Orons P D, Amesur N B, Dauber J H, Zajko A B, Keenan R J, Iacono A T
Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
J Vasc Interv Radiol. 2000 Jan;11(1):89-99. doi: 10.1016/s1051-0443(07)61288-3.
To evaluate the effect of balloon dilation and endobronchial stent placement for bronchial fibrous stenoses and bronchomalacia after lung transplantation.
Bronchial dilation and/or stent placement was performed on 25 lung transplant recipients. Indications included severe dyspnea with postobstructive pneumonia (n = 24) and respiratory failure (n = 1). All patients underwent pulmonary function testing (PFT) before and after bronchial dilation, the results of which were evaluated for changes. A total of 63 procedures were performed between February 1996 and December 1998. Thirty-five lesions were treated (18 were due to bronchomalacia, 17 were due to fibrosis). Areas treated included the left mainstem bronchus (n = 11), bronchus intermedius (n = 10), right mainstem bronchus (n = 7), left upper lobe bronchus (n = 4), right lower lobe bronchus (n = 2), and right middle lobe bronchus (n = 1). Bronchoscopic and/or bronchographic follow-up ranged from 1 to 34 months (mean, 15 months).
Six-month primary patency of stents placed for bronchomalacia was 71% (10 of 14), with three of the four occlusions caused by mechanical failure of Palmaz stents in the mainstem bronchi. Six-month primary patency for treatment of fibrous strictures was 29%. Secondary patency at 1 year was 100% for both bronchomalacia and fibrous strictures. After treatment, there was a significant improvement in mean PFT results (P = .01-.0001). There was one acute complication, obstruction of the left lower lobe bronchus by a Wallstent treated by dilating a hole in the side of the stent.
Balloon dilation and stent placement are safe and effective for bronchial strictures and bronchomalacia after lung transplantation, resulting in significant improvement in PFT results. However, there is almost universal restenosis in patients treated for fibrous strictures necessitating reintervention for prolonged patency.
评估球囊扩张及支气管内支架置入术对肺移植术后支气管纤维性狭窄及支气管软化的疗效。
对25例肺移植受者进行支气管扩张和/或支架置入术。适应证包括伴有阻塞性肺炎的严重呼吸困难（24例）及呼吸衰竭（1例）。所有患者在支气管扩张术前及术后均接受肺功能测试（PFT），评估结果的变化。1996年2月至1998年12月期间共进行了63例手术。治疗了35处病变（18处为支气管软化，17处为纤维化）。治疗部位包括左主支气管（11例）、中间支气管（10例）、右主支气管（7例）、左上叶支气管（4例）、右下叶支气管（2例）及右中叶支气管（1例）。支气管镜和/或支气管造影随访时间为1至34个月（平均15个月）。
置入治疗支气管软化的支架6个月时的初始通畅率为71%（14例中的10例），4例阻塞中有3例是由主支气管内Palmaz支架机械故障所致。治疗纤维性狭窄6个月时的初始通畅率为29%。支气管软化和纤维性狭窄1年时的继发通畅率均为100%。治疗后，平均PFT结果有显著改善（P = 0.01 - 0.0001）。发生1例急性并发症，一枚Wallstent支架阻塞左下叶支气管，通过在支架侧面扩张一个孔进行治疗。
球囊扩张及支架置入术对肺移植术后支气管狭窄及支气管软化安全有效，可使PFT结果显著改善。然而，治疗纤维性狭窄的患者几乎普遍出现再狭窄，需要再次干预以维持长期通畅。
