CAJ | 학술논문

目的评价全覆膜自膨胀气管-支气管支架治疗气管瘘的临床价值.方法回顾性分析2005年8月至2011年11月山东大学附属千佛山医院胸外科应用全覆膜气管-支气管支架治疗的9例气管瘘患者的临床资料,其中男7例,女2例,年龄28 ～ 65岁,平均46岁.9例中支气管胸膜瘘7例,气管胸膜瘘1例,左主支气管-食管瘘1例,8例伴有脓胸；瘘口直径为3.5～25.0 mm,平均8.4 mm.在局部麻醉和X线透视引导下,6例放置L型支架,3例放置Ⅰ型支架,伴脓胸者于支架置入后给予胸腔冲洗治疗.结果所有患者均成功置入支架,从插入导丝至支架成功释放所需时间5 ～ 16 min,平均(10±4) min,未发生与操作相关的并发症.1例胸腔引流管仍有少量气泡溢出,其余8例引流管气泡均立即消失,造影检查示瘘口无造影剂外溢.1例在支架置入后第5天由于剧烈咳嗽将支架咳出,重新置入新支架后未再发生移位.8例脓胸患者中1例行支架置入,术后8d因脓胸合并败血症去世,另1例6个月后脓胸未治愈,死于肺癌脑转移,其他6例在支架置入术后2～5个月(平均3.7个月)治愈.7例患者共随访3～36个月,中位随访时间为13.5个月,随访中1例于支架置入术后8个月取出支架,未发现脓胸复发；其他患者对支架耐受良好,无移位,无脓胸复发,饮食良好.结论使用全覆膜自膨胀金属支架治疗气管瘘是一种安全、有效、快速的微创治疗方法,尤其适合不能耐受手术或其他治疗方法失败的患者.
목적 평개전복막자팽창기관-지기관지가치료기관루적림상개치.방법 회고성분석2005년8월지2011년11월산동대학부속천불산의원흉외과응용전복막기관-지기관지가치료적9례기관루환자적림상자료,기중남7례,녀2례,년령28 ～ 65세,평균46세.9례중지기관흉막루7례,기관흉막루1례,좌주지기관-식관루1례,8례반유농흉；루구직경위3.5～25.0 mm,평균8.4 mm.재국부마취화X선투시인도하,6례방치L형지가,3례방치Ⅰ형지가,반농흉자우지가치입후급여흉강충세치료.결과 소유환자균성공치입지가,종삽입도사지지가성공석방소수시간5 ～ 16 min,평균(10±4) min,미발생여조작상관적병발증.1례흉강인류관잉유소량기포일출,기여8례인류관기포균립즉소실,조영검사시루구무조영제외일.1례재지가치입후제5천유우극렬해수장지가해출,중신치입신지가후미재발생이위.8례농흉환자중1례행지가치입,술후8d인농흉합병패혈증거세,령1례6개월후농흉미치유,사우폐암뇌전이,기타6례재지가치입술후2～5개월(평균3.7개월)치유.7례환자공수방3～36개월,중위수방시간위13.5개월,수방중1례우지가치입술후8개월취출지가,미발현농흉복발；기타환자대지가내수량호,무이위,무농흉복발,음식량호.결론 사용전복막자팽창금속지가치료기관루시일충안전、유효、쾌속적미창치료방법,우기괄합불능내수수술혹기타치료방법실패적환자.
Objective To assess the feasibility,safety and efficacy of the use of a fully covered self-expandable stent for the treatment of airway fistula.Methods From August 2005 to November 2011,9 patients underwent treatment by the introduction of a tracheo-bronchial or bronchial fully covered selfexpandable metallic stent.There were 7 males and 2 females,aged from 28-65 years with a mean of 46 years.In this group,7 cases were diagnosed as bronchopleural fistula,1 case as tracheopleural fistula,1 case as broncho-esophageal fistula,8 cases with thoracic empyema.The fistula orifices were from 3.5-25.0 mm in diameter with a mean 8.4 mm.All patients received topical anesthesia,and L-shaped stent was placed in 6 patients and I-shaped stent in 3 patients under fluoroscopic guidance.After the stent placement,the patients with empyema were treated with continual irrigation of the empyema cavity.Results Stent placement in the tracheo-bronchial tree was technically successful in all patients,without procedurerelated complications.The operating time was from 5-16 minutes,mean time (10 ± 4) minutes.Except for 1 patient,immediate closure of the airway fistula was achieved in the other patients after the procedure,as shown by the immediate cessation of bubbling in the chest drain system or the contrast examination.In this study,1 patient coughed the inserted stent out due to irritable cough on the 5th day and had to receive repositioning of a new stent.Among the patients who were with empyema,1 patient died of septicemia on the 8th day and 1 patient died of brain metastases from lung cancer 6 months after the stent insertion with empyema not cured,the other 6 patients' empyema healed from 2-5 months,mean time 3.7 months.Seven patients were followed from 3 to 36 months with a median of 13.5 months.During follow-up,1 stent was removed from a patient 8 months after the stent implantation without empyema recurred.The remaining patient presented good tolerability to the existence of stent.The stents remained stable,no migration occurred,no empyema recurred,and the patient with broncho-esophageal fistula fed and drunk well.Conclusion The use of fully covered self-expandable stents proved to be a safe,effective and fast minimally invasive method to treat airway fistula,especially for patients with a higher surgical risk or other failed treatments.