Burns Karen E A, Orons Philip D, Dauber James H, Grgurich Wayne F, Stitt Larry W, Raghu Sujatha, Iacono Aldo T
Division of Pulmonary Transplantation, and Pulmonary, Critical Care Medicine, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, Pennsylvania, USA.
Ann Thorac Surg. 2002 Dec;74(6):1934-41. doi: 10.1016/s0003-4975(02)04033-x.
In lung transplant recipients, bronchial stenosis (SB) and bronchomalacia (MB) result in obstructive airway disease and allograft dysfunction due to pulmonary infection. We hypothesized that endobronchial metallic stent placement for SB and MB would result in long-term improvement in respiratory function and rates of pulmonary infection.
We studied symptomatic lung transplant recipients with bronchoscopic evidence of proximal airway complications (SB or MB) and a synchronous decline in forced expiratory volume in 1 second (FEV1) of at least 10% in the 6-month period before intervention. Stent placement was the primary intervention for SB and all focal MB lesions and for recurrent or refractory SB lesions failing a single initial attempt at balloon dilation. FEV1 and rates of pulmonary infection were assessed in the 12-month interval before and after stent placement. Spirometric evaluation was performed at 3-month intervals and compared with spirometry at the time of stent placement. The rates of pulmonary infection, determined by the number of antibiotics prescribed, was determined before and after endobronchial correction.
Thirty recipients underwent a total of 75 procedures (50 stent insertions and 25 balloon dilations). FEV1 improved significantly after stent placement compared with base line (1.29 +/- 0.43 L) as follows: 3 months, 1.45 +/- 0.50 L, p = 0.014; 6 months, 1.59 +/- 0.57 L, p = 0.002; 12 months 1.59 +/- 0.53 L, p = 0.006. The infection rate decreased from the 12-month period preceding stent insertion to the corresponding period after stent insertion (6.97/100 days +/- 6.33 versus 5.74/100 days +/- 7.76, p = 0.018). Recurrent SB occurred in 17.3%. No life-threatening complications occurred after stent placement and no deaths were attributed to stent malfunction or malposition.
In lung transplant recipients with SB and MB, maintenance of airway patency by stent placement is safe and resulted in improvements in lung function and reduced pulmonary infection rates for up to 1 year after their insertion.
在肺移植受者中，支气管狭窄（SB）和支气管软化（MB）会导致阻塞性气道疾病以及因肺部感染引起的移植物功能障碍。我们推测，为SB和MB放置支气管内金属支架将使呼吸功能和肺部感染率得到长期改善。
我们研究了有症状的肺移植受者，这些受者在支气管镜检查中有近端气道并发症（SB或MB）的证据，并且在干预前6个月内第一秒用力呼气量（FEV1）同步下降至少10%。支架置入是SB和所有局灶性MB病变以及单次初次球囊扩张失败的复发性或难治性SB病变的主要干预措施。在支架置入前后的12个月期间评估FEV1和肺部感染率。每3个月进行一次肺量计评估，并与支架置入时的肺量计检查结果进行比较。根据开具的抗生素数量确定支气管内矫正前后的肺部感染率。
30名受者共接受了75次手术（50次支架置入和25次球囊扩张）。与基线（1.29±0.43升）相比，支架置入后FEV1有显著改善，如下所示：3个月时，1.45±0.50升，p = 0.014；6个月时，1.59±0.57升，p = 0.002；12个月时，1.59±0.53升，p = 0.006。感染率从支架置入前的12个月期间降至支架置入后的相应期间（6.97/100天±6.33对5.74/100天±7.76，p = 0.018）。17.3%发生了复发性SB。支架置入后未发生危及生命的并发症，也没有死亡归因于支架故障或位置不当。
在患有SB和MB的肺移植受者中，通过放置支架维持气道通畅是安全的，并在置入后长达1年的时间里改善了肺功能并降低了肺部感染率。
