Bi Yonghua, Li Jindong, Yu Zepeng, Ren Jianzhuang, Han Xinwei, Wu Gang
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Cardiovasc Intervent Radiol. 2019 Mar;42(3):426-432. doi: 10.1007/s00270-018-2126-6. Epub 2018 Nov 21.
We aimed to determine the safety and feasibility of bifurcated covered self-expanding stents for the treatment of complex tracheobronchial fistulas or stenosis.
Twenty-eight patients were treated by multiple bifurcated covered airway stents (Micro-Tech Co. Ltd., Nanjing, China), including 18 cases of gastrobronchial or gastrotracheal fistula, 6 cases of bronchopleural fistula and 4 cases of severe tracheobronchial stenosis. The large bifurcated covered stent was placed at the main carina, and the small stents were inserted into primary right carina or secondary left carina. Clinical and imaging data were retrospectively analyzed.
Stents were successfully inserted in 27 patients at the first attempt. In total, 29 large bifurcated covered stents, 27 small bifurcated covered stents and 5 small bifurcated covered single-plugged stents were inserted. All patients with fistula could resume eating without coughing after the procedure. No perioperative death or severe complications occurred. Two patients underwent stent removal due to intolerance of stenting; the clinical success rate was 93% (26/28). Nineteen complications were found in 12 patients; 8 patients needed stent removal or replacement, for a major complication rate of 29% (8/28). Eight patients underwent successful stent removal due to complications. Fifteen patients died of tumors and one patient died of pulmonary infection. The median survival was 33 months. Fistula recurrence was found in one patient 5 months after stenting, and second small bifurcated covered stent was inserted.
Multiple bifurcated covered metallic stenting is effective and safe for complex tracheobronchial fistulas or stenosis, with good symptom palliation.
我们旨在确定分叉型覆膜自膨式支架治疗复杂性气管支气管瘘或狭窄的安全性和可行性。
28例患者接受了多个分叉型气道覆膜支架（中国南京微创医疗器械有限公司）治疗，其中包括18例胃支气管瘘或胃气管瘘、6例支气管胸膜瘘和4例严重气管支气管狭窄。将大型分叉覆膜支架置于主隆突处，小型支架插入右主隆突或左主支气管二级分支处。对临床和影像数据进行回顾性分析。
27例患者首次尝试时成功植入支架。共植入29个大型分叉覆膜支架、27个小型分叉覆膜支架和5个小型分叉覆膜单封堵支架。所有瘘患者术后均可恢复进食且无呛咳。围手术期无死亡或严重并发症发生。2例患者因支架不耐受而取出支架；临床成功率为93%（26/28）。12例患者出现19项并发症；8例患者需要取出或更换支架，主要并发症发生率为29%（8/28）。8例患者因并发症成功取出支架。15例患者死于肿瘤，1例患者死于肺部感染。中位生存期为33个月。1例患者在支架置入5个月后出现瘘复发，再次植入小型分叉覆膜支架。
多个分叉型覆膜金属支架治疗复杂性气管支气管瘘或狭窄有效且安全，症状缓解良好。
