自膨式金属支架置入治疗中央气道狭窄和瘘的临床结果和生存情况。
Clinical outcomes and survival following placement of self-expandable metallic stents for central airway stenosis and fistula.
机构信息
Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan.
Department of Respiratory Medicine, Kanazawa Medical University, Ishikawa, Japan.
出版信息
Thorac Cancer. 2021 Jan;12(1):48-56. doi: 10.1111/1759-7714.13707. Epub 2020 Nov 12.
BACKGROUND
Self-expandable metallic stent (SEMS) placement is an urgent procedure for patients with malignant central airway stenoses (CASs) and central airway fistulas (CAFs). The aim of this study was to determine the outcome and survival after SEMS placement in patients with malignant CASs and CAFs.
METHODS
SEMSs were inserted into 20 patients with malignant CASs and four with malignant CAFs. Hospital records, the modified Medical Research Council dyspnea scale (mMRC) grade, performance status (PS), symptoms, procedure-related complications and survival after placement were retrospectively reviewed.
RESULTS
Spiral Z stents were inserted in nine patients, covered Ultraflex stents in 14, and a bare Ultraflex in one patient. After SEMS placement, 20 patients (83.3%) showed improvement in mMRC grade, 19 (79.2%) showed improvement in PS, and 21 (87.5%) showed improvement in symptoms. There were three patients whose stents migrated out of place, but there were no patients with obstructive granulation, infection, or mucous plugs. Median survival days after stent insertion was 98 days for CAS and 103 days for CAF, and mean survival days was 383 ± 707 days for CAS and 93 ± 33 days for CAF. Two patients with CAS by malignant lymphoma and thymic cancer survived more than six years because they were also treated with efficient therapies. The five-year survival rate after stent insertion was 7.7%.
CONCLUSIONS
SEMS placement for CAS and CAF is associated with improvement in mMRC grade, PS and symptoms in 87.5% of patients. Patients with a malignant CAS are usually terminal, but the possibility of increasing survival rate will become a reality with new efficient therapies.
KEY POINTS
SIGNIFICANT FINDINGS OF THE STUDY: Reasonable clinical outcomes and improved survival of patients following SEMS placement for thoracic malignancy with central airway stenosis and fistula.
WHAT THIS STUDY ADDS
The possibility of increasing survival rate will become a reality with new efficient therapies.
背景
自膨式金属支架（SEMS）置入术是治疗恶性中央气道狭窄（CAS）和中央气道瘘（CAF）患者的紧急程序。本研究旨在确定恶性 CAS 和 CAF 患者行 SEMS 置入术后的结局和生存情况。
方法
对 20 例恶性 CAS 患者和 4 例恶性 CAF 患者行 SEMS 置入术，回顾性分析其病历资料、改良的医学研究委员会呼吸困难量表（mMRC）分级、体力状况（PS）、症状、与操作相关的并发症以及置入术后的生存情况。
结果
9 例患者置入螺旋 Z 支架，14 例患者置入覆膜 Ultraflex 支架，1 例患者置入裸 Ultraflex 支架。SEMS 置入术后，20 例（83.3%）患者的 mMRC 分级改善，19 例（79.2%）患者 PS 改善，21 例（87.5%）患者症状改善。有 3 例患者支架移位，但无支架阻塞性肉芽组织、感染或黏液栓形成。CAS 患者的中位支架置入后生存天数为 98 天，CAF 患者为 103 天，CAS 患者的平均生存天数为 383 ± 707 天，CAF 患者为 93 ± 33 天。2 例恶性淋巴瘤和胸腺癌 CAS 患者因接受有效治疗而存活超过 6 年。支架置入后 5 年生存率为 7.7%。
结论
SEMS 置入术治疗恶性中央气道狭窄和瘘管可改善 87.5%患者的 mMRC 分级、PS 和症状。恶性 CAS 患者通常处于终末期，但随着新的有效治疗方法的出现，提高生存率的可能性将成为现实。
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