Cho Sung Bae, Cha Seon Ah, Choi Joon Young, Lee Jong Min, Kang Hyeon Hui, Moon Hwa Sik, Kim Sei Won, Yeo Chang Dong, Lee Sang Haak
Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Tuberc Respir Dis (Seoul). 2015 Jan;78(1):31-5. doi: 10.4046/trd.2015.78.1.31. Epub 2015 Jan 29.
An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.
一名18岁女性因慢性咳痰和呼吸困难接受评估。她随后被诊断为纵隔非霍奇金淋巴瘤（NHL）。植入了覆膜自膨式金属支架（SEMS）以缓解双侧主支气管狭窄。经过六个化疗周期后，NHL完全缓解，但在SEMS植入18个月后左肺下叶出现肺不张。左主支气管被肉芽组织完全阻塞。然而，右主支气管和中间支气管通畅。在SEMS附近观察到肉芽组织。切除肉芽组织和SEMS，使用硬支气管镜成功植入硅酮支架。SEMS因其易于植入而具有优势，但存在相当多潜在并发症，如严重的反应性肉芽、支架破裂，严重时可导致通气衰竭。因此，对于良性气道疾病患者应尽可能避免使用SEMS。该病例强调，即使在恶性气道阻塞病例中，如果潜在恶性肿瘤可治愈，也应避免植入SEMS。
