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目的 :探讨气管、支气管支架置入疗法在支气管结核 (EBTB)治疗中的应用范围 ,并评价其疗效及安全性。 方法 :选择4 7例支气管结核并已出现明显的气管、支气管管腔狭窄和 (或 )管壁软化的患者 ,结合传统外科手术治疗 EBTB气道狭窄的经验 ,制定了腔内支架置入疗法治疗 EBTB的适应证 ,并根据患者的病变部位、范围及性质的不同 ,分别选择了 2 2枚国产镍钛记忆合金支架和 2 5枚进口 ultraflex支架 ,在全麻或局麻下置入。于支架置入前、置入后 1周及 4～ 6个月期间 ,分别对患者气道狭窄段的腔径、气促指数及肺功能进行测定 ,以评价支架置入对改善患者肺通气功能的效果。结果 :4 7例 EBTB患者在支架置入 7d后 ,气道狭窄段的腔径由原来的 (3.31± 0 .89) mm扩展至 (9.4 2± 2 .37) mm(P<0 .0 1 ) ;气促指数由原来的 3.1 2± 1 .1 2降至0 .6 4± 0 .6 1 ;肺活量 (VC)及 1秒钟最大呼气量 (FEV1 )亦由原来的 (1 .6 4± 0 .36 ) L 和 (0 .4 6± 0 .2 5 ) L 升至 (2 .79± 0 .4 2 ) L 和(2 .6 7± 0 .38) L (n=4 0 ,P<0 .0 1 )。 4～ 6个月时 ,尽管少数患者出现了支架置入后的再狭窄 ,但总体疗效维持不变。4 7例 EBTB支架置入后有 1 1例 (2 3.4 % )出现了不同程度的再狭窄 ,其中溃疡坏死型和肉芽增殖型 EBTB再狭窄的?
Objective: To explore the application of tracheal and bronchial stent implantation in the treatment of bronchial tuberculosis (EBTB) and to evaluate its efficacy and safety. METHODS: Forty-seven patients with bronchial tuberculosis who had developed significant tracheal and bronchial stenosis and / or softening of the wall were enrolled in this study. In combination with the experience of traditional surgery for EBTB airway stenosis, an endovascular stent placement EBTB indications, and according to the patient’s lesion location, scope and nature of the different were selected 22 domestic nickel-titanium memory alloy stent and 25 imported ultraflex stent, under general anesthesia or local anesthesia. During the first week and the fourth to sixth month after stent implantation, the diameters of the airway stenosis, the index of breath and pulmonary function were measured respectively to evaluate the effect of stent placement on the improvement of pulmonary function Effect. Results: After 7 days of stent implantation, the diameter of tracheal stenosis increased from 3.31 ± 0.89 mm to 9.4 2 ± 2.37 mm in 47 7 EBTB patients (P <0.01) ). The index of breathlessness decreased from 3.1 2 ± 1.12 to 0.64 ± 0.61; the vital capacity (VC) and maximum expiratory volume of 1 second (FEV1) also decreased from the original (1.6 4 ± 0.36) L and (0.46 ± 0.52) L to (2.79 ± 0.42) L and (2.67 ± 0.38) L (n = 40 , P <0. 01). At 4 to 6 months, the overall effect remained unchanged despite a small number of patients with stent restenosis. In 41 cases of EBTB stent implantation, 11 cases (2 3.4%) had different degree of restenosis, including ulcer necrosis and granulomatous EBTB restenosis?