气管支架在食管癌致食管气管瘘并发肺部感染的作用分析  

Role of tracheal stent in esophageal cancer-induced esophagotracheal fistula complicated with pulmonary infection

作　　者：占丰富[1] 黄茂宏[1] 曾惠清[1] 杜艳萍[1] 陈怡园 张孝斌[1] Zhan Fengfu;Huang Maohong;Zeng Huiqing;Du Yanping;Chen Yiyuan;Zhang Xiaobin(Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院呼吸与危重症医学科,厦门361004

出　　处：《国际呼吸杂志》2022年第18期1398-1403,共6页International Journal of Respiration

摘　　要：目的探讨气管支架在食管癌致食管气管瘘并发肺部感染的临床应用价值。方法本研究为病例对照研究。采用非随机抽样法,分析厦门大学附属中山医院呼吸与危重症医学科2019年10月至2022年1月诊治的26例食管癌致食管气管瘘并发肺部感染且未置入食管支架患者的临床资料。其中16例患者在置入鼻空肠管的基础上,在电子气管镜实时引导下行气管支架置入治疗,纳入气管支架联合鼻空肠管组;10例患者放弃行气管支架置入,仅置入鼻空肠管,纳入单纯鼻空肠管组;观察2组患者的生活质量、症状、炎症指标及影像学变化。结果气管支架联合鼻空肠管组16例食管癌致食管气管瘘并发肺部感染患者成功置入金属覆膜支架6枚,直筒型硅酮支架4枚,Y型硅酮支架6枚。支架置入后患者的Karnofsky(KPS)生活质量评分明显高于支架置入前(P<0.05),白细胞计数、中性粒细胞计数、C反应蛋白、降钙素原、CT评分较支架置入前明显下降(P值均<0.05)。单纯鼻空肠管组10例患者术后KPS评分明显高于术前(P<0.05),白细胞计数、中性粒细胞计数、C反应蛋白、降钙素原、CT评分较置入前明显下降(P值均<0.05)。气管支架联合鼻空肠管组患者和单纯鼻空肠管组患者术前KPS评分、白细胞计数、中性粒细胞计数、C反应蛋白、降钙素原、CT评分比较差异均无统计学意义(P值均>0.05);术后2组KPS评分、白细胞计数、中性粒细胞计数、3个月生存率比较差异均无统计学意义(P值均>0.05);同单纯鼻空肠管组患者比较,气管支架联合鼻空肠管组患者术后C反应蛋白、降钙素原、CT评分更低,咳嗽改善所需时间、体温恢复正常所需时间更短(P值均<0.05)。结论气管支架联合鼻空肠管治疗食管癌致食管气管瘘并发肺部感染效果显著,能提高患者的生活质量,改善患者症状,促进肺部炎症吸收,值得临床推广。Objective To explore the clinical value of tracheal stent in esophageal cancer-induced esophagotracheal fistula complicated with pulmonary infection.Methods This was a case-control study.The clinical data of 26 patients with esophageal cancer-induced esophagotracheal fistula complicated with pulmonary infection who didn′t receive esophageal stents in the Department of Pulmonary and Critical Care Medicine in Zhongshan Hospital,Xiamen University from October 2019 to January 2022 were analyzed by non-random sampling method.Among them,16 patients,who were placed with tracheal stent under the real-time guidance of electronic bronchoscope on the basis of nasojejunal tube placement,were included in the tracheal stent combined with nasojejunal tube group;the remaining 10 patients,who gave up tracheal stent and only received the nasojejunal tube,were included in the simple nasojejunal tube group.The life quality,symptoms,inflammatory indexes,and imaging changes of the two groups were observed.Results The sixteen patients in the tracheal stent combined with nasojejunal tube group were successfully implanted with 6 metal covered stents,4 straight-tube silicone stents,and 6 Y-shaped silicone stents.The Karnofsky(KPS)score of patients after stent placement was significantly higher than that before stent placement(P<0.05).Meanwhile,the white blood cell count,neutrophil count,C-reactive protein,procalcitonin,and CT scores were significantly lower than those before stent placement(all P<0.05).The KPS score in patients with simple nasojejunal tube placement was significantly higher than that before implantation(P<0.05).Meanwhile,the white blood cell count,neutrophil count,C-reactive protein,procalcitonin,and CT scores were significantly lower than those before implantation(all P<0.05).There was no significant difference in KPS score,white blood cell count,neutrophil count,C-reactive protein,procalcitonin,and CT score between the two groups before the implantation of nasojejunal tube and tracheal stent(all P>0.05).There was no s

关 键 词：食管肿瘤 气管食管瘘 气管支架 肺部感染 疗效 

分 类 号：R735.1[医药卫生—肿瘤] R563.1[医药卫生—临床医学]