Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Ann Thorac Surg. 2013 Feb;95(2):440-4. doi: 10.1016/j.athoracsur.2012.09.037. Epub 2012 Nov 30.
Decannulation is the ultimate therapeutic goal for patients who undergo stenting because of inoperable benign tracheal stenosis. In this study, our objectives were to evaluate whether long-term airway stenting allows decannulation in patients with benign tracheal stenosis who were deemed inoperable and to identify possible predictive factors for successful decannulation (SD).
Retrospective cohort study including all patients with inoperable benign tracheal stenosis who underwent tracheal stenting in our tertiary-care university-based institution from 1998 to 2008. For benign stenosis, we use only silicone stents (T tubes, Dumon stents, and Y stents). The main outcome was SD, which was defined as removal of the tracheal stent followed by absence of respiratory symptoms and no requirement for new dilation procedures for at least 6 months. A Kaplan-Meier curve was built to evaluate SD in 5 years, and we used a Cox model to evaluate predictors for a SD.
Ninety-two patients were included, and during the study period 21 were decannulated. However, 2 of them had to undergo new airway procedures and were considered to represent failure. Therefore, 19 patients were successfully decannulated. According to the Kaplan-Meier estimate, the SD rate in 5 years was 27.5%. The mean follow-up time after SD was 34.3 ± 33.9 months (range, 6 to 108 months). Cox regression showed only 1 significant factor: tracheostomy before stent insertion caused a threefold increase in the likelihood of the patient remaining with a tracheal stent (p = 0.048).
Tracheal stenting may be considered a curative therapeutic approach in as many as 27.5% of patients with inoperable benign tracheal stenosis.
对于因无法手术的良性气管狭窄而接受支架置入的患者，拔管是最终的治疗目标。在本研究中，我们的目的是评估对于被认为无法手术的良性气管狭窄患者，长期气道支架置入是否能实现拔管，并确定成功拔管（SD）的可能预测因素。
这是一项回顾性队列研究，纳入了 1998 年至 2008 年期间在我们的三级保健大学附属医院因无法手术的良性气管狭窄而接受气管支架置入的所有患者。对于良性狭窄，我们仅使用硅酮支架（T 管、Dumon 支架和 Y 支架）。主要结局是 SD，定义为移除气管支架后，至少 6 个月内无呼吸症状且无需再次进行扩张治疗。我们构建了 Kaplan-Meier 曲线来评估 5 年内的 SD，并使用 Cox 模型来评估 SD 的预测因素。
共纳入 92 例患者，研究期间有 21 例患者拔管。然而，其中 2 例患者需要进行新的气道手术，被认为是失败。因此，有 19 例患者成功拔管。根据 Kaplan-Meier 估计，5 年内的 SD 率为 27.5%。SD 后平均随访时间为 34.3±33.9 个月（范围 6 至 108 个月）。Cox 回归仅显示出 1 个显著因素：支架置入前的气管造口术使患者继续带气管支架的可能性增加了 3 倍（p=0.048）。
在无法手术的良性气管狭窄患者中，气管支架置入可能被视为一种有治愈潜力的治疗方法，其成功率约为 27.5%。
