Oki Masahide, Saka Hideo
Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
J Bronchology Interv Pulmonol. 2013 Jan;20(1):21-7. doi: 10.1097/LBR.0b013e3182824365.
Airway stenting has become a popular method for palliation of airway stenosis; however, little has been reported about their use for patients with malignant lymphoma that occasionally causes a life-threatening condition. The aim of the study was to evaluate the efficacy and safety of airway stenting in chemoradiotherapy naive patients with severe airway stenosis due to malignant lymphoma.
Patients who underwent airway stent placement from April 2007 to July 2011 in a single center were retrospectively reviewed. All stenting procedures were performed using rigid and flexible bronchoscopes under general anesthesia.
We performed 174 airway stenting procedures (silicone stents in 154 procedures and metallic in 20 procedures) for 150 patients during the study period. Of the patients, 7 had untreated malignant lymphomas (4 diffuse large B-cell lymphomas, 2 lymphoblastic lymphomas, 1 mucosa-associated lymphoid tissue lymphoma). All patients underwent stenting using the silicone Y-stent (6 on the main carina and 1 on the primary right carina). Dyspnea was relieved immediately in 6 of 7 patients including the mechanically ventilated patient. Stents could be removed in all patients (median 90 d after stenting; range, 32 to 245 d) because of the tumor response to tumor-specific therapy. One granuloma formation and 1 mucus retention triggered the decision to remove the stents.
Airway stenting using silicone stents is safe and effective in palliation of airway stenosis in patients with untreated malignant lymphoma, and permits postprocedural tumor-specific therapy. The response to tumor-specific therapy can be expected, and so removable stents should be selected.
气道支架置入术已成为缓解气道狭窄的常用方法;然而,关于其在偶尔导致危及生命状况的恶性淋巴瘤患者中的应用报道较少。本研究的目的是评估气道支架置入术在未经放化疗的、因恶性淋巴瘤导致严重气道狭窄患者中的疗效和安全性。
回顾性分析2007年4月至2011年7月在单一中心接受气道支架置入术的患者。所有支架置入手术均在全身麻醉下使用硬质和软质支气管镜进行。
在研究期间,我们为150例患者进行了174次气道支架置入手术(154次使用硅酮支架,20次使用金属支架)。其中,7例患者患有未经治疗的恶性淋巴瘤(4例弥漫性大B细胞淋巴瘤,2例淋巴母细胞淋巴瘤,1例黏膜相关淋巴组织淋巴瘤)。所有患者均使用硅酮Y形支架进行支架置入(6例在主隆突,1例在右主支气管隆突)。7例患者中有6例(包括机械通气患者)的呼吸困难立即得到缓解。由于肿瘤对肿瘤特异性治疗有反应,所有患者的支架均可取出(支架置入后中位时间90天;范围32至245天)。1例肉芽肿形成和1例黏液潴留促使决定取出支架。
使用硅酮支架进行气道支架置入术在缓解未经治疗的恶性淋巴瘤患者的气道狭窄方面是安全有效的,并允许进行术后肿瘤特异性治疗。可以预期对肿瘤特异性治疗的反应,因此应选择可取出的支架。