Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110490. doi: 10.1016/j.ijporl.2020.110490. Epub 2020 Nov 10.
To illustrate a previously unreported method of tracheal stent removal that appears to cause less mucosal injury we present a case of a 9-year-old Down syndrome patient with a history of tracheoesophageal fistula, brought to our attention after recurrent bouts of exacerbating cough and tracheo-bronchitis. Endoscopic examination under general anesthesia noted the presence of severe tracheomalacia with inspiratory collapse, and a 10-mm balloon expandable metallic stent (BEMS) was deployed and symptomatic improvement was noted. The initial stent was then removed to consider a definitive procedure using the typical grasping fashion with an alligator forceps and expected mucosal excoriation was noted. Due to symptom recurrence, the patient underwent placement of a second BEMS stent. Initial improvement was noted followed by recurrent episodes of respiratory distress due to granulation tissue formation and stent compression and a decision to remove the stent was made. A new method of stent removal deemed ABC (airway balloon collapse) method was utilized where an expandable airway balloon is placed outside the stent between the stent and tracheal wall and then inflated to collapse the stent, facilitating easy removal.
为了说明一种以前未报道过的气管支架取出方法，这种方法似乎造成的黏膜损伤较小，我们报告了 1 例 9 岁唐氏综合征患者的病例，该患者有气管食管瘘病史，因反复咳嗽和气管支气管炎加重而引起我们的注意。全身麻醉下的内镜检查发现存在严重的气管软化，吸气时塌陷，放置了 10mm 球囊扩张金属支架（BEMS），并注意到症状改善。最初的支架随后被移除，考虑使用典型的鳄嘴钳进行确定性手术，并预计会出现黏膜擦伤。由于症状复发，患者接受了第二个 BEMS 支架的放置。最初的情况有所改善，但随后由于肉芽组织形成和支架压迫导致呼吸窘迫反复发作，决定取出支架。使用了一种新的支架取出方法，称为 ABC（气道球囊塌陷）法，即在支架和气管壁之间的支架外部放置一个可膨胀的气道球囊，然后充气使支架塌陷，便于取出。
