[金属支架植入治疗良性气管及主支气管狭窄后的再狭窄及其处理]

Yao Xiao-peng, Li Qiang, Bai Chong, Huang Yi, Dong Yu-chao, Liu Zhong-ling, Wang Qin

Department of Respiratory, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.

Zhonghua Nei Ke Za Zhi. 2005 Dec;44(12):885-9.

OBJECTIVE

To observe the occurrence of restenosis after metallic stents implantation in benign tracheal and main bronchial stenosis, and to evaluate the therapeutic effects of balloon dilatation, cryotherapy and electrocautery.

METHODS

Thirty patients with benign tracheal stenosis and 35 patients with main bronchial stenosis caused by tuberculosis were treated with metallic stents implantation and a follow-up was carried out to observe the occurrence of restenosis. Combined balloon dilatation, cryotherapy and electrocautery were used to manage the restenosis. The lumen of stenotic segment, dyspnea index and pulmonary function were measured before management and after the patient's condition became stable.

RESULTS

Restenosis occurred in 6 of the 30 patients receiving tracheal stenting and in 8 of the 35 patients receiving bronchial stenting, the restenosis rates were 20% and 22.86%, respectively. In total, 30 Chinese-made stents and 36 Ultraflex stents were implanted, and the restenosis rate was 20% and 22.2%, respectively (P > 0.05). The restenosis rate was 4/9 in the upper segmental tracheal stents, and was 9.09% in the middle-lower segmental stents (chi(2) = 5.114, P < 0.05, but chi(c)(2) = 3.100, P > 0.05). The restenosis rate was 16.67% in the fibrotic stage of endobronchial tuberculosis (EBTB), and was 60% in the inflammatory reaction stage of EBTB (chi(2) = 4.564, P < 0.05, but chi(c)(2) = 2.437, P > 0.05). The effective rate was 4/6 in the tracheal stenting restenosis patients, and was 2/4 and 2/2 in the upper and middle-lower segment groups, respectively. The effective rate was 7/8 in the bronchial stenting restenosis patients. After management, the lumen diameter of stenotic segment in the tracheal stenting restenosis patients increased from (3.33 +/- 1.63) mm to (9.33 +/- 3.98) mm (P < 0.02), the dyspnea index decreased from (3.67 +/- 0.52) to (1.50 +/- 1.64) (P < 0.02), the vital capacity (VC) increased from (1.39 +/- 0.17) L to (2.43 +/- 0.70) L (P < 0.01), the forced expiratory volume in one second (FEV(1)) increased from (1.02 +/- 0.15) L to (2.00 +/- 0.72) L (P < 0.02). After management, the lumen diameter of stenosis segment in the bronchial stenting restenosis patients increased from (3.00 +/- 0.76) mm to (7.38 +/- 2.00) mm (P < 0.001), the dyspnea index decreased from (1.63 +/- 0.52) to (0.50 +/- 0.76) (P < 0.005), VC increased from (1.74 +/- 0.16) L to (2.74 +/- 0.41) L (P < 0.001), FEV(1) increased from (1.41 +/- 0.19) L to (2.36 +/- 0.37) L (P < 0.001).

CONCLUSION

Restenosis occurred in some patients with benign tracheal and tuberculous bronchial stenosis after metallic stent implantation. The restenosis rate was higher in the upper tracheal stenosis than that in the middle-lower tracheal stenosis. Caution should be taken when metallic stents are placed in this part of the trachea. The restenosis rate was higher in the inflammatory reaction stage of EBTB than in the fibrotic stage. Effort should be made to avoid placing metallic stents at this stage of the disease. Balloon dilatation, cryotherapy and eletrocautery are effective methods in managing restenosis after stent implantation.

目的

观察金属支架植入治疗良性气管及主支气管狭窄后再狭窄的发生情况，并评价球囊扩张、冷冻治疗及电烧灼治疗的效果。

方法

对30例良性气管狭窄患者和35例结核所致主支气管狭窄患者行金属支架植入治疗，并进行随访观察再狭窄的发生情况。采用球囊扩张、冷冻治疗及电烧灼联合治疗再狭窄。在治疗前及病情稳定后测量狭窄段管腔、呼吸困难指数及肺功能。

结果

30例气管支架植入患者中6例发生再狭窄，35例支气管支架植入患者中8例发生再狭窄，再狭窄率分别为20%和22.86%。共植入30枚国产支架和36枚Ultraflex支架，再狭窄率分别为20%和22.2%（P>0.05）。气管上段支架再狭窄率为4/9，气管中下段支架再狭窄率为9.09%（χ²=5.114，P<0.05，但χc²=3.100，P>0.05）。支气管内膜结核（EBTB）纤维化期再狭窄率为16.67%，EBTB炎症反应期再狭窄率为60%（χ²=4.564，P<0.05，但χc²=2.437，P>0.05）。气管支架植入再狭窄患者有效率为4/6，上段组和中下段组分别为2/4和2/2。支气管支架植入再狭窄患者有效率为7/8。治疗后，气管支架植入再狭窄患者狭窄段管腔直径由（3.33±1.63）mm增至（9.33±3.98）mm（P<0.02），呼吸困难指数由（3.67±0.52）降至（1.50±1.64）（P<0.02），肺活量（VC）由（1.39±0.17）L增至（2.43±0.70）L（P<0.01），第1秒用力呼气容积（FEV₁）由（1.02±0.15）L增至（2.00±0.72）L（P<0.02）。治疗后，支气管支架植入再狭窄患者狭窄段管腔直径由（3.00±0.76）mm增至（7.38±2.00）mm（P<0.001），呼吸困难指数由（1.63±0.52）降至（0.50±0.76）（P<0.005），VC由（1.74±0.16）L增至（2.74±0.41）L（P<0.001），FEV₁由（1.41±0.19）L增至（2.36±0.37）L（P<0.001）。