Aktaş Zafer, Öztürk Ayperi, Yılmaz Aydın, Kızılgöz Derya, Yurtseven Gülşah
Clinic of Interventional Pulmonology, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Service of Palliative Care, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Tuberk Toraks. 2019 Mar;67(1):22-30. doi: 10.5578/tt.68070.
Malignant central airway obstruction around the main carina often requires placement of Y‑shaped stents. In this study, we aimed to determine the safety of silicone Y stents placed around the main carina in the malignant airway obstruction by examining the long term complications, emergence times and treatment approaches of complications.
Between May 2012 and July 2015, 47 silicone Y stents were placed in 46 patients with malignant external compression or mixed type stenosis around the main carina. Patient stents were placed via rigid bronchoscopy under total intravenous anesthesia in operating room conditions.
In the half of the patients (23/46), stents were placed under urgent conditions due to acute respiratory failure. Stents were deployed successfully in all the patients. No procedure related deaths were observed. The median time of survival following stent insertion was 157 days. The total long-term complication rate of silicone Y stents was 28.3%. Mucostasis (8.7%) and migration (2.2%) were observed within the first month after placement of the silicone Y stents (median 18 days), stent-edge granulation tissue development (13.0%) was observed at the earliest one month (median 64, range 34-386 days) and stent-edge tumor tissue development (4.3%) were observed at the earliest 3 months (median 151, range 85-217 days). A total of 7 (15.2%) stents were removed, 2 of which were due to mucostasis and 5 of which were due to granulation tissue development. One patient's stent was replaced with a longer silicone Y stent due to stent-edge tumor tissue development.
The best palliative treatment of malignant tumor stenosis around the main carina is still silicone Y stent placement, but the long-term complication rate can be high. For this group of patients, bronchoscopy to be performed at the first and third months after silicone Y stent placement may provide early detection of stent-edge tissue development.
主隆突周围的恶性中央气道阻塞通常需要置入Y形支架。在本研究中，我们旨在通过检查长期并发症、出现时间及并发症的治疗方法，确定在恶性气道阻塞中主隆突周围置入硅酮Y形支架的安全性。
2012年5月至2015年7月期间，46例主隆突周围存在恶性外部压迫或混合型狭窄的患者置入了47个硅酮Y形支架。在手术室条件下，通过硬质支气管镜在全静脉麻醉下为患者置入支架。
半数患者（23/46）因急性呼吸衰竭在紧急情况下置入支架。所有患者支架均成功置入。未观察到与手术相关的死亡病例。支架置入后的中位生存时间为157天。硅酮Y形支架的总长期并发症发生率为28.3%。硅酮Y形支架置入后的第一个月内（中位时间18天）观察到黏液潴留（8.7%）和移位（2.2%），最早在置入后1个月（中位时间64天，范围34 - 386天）观察到支架边缘肉芽组织形成（13.0%），最早在3个月（中位时间151天，范围85 - 217天）观察到支架边缘肿瘤组织形成（4.3%）。共取出7个（15.2%）支架，其中2个因黏液潴留，5个因肉芽组织形成。1例患者因支架边缘肿瘤组织形成，将支架更换为更长的硅酮Y形支架。
主隆突周围恶性肿瘤狭窄的最佳姑息治疗方法仍是置入硅酮Y形支架，但长期并发症发生率可能较高。对于这组患者，在硅酮Y形支架置入后的第一个月和第三个月进行支气管镜检查，可能有助于早期发现支架边缘组织的变化。
