经电子支气管镜放置支架治疗气道狭窄及气管食管瘘30例剖析.docVIP

经电子支气管镜放置支架治疗气道狭窄及气管食管瘘30例剖析 　　 【摘要】 目的 探讨电子支气管镜直视下放置镍钛合金支架对气管、支气管狭窄及气管食管瘘的治疗效果及不良反应。方法 对 30例不同原因引起的气管、主支气管狭窄及气管食道瘘患者在气管镜直视下行气道镍钛记忆合金支架置入，观察支架置入前后患者症状、血气分析变化及相关并发症。结果 所有患者术后呼吸困难均立即明显缓解，8例合并气管食管瘘患者在置入带膜气管支架后进食呛咳消失，动脉血氧分压升高。术后1个月肉芽组织增生 2例，随访6个月1例患者支架断裂。 结论 电子支气管镜直视下置入镍钛合金支架是治疗气道狭窄及气管食管瘘安全、有效的方法。? 　　【关键词】 　　支气管镜;支架;气道狭窄;气管食管瘘 　　 Endoscopic airway stenting for tracheobronchial stenosis and tracheoesophageal fistula 　　 　　CHEN Shu?wen. Department of Respiratory Diseases, Luoyang Central Hospital, Luoyang 471000, China 　　? 　　 　　【Abstract】 Objective 　　To evaluate the therapeutic efficacy and complications of endoscopic placement of nickel?titanium alloy stents for the treatment of airway stenosis and tracheoesophageal fistula. Methods Nickel titanium alloy stents were placed into the airway of 21 patients with tracheobronchial stenosis under direct view of bronchoscope. The symptoms of the patients, the change in the blood gas analysis and the complications before and after the trachel stent implantation were observed. Results Dyspnea was relived in all of patients immmediately after stenting and dilatation. Disappearance of cough during food taking was found in 8 patients with tracheoesophageal fistula after placement of coated stent, arterial partial pressure of oxygen was increased in all 30 patients. Granuloma occurred in 2 patients in 1 month after senting,stent breakage in 1 patients in 6 month after senting. Conclusion Endoscopic placement of nickel?titanium alloy stents is a safe and useful measure for the treatment of airway stenosis and tracheoesophageal fistula.? 　　【Key words】 　　Bronchoscopy; Stent; Tracheobronchial stenosis;Tracheoesophageal fistula 　　 　　各种恶性肿瘤及良性病变所致气管或主支气管狭窄在临床上较为常见，采用外科手术治疗风险较大，且易出现术后再狭窄。目前气管及主支气管支架置入治疗成为一种治疗气管、主支气管狭窄及气管食管瘘主要方法之一[1]，近5年来，我院呼吸内科经电子支气管镜放置支架治疗气道狭窄及气管食管瘘30例，取得较好疗效。? 　　1 资料与方法? 　　1.1 一般资料 我院呼吸内科于2006年3月至2011年3月收治各种原因所致气道狭窄患者30例，其中支气管肺癌18例，食道肿瘤压迫或侵犯气道10例，外伤后肉芽组织所致气道狭窄1例，纵膈肿瘤所致气道狭窄1例。年龄45~78岁，平均60岁；男26例，女4例。单纯气管狭窄26