Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 Sep;82(9):727-731. doi: 10.1097/JCMA.0000000000000048.
Tracheobronchial (TB) lumen narrowing may require prolonged positive-pressure ventilation, endotracheal tube intubation or even surgical interventions. Therapeutic flexible bronchoscopy (TFB) of balloon-expandable metallic stent (BEMS) placement and subsequent forceps, laser and balloon dilatation management might be less invasive and helpful. This study aimed to analyse the placement, follow-up management with TFB and long-term outcomes in small infants with BEMS.
This retrospective study reviewed the medical records and associated TFB videos of infants with a maximum body weight (BW) of 5.0 kg who had TB BEMS placement from January 2005 to December 2017 at our institution. All TFB procedures were supported with a novel noninvasive ventilation, nasopharyngeal oxygen with intermittent nose closure and abdominal compression.
Forty-one BEMSs were placed in 24 infants. The mean BW and mean age were 4.0 ± 0.7 kg and 4.9 ± 2.4 months, respectively. There were 20, 8 and 13 stents located in trachea, carina and main-stem bronchi, respectively. Seven infants with 13 stents died without obvious stent-related mortality. Seven stents in five infants were successfully retrieved by rigid endoscopy (RE). At placement, the diameters of 28 tracheal and 21 bronchial stents were 7.5 ± 1.1 (4-10) and 5.4 ± 0.9 (4-8) mm, respectively. These implanted BEMSs could be gradually and significantly (p < 0.01) expanded. At the end of the follow-up period, all the remaining 21 stents in 12 infants were functional. The diameters of the 14 remaining tracheal and 13 remaining bronchial stents were 9.6 ± 2.0 (8-14) and 7.2 ± 1.4 (4-10) mm, respectively.
BEMSs are practical and effective in selected small infants with benign TB narrowing and can be safely implanted and managed with TFB, and finally retrieved by RE.
气管支气管（TB）管腔狭窄可能需要长时间的正压通气、气管内插管甚至手术干预。球囊扩张金属支架（BEMS）置入的治疗性软性支气管镜（TFB）和随后的钳子、激光和球囊扩张管理可能具有更小的侵入性和帮助。本研究旨在分析小婴儿 BEMS 置入、TFB 随访管理和长期结果。
这项回顾性研究回顾了 2005 年 1 月至 2017 年 12 月在我院接受 BEMS 置入的最大体重（BW）为 5.0kg 的婴儿的病历和相关 TFB 视频。所有 TFB 手术均采用新型无创通气、鼻咽吸氧伴间歇性鼻闭合和腹部压迫支持。
41 个 BEMS 被放置在 24 名婴儿中。平均 BW 和平均年龄分别为 4.0±0.7kg 和 4.9±2.4 个月。气管、隆突和主支气管分别有 20、8 和 13 个支架。7 名婴儿的 13 个支架无明显支架相关死亡率。5 名婴儿的 7 个支架通过硬性内镜（RE）成功取出。置入时，28 个气管支架和 21 个支气管支架的直径分别为 7.5±1.1（4-10）和 5.4±0.9（4-8）mm。这些植入的 BEMS 可以逐渐显著扩张（p<0.01）。在随访期末，12 名婴儿中的 21 个支架均功能良好。14 个剩余的气管支架和 13 个剩余的支气管支架的直径分别为 9.6±2.0（8-14）和 7.2±1.4（4-10）mm。
BEMS 在良性 TB 狭窄的选定小婴儿中是实用和有效的，可以通过 TFB 安全植入和管理，并最终通过 RE 取出。
