硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌致中央气道狭窄的临床疗效

Efficacy of tracheal stent placement in treatment of tracheal stenosis caused by esophageal cancer under direct vision with rigid bronchoscope and electronic bronchoscope

摘要:

目的 探讨硬质支气管镜联合电子支气管镜直视下置入金属或硅酮气管支架治疗食管癌侵犯气管致中央气道狭窄的临床应用价值。方法 回顾性分析该院呼吸与危重症医学科2019年10月－2021年7月诊治的13例食管癌侵犯气管致中央气道中重度狭窄患者的临床资料，所有患者均在全身麻醉肌松下插入硬质支气管镜，在电子支气管镜实时引导下行金属支架或硅酮支架置入治疗，观察其临床效果。结果 13例患者成功置入金属支架7枚，硅酮支架6枚（1枚直筒型，5枚Y型）。支架置入后，患者卡氏功能状态（KPS）评分、经皮动脉血氧分压（PaO₂）和经皮动脉血氧饱和度（SpO₂）明显高于支架置入前（P < 0.05）；气管狭窄程度较支架置入前明显改善，气促分级、呼吸困难博格评分和二氧化碳分压（PCO₂）明显低于支架置入前（P < 0.05）；金属支架组和硅酮支架组术后近期并发症、远期并发症、3个月生存率和6个月生存率比较，差异均无统计学意义（P > 0.05）。结论 在硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌所致的中央气道狭窄，安全可行，能迅速解除气管狭窄，近期效果显著，为患者后续治疗提供了保障。

Abstract:

Objective To explore the clinical application value inserting metal tracheal stent or silicone tracheal stent under direct vision with rigid bronchoscope and electronic bronchoscope in treatment of tracheal stenosis caused by esophageal cancer invading the trachea.Methods The clinical data of 13 patients with moderate to severe tracheal stenosis caused by esophageal cancer invading the trachea diagnosed and treated by the department of pulmonary and critical care medicine from October 2019 to July 2021 were retrospectively analyzed. All the patients underwent rigid bronchoscope insertion under general anesthesia and muscle relaxation, and then metal stents or silicone stents were placed under the real-time guidance of electronic bronchoscope. We observed the clinical effect of the 13 patients.Results 7 metal stents and 6 silicone stents were successfully placed in 13 patients with central tracheal stenosis caused by esophageal cancer invading the trachea. The Karnofsky performance status (KPS) score, percutaneous arterial oxygen partial pressure (PaO₂) and percutaneous arterial oxygen saturation (SpO₂) of patients after metal stent or silicone stent placement were significantly higher than those before stent placement (P < 0.05). Degree of tracheal stent was significantly improved compared with that before stent placement, breath index, Borg dyspnea score, and partial pressure of carbon dioxide (PCO₂) were significantly lower than those before stent placement (P < 0.05). There was no significant difference between the metal stent group and the silicone stent group in terms of short-term complications, long-term complications, 3-month survival rate, and 6-month survival rate (P > 0.05).Conclusion Placement of tracheal stent under direct vision with rigid bronchoscope and electronic bronchoscope in treatment of tracheal stenosis caused by esophageal cancer is feasible, safe, and has a significant short-term effect.