论文部分内容阅读
目的探讨镍钛记忆合金支架治疗颈段气管狭窄的适应证、方法、并发症以及注意事项。方法回顾分析镍钛记忆合金支架治疗颈段气管狭窄43例患者,其中肿瘤压迫致气管狭窄15例;外伤性气管狭窄7例;肉芽增生4例,包括1例Wegener肉芽肿, 2例鼻硬结病, 1例不明原因炎性肉芽增生;复发性多软骨炎7例; 1例(支)气管淀粉样变; 4例(支)气管内膜结核; 5例气管软化。狭窄程度Ⅰ期15例,Ⅱ期24例,Ⅲ期4例。5例狭窄上端延至声门下。结果42例患者置入支架后,呼吸困难立即改善; 1例因为术中意外中止手术。26例带管者中18例术后3~4d拔除气管套管和封闭颈前气管造口; 8例未能同期除管者中3例喉裂开术后带管出院, 1例患者术中出现呼吸心跳骤停而终止手术后转科治疗, 2例支架移位使呼吸困难缓解不明显, 2例支架上口肉芽增生阻塞气道,二次手术去除肉芽组织。支架位于声门下的5例患者术后3例有轻度误咽, 1例声音嘶哑,通过调整进食姿势等逐步适应,误咽症状减轻。结论镍钛记忆合金支架可迅速扩张气管狭窄,明显改善呼吸困难,具有手术微创和操作简单的优点,可以作为气管狭窄治疗手段之一。
Objective To investigate the indications, methods, complications and precautions of nitinol memory alloy stent in the treatment of tracheal stenosis. Methods Forty-three patients with cervical tracheal stenosis treated with nickel-titanium memory alloy stent were retrospectively analyzed. Among them, 15 were tracheal stenosis caused by tumor compression, 7 were traumatic tracheal stenosis, 4 were granulomatous hyperplasia including 1 Wegener’s granulomatosis, 2 nasal tuberculosis , One case of unexplained inflammatory granulation hyperplasia; 7 cases of recurrent polychondritis; 1 case (branch) of tracheal amyloidosis; 4 cases (branch) of tracheal endometrial tuberculosis; Stenosis stage Ⅰ 15 cases, Ⅱ 24 cases, Ⅲ 4 cases. 5 cases of the upper extended to the glottis. Results After 42 patients were placed in the stent, dyspnea was immediately improved; one patient was stopped because of accidental operation. Of 26 implants, 18 patients underwent tracheal cannula and closed anterior cervical tracheostomy 3 to 4 days after operation. Among the 8 patients who failed to perform synchronous laryngectomy, 3 patients were discharged from the hospital with laryngeal rupture and 1 patient underwent surgery There was arrest of respiration and heartbeat and termination of surgery after treatment. Two cases of stent displacement did not alleviate dyspnea. Two cases of granulomatous hyperplasia blocked the airway and the second operation removed granulation tissue. In 5 patients underglossia, 3 patients had mild swallowing, 1 had hoarse voice, and gradually adapted to adjust for eating posture. The symptom of swallowing was relieved. Conclusion Nitinol stent can rapidly expand the tracheal stenosis and improve the breathing difficulty obviously. It has the advantages of minimally invasive surgery and simple operation, and can be used as one of the treatment methods of tracheal stenosis.