Verma Akash, Phua Chee Kiang, Wu Qiu Mei, Sim Wen Yuan, Rui Audrey Wee Chuan, Goh Soon Keng, Ho Benjamin, Kor Ai Ching, Wong Andrew S Y, Lim Albert Y H, Tai Dessmon Y H, Abisheganaden John
Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore.
J Clin Med Res. 2017 Jan;9(1):58-63. doi: 10.14740/jocmr2811w. Epub 2016 Nov 24.
We studied the safety, effectiveness, and limitations of airway stenting using self-expanding metal stent (SEMS) in patients with malignant central airway obstruction (CAO).
A retrospective review of records of patients undergoing SEMS placement for malignant CAO during year 2013 - 2014 was done.
Sixteen patients (11 males and five females) underwent SEMS placement for malignant CAO. Median (range) age was 66 (54 - 78) years. No perioperative or immediate postoperative complications were seen except acute myocardial infarction (AMI) in one patient. Three patients were transferred to intensive care unit (ICU) for closer monitoring after the procedure and were discharged the next day. All four patients with lung atelectasis on presentation experienced complete re-expansion of the lung post-stenting. The dyspnea was substantially relieved in 14 (87.5%) patients. Two of the three patients who had been intubated were weaned off from the ventilator following stent insertion. Stent patency was maintained until death in all patients except one. Median survival from the date of diagnosis and the date of stent placement in lung cancer, esophageal cancer, and thyroid cancer were 140 (21 - 564) and 85 (15 - 361), 288 (80 - 419) and 61 (60 - 171), and 129 (71 - 187) and 67 (16 - 118) days, respectively. This survival was similar to reported expected survival associated with the underlying malignancy. During follow-up, granulation tissue (n = 1), mucostasis (n = 1), and tumor ingrowth (n = 2) were the most frequently encountered complications.
SEMSs are safe and effective in reversing respiratory failure caused by malignant CAO, averting premature death, allowing application of cancer targeted therapy, and restoring impending shortened survival to expected life expectancy associated with the underlying malignancy.
我们研究了使用自膨式金属支架（SEMS）对恶性中央气道梗阻（CAO）患者进行气道支架置入的安全性、有效性及局限性。
对2013 - 2014年期间因恶性CAO接受SEMS置入的患者记录进行回顾性分析。
16例患者（11例男性，5例女性）因恶性CAO接受了SEMS置入。中位（范围）年龄为66（54 - 78）岁。除1例患者发生急性心肌梗死（AMI）外，未观察到围手术期或术后即刻并发症。3例患者术后转入重症监护病房（ICU）进行密切监测，次日出院。所有4例就诊时存在肺不张的患者在支架置入后肺均完全复张。14例（87.5%）患者的呼吸困难得到显著缓解。3例插管患者中有2例在支架置入后脱机。除1例患者外，所有患者的支架通畅性均维持至死亡。肺癌、食管癌和甲状腺癌患者从诊断日期到支架置入日期的中位生存期分别为140（21 - 564）天和85（15 - 361）天、288（80 - 419）天和61（60 - 171）天、129（71 - 187）天和67（16 - 118）天。该生存期与报道的相关潜在恶性肿瘤的预期生存期相似。随访期间，肉芽组织（n = 1）、黏液潴留（n = 1）和肿瘤长入（n = 2）是最常见的并发症。
SEMS在逆转恶性CAO所致呼吸衰竭、避免过早死亡、允许应用癌症靶向治疗以及将即将缩短的生存期恢复至与相关潜在恶性肿瘤预期寿命相关方面是安全有效的。
