气管瘘、支气管-胸膜瘘和气管-纵隔瘘的疗效和安全性,并探讨气管和/或食管支架置入对气道瘘患者生存的影响因素。方法回顾性分析32例在X线透视下放置个体化覆膜金属内支架的气道瘘患者。19例气管-食管瘘中全麻下气道支架7例,食管支架置入12例,食管气管双支架6例。11例支气管-胸膜瘘中主支气管残端瘘8例,置入大Y子弹头支架共8枚,叶支气管胸膜瘘3例,置入小Y子弹头支架共3枚,大Y支架2枚。2例气管-纵隔瘘均置入直筒气管覆膜支架。结果所有支架均一次性置入成功。患者呛咳、咯脓痰等症状即刻缓解,症状改善率近100%。恶性气道瘘患者的3个月、6个月、1年的生存率分别为50%、27%、14%,中位生存时间为4个月,平均生存期为178.8 d。良性气道瘘中1例支架置入后1周因肺部感染死亡,1例瘘口封堵不严,7例治愈。结论金属覆膜支架是治疗良/恶性食管-气管瘘、支气管-胸膜瘘和气管-纵隔瘘的一种简便、安全、有效的方法,可预期治愈良性气道瘘,有效延长恶性气道瘘患者生存期,并可显著改善良/恶性气道瘘患者生活质量。Objective To investigate the efficacy and safety of metal coated stent implantation in the treatment of benign and malignant esophagotracheal fistula,bronchopleural fistula and tracheomediastinal fistula,and to explore the effect of airway and/or esophageal stent implantation on the survival of patients with airway fistula.Methods The clinical data of 32 patients with airway fistula,who were treated with fluoroscopy-guided implantation of individualized metal coated stent,were retrospectively analyzed.Among the 19 patients with esophagotracheal fistula,under general anesthesia airway stent implantation was performed in 7,esophageal stent implantation in 12,and esophageal plus airway dual stent implantation in 6.In 11 patients with bronchopleural fistula,bronchial stump fistula was seen in 8 and a total of 8 large Y bullet stents were implanted,lobar bronchopleural fistula was seen in 3 and 3 small Y bullet stents plus 2 large Y bullet stents were implanted.Straight-tube tracheal coated stent implantation was carried out in 2 patients with tracheomediastinal fistula.Results All stents were successfully implanted with single procedure.The remission of symptoms such as cough,purulent phlegm,etc.were immediately obtained,the symptom improvement rate was nearly 100%.The 3-month,6-month,1-year survival rates in patients with malignant airway fistula were 50%,27% and 14% respectively,the median survival time was 4 months,and the average survival time was 178.8 days.In patients with benign airway fistula,one patient died of pulmonary infection one week after stent implantation,incomplete closure of fistula was detected in one patient,and clinical cure of fistula was achieved in 7 patients.Conclusion For the treatment of benign and malignant esophagotracheal fistula,bronchopleural fistula and tracheomediastinal fistula,metal coated stent implantation is a simple,safe and effective method.It can be reasonably expected that metal coated stent implantation will be able to cure benign airway fistula,to effectively prolong the

关 键 词：气道-食管痿 支气管残端胸膜痿 气道-纵隔痿 金属支架 Y型 

分 类 号：R735.1[医药卫生—肿瘤]