Cao Ming, Zhu Qiang, Wang Wei, Zhang Tian Xiao, Jiang Min Zhong, Zang Qi
Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Division of Graduate, Weifang Medical College, Weifang, Shandong, China.
Thorac Cardiovasc Surg. 2016 Sep;64(6):533-9. doi: 10.1055/s-0034-1396681. Epub 2015 Jan 12.
Background The study was designed to access the feasibility, safety, and efficacy of fully covered self-expandable metal stents in the treatment of bronchial fistula. Methods Clinical data of nine patients (seven males and two females) who were treated with placement of tracheobronchial or bronchial fully covered self-expandable metal stents from August 2005 to November 2011 were analyzed retrospectively. Among these patients, seven were diagnosed with bronchopleural fistula, one with tracheopleural fistula, and one with left main bronchoesophageal fistula. Eight had accompanying thoracic empyema. The fistula orifices ranged from 3.5 mm to 25 mm in diameter. All patients received topical anesthesia. L-shaped stents were placed in six patients and I-shaped stents in three under fluoroscopic guidance. After stent placement, patients with empyema were treated with pleural lavage. Results Stent placement in the tracheobronchial tree was successful in all patients, without procedure-related complications. The operating time was 5 to 16 minutes. A small amount of bubble overflowed from the intrathoracic drainage tube of only one patient. In the other patients, the bubble in the intrathoracic drainage tube disappeared immediately or angiography showed no overflow of contrast agent from the fistula orifice. The effective rate of fistula orifice closure after stent placement was 100%, with 88.9% rated as excellent. One patient coughed the stent out 5 days after placement and hence a new stent was placed. Among the patients with empyema, one died of septicemia arising from empyema on day 8 and another died of brain metastases of lung cancer 6 months after stent insertion with persistent empyema. In the other six patients, empyema resolved after 2 to 5 months (cure rate 75%). Seven patients were followed up for 3 to 36 months. During follow-up, one stent was removed 8 months after implantation due to difficult expectoration, without recurrent empyema. The remaining patients tolerated the stents well. The stents remained stable without migration or empyema recurrence, and they could eat and drink well. Conclusion The use of fully covered self-expandable metal stents is a safe, effective, and fast minimally invasive method to treat bronchial fistula, especially for selected cases with empyema.
背景 本研究旨在评估全覆膜自膨式金属支架治疗支气管瘘的可行性、安全性及有效性。方法 回顾性分析2005年8月至2011年11月间9例接受气管支气管或支气管全覆膜自膨式金属支架置入治疗患者的临床资料。其中男性7例，女性2例。7例诊断为支气管胸膜瘘，1例为气管胸膜瘘，1例为左主支气管食管瘘。8例合并胸腔积脓。瘘口直径3.5毫米至25毫米不等。所有患者均接受局部麻醉。6例患者在透视引导下置入L形支架，3例置入I形支架。支架置入后，胸腔积脓患者接受胸腔冲洗治疗。结果 所有患者气管支气管树内支架置入均成功，无手术相关并发症。手术时间为5至16分钟。仅1例患者胸腔引流管有少量气泡溢出。其他患者胸腔引流管内气泡立即消失或血管造影显示造影剂未从瘘口溢出。支架置入后瘘口闭合有效率为100%，其中88.9%效果极佳。1例患者置入支架5天后将支架咳出，因此重新置入新支架。胸腔积脓患者中，1例于第8天死于积脓所致败血症，另1例在支架置入后6个月因肺癌脑转移合并持续胸腔积脓死亡。其他6例患者胸腔积脓在2至5个月后消退（治愈率75%）。7例患者随访3至36个月。随访期间，1例患者因咳痰困难于植入支架8个月后取出支架，无胸腔积脓复发。其余患者对支架耐受性良好。支架保持稳定，无移位或胸腔积脓复发，患者能正常饮食。结论 使用全覆膜自膨式金属支架是治疗支气管瘘安全、有效且快速的微创方法，尤其适用于部分合并胸腔积脓的病例。
