Nam Hae-Seong, Um Sang Won, Koh Won-Jung, Suh Gee Young, Chung Man Pyo, Kwon O Jung, Kim Jhingook, Kim Hojoong
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Thorac Surg. 2009 Aug;88(2):432-9. doi: 10.1016/j.athoracsur.2009.04.083.
The Y-shaped structure of the carinal bifurcation causes difficulties in the treatment of carinal stenosis. We describe a new Y-shaped silicone stent, called the Natural Y stent. We investigated its clinical efficacy through a review of patients with benign carinal stenosis who undewent consecutive Natural Y stent placement.
Between January 2004 and February 2008, 11 patients underwent ballooning, neodymium:yttrium-aluminum-garnet laser resection, or bougienation (by rigid bronchoscopy) to dilate the airway, followed by placement of the Natural Y stent.
The underlying etiologies of carinal stenosis included posttuberculosis stricture in 7 patients (64%), postintubation stenosis in 2 (18%), and postoperative malacia in 2 (18%). All patients reported subjective symptomatic relief immediately after stent placement. No procedurally related deaths or immediate major complications occurred. Stent-related late complications included granulation tissue formation (64%) and mucostasis (18%, defined as > or = 50% narrowing). The median duration of overall stent placement was 439 days (range, 119 to 1729 days). The stents were successfully removed in 4 patients (36%) after a median of 409 days.
The Natural Y stent provides an effective and feasible therapeutic modality in patients with benign carinal stenosis, with or without previous thoracic airway interventions.
气管隆突分叉处的Y形结构给气管隆突狭窄的治疗带来困难。我们描述了一种新型的Y形硅胶支架，称为自然Y支架。我们通过回顾连续接受自然Y支架置入术的良性气管隆突狭窄患者来研究其临床疗效。
2004年1月至2008年2月期间，11例患者接受了球囊扩张、钕：钇铝石榴石激光切除或（通过硬支气管镜）探条扩张气道，随后置入自然Y支架。
气管隆突狭窄的潜在病因包括7例（64%）结核后狭窄、2例（18%）插管后狭窄和2例（18%）术后软化。所有患者在支架置入后均立即报告主观症状缓解。未发生与手术相关的死亡或即刻严重并发症。与支架相关的晚期并发症包括肉芽组织形成（64%）和黏液潴留（18%，定义为狭窄≥50%）。支架置入的总中位持续时间为439天（范围119至1729天）。4例患者（36%）在中位409天后成功取出支架。
自然Y支架为良性气管隆突狭窄患者提供了一种有效且可行的治疗方式，无论患者之前是否接受过胸段气道干预。
