论文部分内容阅读
目的：观察和评价Gianturco气管支气管自扩金属支架治疗气管支气管恶性狭窄的疗效及并发症。材料和方法：在X光及支纤镜指引下应用Gianturco气管支气管自扩金属支架13个治疗气管支气管恶性狭窄10例，狭窄原因：食管鳞癌直接侵犯或纵隔淋巴结转移压迫气道6例，气管鳞癌2例，右主支气管肺鳞癌1例，纵隔肿瘤（恶性胸腺瘤）1例。狭窄部位：气管6例，右主支气管3例，左主支气管1例。结果：全部支架均成功进入预定位置，支架扩张满意。呼吸困难症状明显改善，气管支气管最小直径从术前0．37t0．18cm扩大到1．60±0．45cm（P＝0．000）；血氧分压、皮氧饱和度、生活质量明显提高。严重的并发症有咯血1例、肿瘤支架内生长2例、放化疗中出现食管气管瘘2例。7例已死亡，平均生存5．1月；3例仍生存，分别存活3、6、7月。结论：外压性肿瘤引起的气管支气管狭窄是自扩金属支架的最佳适应征，对于不能手术治疗的气管支气管恶性肿瘤是一种维持气道通畅行之有效的姑息治疗方法，为有效的抗肿瘤治疗创造时机。
Objective: To observe and evaluate the efficacy and complications of Gianturco tracheobronchial self-expanding metal stent in the treatment of malignant bronchobronchial stenosis. Materials and Methods: Thirteen patients with malignant tracheobronchial stenosis treated with Gianturco tracheobronchial self-expanding metal stent under the guidance of X-ray and fiberoptic microscopy were used. The causes of stenosis were direct invasion of esophageal squamous cell carcinoma or mediastinal lymph node metastasis and 6 cases of airway, trachea. There were 2 cases of squamous cell carcinoma, 1 case of right bronchial squamous cell carcinoma, and 1 case of mediastinal tumor (malignant thymoma). Stenosis: 6 cases of trachea, 3 cases of right main bronchus and 1 case of left main bronchus. RESULTS: All stents were successfully placed in the intended position and stent expansion was satisfactory. The symptoms of dyspnea were significantly improved. The minimum diameter of the tracheal bronchus increased from 0.37 to 0.18 cm before surgery to 1.60±0.45 cm (P=0.000); the blood oxygen partial pressure, skin oxygen saturation, and quality of life were significantly improved. Serious complications included 1 case of hemoptysis, 2 cases of tumor growth in stents, and 2 cases of esophageal tracheal fistula during radiotherapy and chemotherapy. 7 cases had died and the average survival was 5.1 months; 3 cases were still alive and survived 3, 6 and 7 months respectively. Conclusion: The tracheobronchial stenosis caused by external pressure tumors is the best indication for self-expanding metal stents. It is an effective palliative treatment for airway patency in patients with inoperable tracheobronchial malignancies and is an effective anti-tumor therapy. Cancer treatment creates opportunities.