Fiorelli Alfonso, Mazzone Salvatore, Di Crescenzo Vincenzo Giuseppe, Costa Giuseppe, Del Prete Assunta, Vicidomini Giovanni, Mazzone Adriano, Santini Mario
Thoracic Surgery Unit, Second University of Naples,Naples, Italy.
Interact Cardiovasc Thorac Surg. 2014 Mar;18(3):390-2. doi: 10.1093/icvts/ivt504. Epub 2013 Dec 9.
Airway stenting is the chosen treatment for patients affected by subglottic tracheal stenosis and unfit for surgery. Among the different types of prostheses, the Dumon stent is a valid option especially in patients without tracheotomy. Insertion is usually achieved by pushing the stent off from a loader using a prosthesis pusher. If the stent is expelled below the stenosis, rigid forceps grasping the proximal end of the stent retract it above the stenosis. However, in difficult cases such as rigid stenosis with a luminal diameter smaller than the profile of the stent, such a manoeuvre may be difficult in non-expert hands. Thus, we proposed a simple and safe technique to facilitate the placement of a Dumon stent. We passed a long thread from outside to the inside of the stent. After the dilatation of the stenosis, the stent was pushed and, if needed, easily retracted with the thread into the proper position to ensure airway patency and to avoid migration. In addition, our procedure could be useful also to rapidly remove the stent if its size turned out to be inaccurate for the stenosis. With such a simple method we successfully treated 7 consecutive patients affected by complex subglottic stenosis and unfit for surgery.
气道支架置入术是声门下气管狭窄且不宜手术患者的首选治疗方法。在不同类型的假体中，杜蒙支架是一种有效的选择，尤其适用于未行气管切开术的患者。通常使用假体推送器将支架从装载器上推出以完成置入。如果支架被推至狭窄部位下方，可用硬质钳子抓住支架近端将其拉回狭窄部位上方。然而，在诸如管腔直径小于支架外形的刚性狭窄等困难病例中，非专业人员进行这种操作可能会很困难。因此，我们提出了一种简单且安全的技术来辅助杜蒙支架的放置。我们将一根长线从支架外部穿至内部。狭窄部位扩张后，推送支架，如有需要，可通过线轻松将其拉回至合适位置，以确保气道通畅并避免移位。此外，如果发现支架尺寸与狭窄部位不匹配，我们的方法也有助于快速取出支架。通过这种简单的方法，我们成功连续治疗了7例患有复杂声门下狭窄且不宜手术的患者。
