CAJ | 학술논문

目的探讨可回收全覆膜金属支架治疗良性气管狭窄的并发症及处理方法.方法可回收全覆膜金属支架治疗良性气管狭窄患者21例,其中男18例,女3例,年龄16～ 65岁,平均年龄(33±15)岁,回顾总结分析支架相关并发症及其治疗方法.结果 21例患者在透视引导下置入28个可回收全覆膜金属支架,均1次成功,于4 ～ 12个月[平均(5.5±2.2)个月]后全部成功回收.支架相关并发症包括:肉芽组织增生18例,支架移位4例,支架咳出2例、分泌物滞留21例,黏液栓1例,口臭8例.并发症处理:2例患者使用二氧化碳激光切除肉芽组织；2例患者由于支架移位和咳出分别更换2次和3次支架；2例患者由于支架移位分别更换1次支架；分泌物滞留的治疗采用雾化吸入生理盐水或乙酰半胱氨酸盐水对分泌物进行稀释,促其排出；1例黏液栓患者,使用吸痰管反复抽吸,剧烈咳嗽后,咳出黏液栓；8例口臭应用抗生素进行治疗,症状缓解.全部21例患者支架取出后肺功能明显改善,支架置入前和取出后狭窄段管径、气促评级及FEV1比较差异有统计学意义.随访时间最短为1个月,最长为36个月[平均(23.2±8.0)个月],未见复发.结论可回收全覆膜金属支架是良性气管狭窄安全有效的治疗方法,并发症可以得到有效的处理和控制.
목적 탐토가회수전복막금속지가치료량성기관협착적병발증급처리방법.방법 가회수전복막금속지가치료량성기관협착환자21례,기중남18례,녀3례,년령16～ 65세,평균년령(33±15)세,회고총결분석지가상관병발증급기치료방법.결과 21례환자재투시인도하치입28개가회수전복막금속지가,균1차성공,우4 ～ 12개월[평균(5.5±2.2)개월]후전부성공회수.지가상관병발증포괄:육아조직증생18례,지가이위4례,지가해출2례、분비물체류21례,점액전1례,구취8례.병발증처리:2례환자사용이양화탄격광절제육아조직；2례환자유우지가이위화해출분별경환2차화3차지가；2례환자유우지가이위분별경환1차지가；분비물체류적치료채용무화흡입생리염수혹을선반광안산염수대분비물진행희석,촉기배출；1례점액전환자,사용흡담관반복추흡,극렬해수후,해출점액전；8례구취응용항생소진행치료,증상완해.전부21례환자지가취출후폐공능명현개선,지가치입전화취출후협착단관경、기촉평급급FEV1비교차이유통계학의의.수방시간최단위1개월,최장위36개월[평균(23.2±8.0)개월],미견복발.결론 가회수전복막금속지가시량성기관협착안전유효적치료방법,병발증가이득도유효적처리화공제.
Objective To study complications and the management of the use of covered retrievable expandable metallic stents in the treatment of benign tracheal stenosis.Methods Fully covered retrievable metal stents were placed in 21 patients with benign tracheal stenosis.Stent-related complications and the management were reviewed and analysised.Results Twenty-eight fully covered retrievable metallic stents were successfully placed fluoroscopically in 21 patients.Stents were removed 4-12 months [mean (5.5 ±2.2) mouths] after placement in all patients.Stent-related complications included granulation tissue (n =18),stent migration (n =4),stent expectoration (n =2),halitosis (n =8),mucous retention (n =21)and mucus plugging(n =1).Granulation tissue was removed with a carbon dioxide laser in 2 patients.Stents were replaced for 2 times and 3 times respectively in 2 patients after stent migration and stent expectoration.An additional stent was placed in 2 patients after stent migration.Symptom of halitosis was relieved after prolonged course of systemic antibiotics treatment in 8 patients.Symptom of mucous retention was relieved with nebulized saline and N-acetylcysteine saline inhalation.Mucous plug was expelled after severe coughing after suctioning using an aspirator in one patient.There were statistically significant differences in stricture diameter,rank of tachypnea and pulmonary function (FEV1) in all 21 patients before stent insertion and after stents removal.No patient has experienced recurrence during the follow-up period of 1-36 months [mean (23.2 ± 8.0) months].Conclusion Fully covered retrievable metallic stent may be a safe and effective in benign tracheal stenosis.Stent-related complications may be effectively managed.