Li Zong-Ming, Jiao De-Chao, Han Xin-Wei, Lu Hui-Bin, Ren Ke-Wei, Yang Hong
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
J Cardiothorac Surg. 2021 Mar 25;16(1):54. doi: 10.1186/s13019-021-01444-8.
Long-term placement of airway stents has a high probability of restenosis of the airway due to granulation tissue hyperplasia, and it is difficult to remove the stent. Our aim is to evaluate the success rate and complications of removal of tracheal tube metallic stents under fluoroscopic guidance, and to compare the difference between uncovered stent and covered stent.
We retrospectively reviewed 45 cases (31 males and 14 females; age, 12-71 years) of tracheal metallic stent removal performed at our center between January 2014 and December 2019. Covered stents were applied in 36 cases, and uncovered stents were applied in 9 cases. In the covered stent group, 15 patients presented with granulation tissue at both ends; 3 cases, with stent fracture; and 2, with stent intolerance due to severe airway foreign body sensation. In the uncovered stents group, all patients presented with granulation tissue formation; 2 patients, with stent fracture; and 1 patient, with stent intolerance.
A total of 41 (91.1%) stents were successfully removed (34 [94.4%] in the covered stent group and 7 [77.8%] in the uncovered stent group). The average duration of stent placement was 3.2 ± 0.7 and 2.5 ± 1.2 months in the covered stent group and uncovered stent group, respectively. With regard to the complications, hemoptysis occurred in 4 cases (average blood volume lost, 100 ml), tracheal mucosa tear occurred in 5 cases, tracheal collapse requiring emergency airway stent placement occurred in 1 case, and tracheal rupture requiring emergency surgical suture occurred in 1 case. No procedure-related deaths occurred in either group.
It is safe to remove the metal stent of the tracheal tube under the guidance of fluoroscopy, with low complications, and can avoid the long-term placement of the airway stent.
由于肉芽组织增生，气道支架长期置入后气道再狭窄的概率较高，且支架取出困难。我们的目的是评估在透视引导下取出气管金属支架的成功率和并发症，并比较裸支架和覆膜支架之间的差异。
我们回顾性分析了2014年1月至2019年12月在本中心进行的45例气管金属支架取出病例（男性31例，女性14例；年龄12 - 71岁）。其中36例应用覆膜支架，9例应用裸支架。在覆膜支架组中，15例患者两端出现肉芽组织；3例出现支架断裂；2例因严重气道异物感出现支架不耐受。在裸支架组中，所有患者均出现肉芽组织形成；2例出现支架断裂；1例出现支架不耐受。
共成功取出41枚（91.1%）支架（覆膜支架组34枚[94.4%]，裸支架组7枚[77.8%]）。覆膜支架组和裸支架组的支架平均置入时间分别为3.2±0.7个月和2.5±1.2个月。关于并发症，4例发生咯血（平均失血量100 ml），5例发生气管黏膜撕裂，1例发生气管塌陷需要紧急置入气道支架，1例发生气管破裂需要紧急手术缝合。两组均未发生与手术相关的死亡。
在透视引导下取出气管金属支架是安全的，并发症少，可避免气道支架的长期置入。
