Soong Wen-Jue, Tsao Pei-Chen, Lee Yu-Sheng, Yang Chia-Feng
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2018 Feb 8;13(2):e0192557. doi: 10.1371/journal.pone.0192557. eCollection 2018.
To assess the placement, surveillance management and long-term outcomes of the tracheobronchial (TB) balloon expandable metallic stent (BEMS) managed by therapeutic flexible endoscopy (TFE).
This is a retrospective review and analysis of all computerized medical records and related flexible endoscopy videos of pediatric patients who received TB BEMS during 20 years period, from January 1997 to December 2016. TFE techniques with forceps debridement, balloon dilatation and laser ablation were used to implant stents, perform regular surveillance, maintain their functions, and expand the diameters of BEMS. Short-length (30cm-36cm) endoscopes of OD 3.2mm to 5.0mm coupled with the noninvasive ventilation, without ventilation bag, mask or airway tube, supported the whole procedures.
146 BEMS were implanted in 87 consecutive children, including 84 tracheal, 15 carinal and 47 bronchial stents. At the time of placement, the mean age was 35.6 ± 54.6 month-old (range 0.3-228) and the mean body weight was 13.9 ± 10.6 kg (range 2.2-60). Surveillance period was 9.4 ± 6.7 years (range, 0.3-18.0). Satisfactory clinical improvements were noted immediately in all but two patients. Seventy-two (82.8%) patients were still alive with stable respiratory status, except two patients necessitating TFE management every two months. Fifty-one stents, including 35 tracheal and 16 bronchial ones, were successfully retrieved mainly with rigid endoscopy. Implanted stents could be significantly (< .001) further expanded for growing TB lumens. The final stent diameters were positively correlated to the implanted duration. Altogether, 33 stents expired (15 patients), 51 were retrieved (40 patients), and 62 remained and functioning well (38 patients), with their mean duration of 7.4 ± 9.5, 34.9 ± 36.3 and 82.3 ± 62.5 months, respectively.
In pediatric patients, TFE with short-length scopes coupled with this NIV support has provided a safe, feasible and effective modality in placing and subsequently managing TB BEMS with acceptable long-term outcomes.
评估经治疗性软性内镜（TFE）管理的气管支气管（TB）球囊扩张金属支架（BEMS）的放置、监测管理及长期预后。
这是一项对1997年1月至2016年12月期间接受TB BEMS的儿科患者的所有计算机化病历及相关软性内镜视频进行的回顾性分析。采用钳取清创、球囊扩张和激光消融等TFE技术植入支架、进行定期监测、维持其功能并扩大BEMS直径。外径3.2mm至5.0mm的短长度（30cm - 36cm）内镜结合无创通气，无需通气袋、面罩或气道管，支持整个操作过程。
连续87例儿童共植入146个BEMS，其中气管支架84个、隆突支架15个、支气管支架47个。放置时，平均年龄为35.6±54.6月龄（范围0.3 - 228），平均体重为13.9±10.6kg（范围2.2 - 60）。监测期为9.4±6.7年（范围0.3 - 18.0）。除两名患者外，所有患者均立即出现满意的临床改善。72例（82.8%）患者仍存活，呼吸状态稳定，除两名患者每两个月需要进行TFE管理。51个支架，包括35个气管支架和16个支气管支架，主要通过硬质内镜成功取出。随着TB管腔的生长，植入的支架可显著（<0.001）进一步扩张。最终支架直径与植入持续时间呈正相关。总共有33个支架失效（15例患者），51个被取出（40例患者），62个仍保留且功能良好（38例患者），其平均持续时间分别为7.4±9.5、34.9±36.3和82.3±62.5个月。
在儿科患者中，短长度内镜结合无创通气支持的TFE在放置及后续管理TB BEMS方面提供了一种安全、可行且有效的方式，长期预后可接受。
