Nomori H, Horio H, Suemasu K
Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Chest. 1999 Feb;115(2):582-3. doi: 10.1378/chest.115.2.582.
Dumon stent placement requires use of a technically difficult rigid bronchoscope. A recently developed technique for placing a Dumon stent introduced via a conventional endotracheal tube is detailed herein.
The conventional endotracheal tube is inserted beyond the stenosis site; this procedure is observed with the use of a flexible bronchoscope with the patient undergoing general anesthesia. The Dumon stent is folded and inserted into the endotracheal tube and is introduced into the stenosis site with the use of a cylindrical-tipped stainless steel wire as a pusher. The endotracheal tube is withdrawn while the pusher is positioned to expand the stent at the stenosis site. Dumon stents of 12 to 16 mm in diameter were put in place using the present method in 5 cases of tracheobronchial stenosis.
The mean time from endotracheal tube insertion to stent placement was 181 s. The present method positioned the Dumon stent more easily and safely than the original rigid bronchoscope because the endotracheal tube used was flexible. One patient, however, required a tracheostomy and surgical forceps to remove the stent 3 months after placement.
While Dumon stent removal may require a rigid bronchoscope or tracheostomy, stents can be introduced without difficulty via a conventional endotracheal tube.
放置杜蒙支架需要使用技术难度较高的硬质支气管镜。本文详细介绍了一种通过传统气管导管放置杜蒙支架的最新技术。
将传统气管导管插入狭窄部位远端；在患者全身麻醉状态下，使用可弯曲支气管镜观察该操作过程。将杜蒙支架折叠后插入气管导管，并使用圆柱形头的不锈钢丝作为推送器将其引入狭窄部位。在推送器定位以使支架在狭窄部位展开的同时，将气管导管撤出。采用本方法为5例气管支气管狭窄患者放置了直径为12至16毫米的杜蒙支架。
从插入气管导管到放置支架的平均时间为181秒。由于所使用的气管导管是可弯曲的，因此本方法比原始的硬质支气管镜更容易、更安全地放置杜蒙支架。然而，有1例患者在放置支架3个月后需要进行气管切开术并使用手术钳取出支架。
虽然取出杜蒙支架可能需要硬质支气管镜或气管切开术，但通过传统气管导管引入支架并无困难。
