Interventional Pulmonary Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Chest. 2010 Aug;138(2):350-6. doi: 10.1378/chest.09-2682. Epub 2010 May 21.
The use of self-expandable metallic airway stents (SEMAS) for airway compromise may be associated with significant complications requiring their removal/replacement. The aim of this study is to describe the complications, health-care resources use (HRU), and costs associated with endoscopic removal of SEMAS.
A retrospective analysis of patients who underwent endoscopic removal of SEMAS during a 10-year period (January 2000-August 2009) was performed. HRU was analyzed in terms of the number of endoscopic procedures, hospital and ICU stay, need for mechanical ventilation and airway restenting, and estimation of respective hospital costs.
Fifty-five SEMAS were removed from 46 patients with a mean age of 58.6 +/- 15.8 years. Eighty percent of the stents were placed for benign airway disorders with an average stent in situ duration of 292 days. The median number of removal and total procedures during each encounter was one and two, respectively. Patients required hospitalization and ICU admission in 78% and 39% of the encounters with a median length of stay of 3.5 and 0 days, respectively. The estimated median total cost per encounter to remove the stents was $10,700, ranging from $3,700 to $69,800. The measured outcomes were statistically significantly better when in situ stent duration was <or= 30 days (P < .05).
Endoscopic removal of SEMAS is feasible; however, it is associated with significant complications, HRU, and costs. The use of SEMAS should be restricted to a well-selected patient population and should be planned by a team experienced with this type of therapeutic strategy.
使用自膨式金属气道支架（SEMAS）治疗气道阻塞可能会导致严重并发症，需要将其取出/更换。本研究旨在描述与 SEMAS 内镜下取出相关的并发症、医疗资源使用（HRU）和成本。
回顾性分析了 46 例患者在 10 年内（2000 年 1 月至 2009 年 8 月）接受 SEMAS 内镜下取出的病例。从内镜操作次数、住院和 ICU 住院时间、是否需要机械通气和气道再置管以及估计各自的住院费用等方面分析了 HRU。
46 例患者共取出 55 枚 SEMAS，平均年龄 58.6±15.8 岁。80%的支架用于良性气道疾病，平均支架在位时间为 292 天。每次内镜下取出时，中位数取出和总操作次数分别为 1 次和 2 次。78%和 39%的患者需要住院和 ICU 治疗，中位住院时间分别为 3.5 天和 0 天。每次内镜下取出支架的估计总费用中位数为 10700 美元，范围为 3700 美元至 69800 美元。当支架在位时间<或=30 天时，测量结果在统计学上显著更好（P<0.05）。
SEMAS 的内镜下取出是可行的；然而，它与严重的并发症、HRU 和成本相关。SEMAS 的使用应限制在经过精心选择的患者人群中，并应由经验丰富的团队计划使用这种治疗策略。
