Saad Cynthia P, Ghamande Shekhar A, Minai Omar A, Murthy Sudish, Pettersson Gosta, DeCamp Malcom, Mehta Atul C
Department of Pulmonary and Critical Care, The Cleveland Clinic Foundation, Ohio 44195, USA.
Transplantation. 2003 May 15;75(9):1532-8. doi: 10.1097/01.TP.0000061229.83500.A0.
Airway complications continue to be an important source of morbidity and mortality after lung transplantation (LTx). Different approaches have been used for their nonsurgical management. We describe our experience using self-expandable metallic stents (SEMSs) in patients with airway complications post-LTx.
We present a retrospective analysis of stent related-data of all the LTx patients who received SEMSs to treat postoperative airway complications.
Between January 1992 and December 2001, 36 of 253 patients (14.2%) developed post-LTx airway complications involving 40 of 348 anastomoses (11.5%). A total of 15 SEMSs were placed in 12 patients (mean age 47.3+/-9.6 years) for tracheobronchomalacia, stenosis, and anastomotic dehiscence, including one patient referred from an outside hospital. Mean follow-up was 20.1+/-19.5 months (range 1.2-58 months). Patency and symptom improvement were achieved in 11 of 12 patients. Stenting of the airway led to successful weaning of two patients who were on prolonged mechanical ventilation. Suture dehiscence was effectively managed in two patients who were not candidates for surgical repair. Overall, the complication rate was 0.040 complications per patient per month (total number of complications and total number of months using the stent). Bacterial bronchitis (four patients) and obstructive granulomas (three patients) were the most frequent complications. The survival of LTx patients with airway SEMSs was similar when compared with the survival of all other LTx patients (P=0.74).
SEMSs are safe and effective in the management of airway complications in selected patients post-LTx. Weaning from mechanical ventilation and management of anastomotic dehiscence are the unique attributes of this device.
气道并发症仍然是肺移植(LTx)后发病和死亡的重要原因。已采用不同方法对其进行非手术治疗。我们描述了在LTx术后气道并发症患者中使用自膨式金属支架(SEMS)的经验。
我们对所有接受SEMS治疗术后气道并发症的LTx患者的支架相关数据进行了回顾性分析。
1992年1月至2001年12月期间,253例患者中有36例(14.2%)发生了LTx术后气道并发症,累及348个吻合口中的40个(11.5%)。共对12例患者(平均年龄47.3±9.6岁)置入了15枚SEMS,用于治疗气管支气管软化、狭窄和吻合口裂开,其中1例患者为外院转诊。平均随访时间为20.1±19.5个月(范围1.2-58个月)。12例患者中有11例实现了通畅和症状改善。气道支架置入使2例长期机械通气患者成功脱机。2例不适合手术修复的患者的缝线裂开得到了有效处理。总体而言,并发症发生率为每位患者每月0.040次并发症(并发症总数和使用支架总月数)。细菌性支气管炎(4例患者)和阻塞性肉芽肿(3例患者)是最常见的并发症。与所有其他LTx患者的生存率相比,气道置入SEMS的LTx患者的生存率相似(P=0.74)。
SEMS在选定的LTx术后患者气道并发症管理中是安全有效的。脱机和吻合口裂开处理是该装置的独特优势。