Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, China.
Sci Rep. 2020 Feb 27;10(1):3600. doi: 10.1038/s41598-020-60566-6.
Self-expandable metallic stents (SEMSs) have been widely used in the treatment of malignant central airway obstruction. However, few reports focus on the treatment of atelectasis and how to estimate the prior probability of success via SEMSs placement, This current study aimed to study the safety and effectiveness of SEMSs for the treatment of obstructive atelectasis, and the value of preoperative CT enhancement for ventilation of atelectasis via SEMSs placement. A total of 35 patients with obstructive atelectasis (29 male and 6 female) was included from February 2012 to March 2018. The procedures were performed under fluoroscopic guidance, and bronchoscopic laser resection was performed for severe restenosis cases after SEMSs placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Thirty-eight SEMSs were successfully implanted in 34 patients, included 29 Y type tracheal stents, 4 small y stents, and 5 straight airway stents. After stenting, 26 cases showed full ventilation, and 3 cases were partially ventilated. The technical success and clinical success was 97.1% and 82.9%, respectively. A higher maximum enhancement CT value was found in patients with full ventilation. Mean follow-up time was 18.8 ± 4.0 months. Eight cases showed restenosis and received endoscopic laser resection, included 1 case underwent removal and 3 cases received second stenting. There were 2 cases of perioperative non-operative death, and 11 cases of post-discharge death (2 cardiac deaths and 9 malignant tumors). The survival rates of 3 months, 1 year and 2 years were 78.6%, 58.5% and 58.5%, respectively. In conclusion, SEMSs placement is safe and effective for obstructive atelectasis, and the preoperative CT enhancement played an important role in estimating the prior probability of success in the treatment of atelectasis via SEMSs placement.
自膨式金属支架（SEMS）已广泛应用于恶性中央气道阻塞的治疗。然而，很少有研究关注SEMS 治疗肺不张的效果，以及如何通过 SEMS 放置来预估成功率。本研究旨在探讨 SEMS 治疗阻塞性肺不张的安全性和有效性，以及术前 CT 增强值对 SEMS 放置治疗肺不张通气的价值。
2012 年 2 月至 2018 年 3 月，共纳入 35 例阻塞性肺不张患者（男 29 例，女 6 例）。在透视引导下进行操作，对于 SEMS 放置后严重再狭窄的病例，进行支气管镜下激光切除。记录术前和术后 3 个月的临床和功能肺部数据。随访包括术后 48 小时、1、3、6 和 12 个月的临床资料和影像学检查。
34 例患者成功植入 38 枚 SEMS，其中 Y 型气管支架 29 枚、小 Y 支架 4 枚、直气道支架 5 枚。支架置入后，26 例完全通气，3 例部分通气。技术成功率和临床成功率分别为 97.1%和 82.9%。完全通气患者的最大 CT 增强值较高。平均随访时间为 18.8±4.0 个月。8 例出现再狭窄，行内镜下激光切除，其中 1 例取出，3 例再次放置支架。2 例围手术期非手术死亡，11 例出院后死亡（2 例心源性死亡，9 例恶性肿瘤）。3 个月、1 年和 2 年的生存率分别为 78.6%、58.5%和 58.5%。
综上所述，SEMS 放置治疗肺不张安全有效，术前 CT 增强值对通过 SEMS 放置治疗肺不张的成功率预估具有重要作用。
