Wang Ting, Zhang Jie, Qiu Xiao-Jian, Wang Juan, Pei Ying-Hua, Niu Jin-Mu
Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ann Palliat Med. 2021 Apr;10(4):4184-4192. doi: 10.21037/apm-20-2332. Epub 2021 Mar 29.
Self-expanding Y metal stent insertion is a safe and effective palliative method for malignant lesions involving the lower trachea, tracheal carina, and the main-stem bronchi. However, the length and degree of airway stenosis in different patients tend to vary, which leads to a call for a customized Y stent that could achieve a better treatment effect.
This retrospective analysis included patients who received customized self-expanding bare metallic Y stents for malignant carinal stenosis at Beijing Tiantan Hospital, Capital Medical University between January 2007 and June 2020. CT scans and initial bronchoscopy were performed to provide reliable data for stent selection and size customization. Data on technical success, clinical success, and follow-up were analyzed.
A total of 36 patients (26 males and 10 females; median age, 61 years; age range, 30-83 years) were enrolled. Technical success was 97.2% (35/36), while clinical success was 97.2% (35/36). There was no procedure-related mortality. Out of 35 patients, 4 (11.4%) had stent-associated complications that did not affect the procedure of stent insertion. Re-stenosis of the stent due to tumor progression was the main mid- and long-term stent-related complication (65% and 57.1%, respectively), followed by stent fractures (5% and 14.3%, respectively).
The current study described the design and insertion of customized self-expanding bare metal Y-stents and demonstrated the feasibility of their use for maintaining tracheal and main-stem bronchus patency in malignant carinal stenosis. This approach could be used as a bridging method before commencing adjuvant therapy and final palliative therapy for the relief of symptoms.
自膨式Y形金属支架置入术是治疗累及气管下段、气管隆突和主支气管的恶性病变的一种安全有效的姑息治疗方法。然而，不同患者气道狭窄的长度和程度往往有所不同，这就需要一种定制的Y形支架，以获得更好的治疗效果。
本回顾性分析纳入了2007年1月至2020年6月期间在首都医科大学附属北京天坛医院接受定制自膨式裸金属Y形支架治疗恶性隆突狭窄的患者。进行CT扫描和初始支气管镜检查，为支架选择和尺寸定制提供可靠数据。分析技术成功率、临床成功率和随访数据。
共纳入36例患者（男26例，女10例；中位年龄61岁；年龄范围30 - 83岁）。技术成功率为97.2%（35/36），临床成功率为97.2%（35/36）。无手术相关死亡。35例患者中，4例（11.4%）出现与支架相关的并发症，但不影响支架置入操作。肿瘤进展导致的支架再狭窄是主要的中长期支架相关并发症（分别为65%和57.1%），其次是支架断裂（分别为5%和14.3%）。
本研究描述了定制自膨式裸金属Y形支架的设计和置入，并证明了其用于维持恶性隆突狭窄患者气管和主支气管通畅的可行性。这种方法可作为辅助治疗和最终姑息治疗开始前缓解症状的一种过渡方法。
