良性气管支气管狭窄中自膨式金属支架的长期随访：一项回顾性研究。
Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study.
机构信息
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, NO.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
Department of Respiratory Medicine, Chengdu Third People's Hospital, NO.82 Qinglong Street, Qingyang District, Chengdu, 610031, Sichuan, China.
出版信息
BMC Pulm Med. 2019 Feb 8;19(1):33. doi: 10.1186/s12890-019-0793-y.
BACKGROUND
Self-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway stenosis. However, the long-term efficacy and safety of this treatment in patients with benign airway stricture are unclear. We conducted this study to retrospectively determine the efficacy and long-term outcomes in patients who have undergone SEMS placement for benign tracheobronchial stenosis.
METHODS
All patients treated with SEMSs from July 2003 to June 2016 were reviewed for symptomatic response, complications, and long-term outcomes.
RESULTS
Total 131 stents were successfully deployed in 116 patients. Ninety-eight patients demonstrated clinical improvement after stent insertion (84.48%; 95% confidence interval [CI]: 77.89-91.07). Compared with uncovered stents, covered stents were associated with more sore throats complaints or chest pain (13.89% versus 28.81%, P = 0.036) and with higher incidences of major and minor granulation tissue formation and with recurrent stenosis (4.17% versus 15.25%, P = 0.029; 11.11% versus 37.29%, P < 0.0001 and 9.72% versus 28.81%, P = 0.005, respectively). Each covered and uncovered stent developing tissue hyperplasia required a median of 2 (range: 1-15) and 1(range: 1-7) fibrobronchoscope with electrocautery therapy, respectively. At follow-up (median: 1276 days; range: 2-4263), 68 patients had complete resolution, 15 remained under interventional treatment, 8 had bronchial occlusions, 7 underwent surgery, 14 were lost to follow-up, and 4 died of stent unrelated causes.
CONCLUSION
SEMS placement achieved most clinical improvement among patients in our study, if adequate endotracheal measures were used to address stent-related complications. The use of permanent SEMSs for benign tracheobronchial stenosis was effective and safe for the majority of patients in a long-term follow-up.
TRIAL REGISTRATION
The study has been retrospectively registered in the China Clinical Trial Registry on October 21, 2018 (Registry ID: ChiCTR1800019024 ).
背景
自膨式金属支架（SEMS）已能够实现恶性气道狭窄的有效治疗。然而，在良性气道狭窄患者中，这种治疗的长期疗效和安全性尚不清楚。我们进行这项研究旨在回顾性确定在良性气管支气管狭窄患者中使用 SEMS 置入术的疗效和长期结果。
方法
回顾性分析 2003 年 7 月至 2016 年 6 月期间接受 SEMS 治疗的所有患者，评估症状缓解、并发症和长期结果。
结果
116 例患者共成功植入 131 枚支架。支架置入后 98 例（84.48%；95%置信区间[CI]：77.89-91.07）患者临床症状改善。与未覆盖支架相比，覆盖支架更易引起咽痛或胸痛（13.89%比 28.81%，P=0.036），且更容易发生大、小结节肉芽组织形成和再狭窄（4.17%比 15.25%，P=0.029；11.11%比 37.29%，P<0.0001 和 9.72%比 28.81%，P=0.005）。每个覆盖和未覆盖支架发生组织增生均需接受中位数为 2（范围：1-15）和 1（范围：1-7）次纤维支气管镜下电灼治疗。在随访期间（中位数：1276 天；范围：2-4263），68 例患者完全缓解，15 例患者继续接受介入治疗，8 例患者出现支气管阻塞，7 例患者接受手术治疗，14 例患者失访，4 例患者因与支架无关的原因死亡。
结论
如果采用充分的气管内措施来解决支架相关并发症，SEMS 置入术可使大多数患者获得最佳临床改善。在长期随访中，良性气管支气管狭窄的永久性 SEMS 置入术对大多数患者是有效和安全的。
试验注册
本研究于 2018 年 10 月 21 日在中国临床试验注册中心进行了回顾性注册（注册号：ChiCTR1800019024）。
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