支气管镜联合X线透视下带膜气管支架 置入治疗气管食管瘘

Deployment of covered expandable metallic airway stent under bronchoscopy and fluoroscopic guidance in patients with tracheoesophageal fistula: report of 10 patients

摘要:

目的 初步探讨支气管镜联合X线透视下带膜气管支架置入治疗气管食管瘘的临床疗效及安全性。方法 收集10例气管食管瘘在纤维支气管镜指导及X线监视下接受自膨胀式带膜金属气管支架治疗的患者资料，比较治疗前后呼吸困难分级和Karnofsky评分及进行治疗后随访。结果 10例恶性气管食管瘘患者，在纤维支气管镜指导及X线监视下共置入10枚自膨胀式带膜金属气管支架，带膜气管支架均一次性置入成功，10例患者置入内支架后均症状缓解。呼吸困难分级由Ⅲ、Ⅳ级改善为0～Ⅱ级，Karnofsky评分改善明显，术后1周与术前评分比较差异有显著性（P <0.05）。其中4例病变累及隆突的气管食管瘘患者，置入Y型部分带膜支架。随访显示10例患者均在术后1年内死亡，平均生存期（18±3.2）（3~42）周。结论 支气管镜联合X线透视下置入带膜气管支架治疗气管食管瘘，技术可行，操作简单、安全，近期疗效可靠，值得进一步推广应用。

Abstract:

【Objective】 To investigate the feasibility and primary therapeutic effect of covered expandable metallic airway stent under bronchoscopy and fluoroscopic guidance for tracheoesophageal fistula. 【Methods】 We retrospectively reviewed patients who undergone placement of covered repandable metallic stents for palliation of tracheoesophageal fistula under bronchoscopy and fluoroscopic guidance. The main outcome measurements were dyspnea grade, Karnofsky performance scores and mean survival time. 【Results】 10 stents were implanted in 10 cases of malignant tracheoesophageal fistula under the guidance of interventional fibroscopy and fluoroscopy. The covered repandable metallic stents were placed successfully with instantaneous relief of the symptoms and improving of living quality. Medical Research Council dyspnea grade improved significantly from Ⅲ~Ⅳ to 0~Ⅱ and Karnofsky performance scores improved significantly(P <0.05). 4 cases involving the carina were implanted Y-stent. All patients died during the 1-year follow-up period ,mean survival time was (18±3.2) weeks(range 3~42weeks). 【Conclusion】 The placement of covered expandable metallic airway stent under bronchoscopy and fluoroscopic guidance is a feasible and safe for treating tracheoesophageal fistula.