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目的 探讨气道内激光加内置支架在气道完全闭塞治疗中的应用价值。方法 对 17例气道完全闭塞患者应用掺钕钇铝石榴石激光加气道内置支架治疗 ,并定期随访 2～ 2 0个月。结果 17例患者经激光治疗后气道均有扩大 ,平均扩大 (5 82± 1 0 1)mm ;气促分级减少 ,除 1例患者无变化外 ,减少 1级 4例 ,2级减少 11例 ,3级减少 1例 ;1秒钟用力呼气容积 (FEV1)增加 (0 49± 0 18)L。14例患者经激光治疗后行气道内支架置入术 ,术后患者的气道直径平均又增大 (3 5 0± 0 94)mm ;气促分级又进一步减少 ,除 2例患者无变化外 ,有 8例减少 1级 ,4例减少 2级 ;FEV1平均又增加 (0 41± 0 2 0 )L。在激光治疗过程中有 15例患者出现低氧血症 ,2例患者出现出血 ,有 3例患者术后早期出现呼吸困难 ;支架置入后出现反复肺部感染者 4例 ,支架网眼内肉芽组织或肿瘤组织生长形成阻塞 5例 ,支架出现移位 1例 ,经处理后气道均保持通畅。结论 激光治疗加气道内置支架在气道完全闭塞患者的治疗中是行之有效的。
Objective To investigate the value of endo-laser plus built-in stent in the treatment of complete bronchial obstruction. Methods Seventeen patients with complete airway occlusion were treated with neodymium-doped yttrium aluminum garnet laser and balloon-assisted stenting. The patients were followed up for 2 to 20 months. Results After the laser treatment, all the 17 patients had an enlarged airway (average 5 82 ± 1 0 1) mm. The reduction in the severity of irritation decreased, except for 1 patient, in which 4 patients were reduced to grade 1 and 11 patients reduced to grade 2 , 1 in 3 cases, and FEV1 in 1 second (0 49 ± 0 18) L. After laser treatment, 14 patients underwent airway stenting, and the average diameter of airway increased to (35 0 ± 0 94) mm after surgery. The further improvement was found in all patients except for 2 patients , 8 cases decreased by 1 grade, 4 cases decreased by 2 grades; FEV1 increased by an average (0 41 ± 0 0) L. During laser treatment, 15 patients developed hypoxemia, 2 patients developed hemorrhage, and 3 patients had dyspnea at the early postoperative period. Four patients with recurrent lung infection after stenting were implanted, and the intraocular granulation tissue Or tumor growth in the formation of obstruction in 5 cases, stent displacement occurred in 1 case, after treatment, the airway remained unobstructed. Conclusion Laser-assisted balloon-assisted stenting is effective in the treatment of patients with complete airway obstruction.