State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Pulmonary and Critical Care Medicine Department, Huilai People Hospital, Jieyang, China.
Ther Adv Respir Dis. 2021 Jan-Dec;15:17534666211019564. doi: 10.1177/17534666211019564.
Post-tuberculosis bronchial stenosis (PTBS) is one of the most common complications of tracheobronchial tuberculosis. Silicone stent serves as a major treatment for maintaining airway patency. However, silicone stent placement remains a large challenge in patients with severe cicatricial PTBS. Our objective was to evaluate the efficacy and safety of covered, self-expanding, metallic stents (SEMSs) as a transition to silicone stent implantation for treating severe PTBS.
We retrospectively reviewed the data of patients with severe PTBS who received airway stenting in the First Affiliated Hospital of Guangdong Medical University between September 2015 and May 2019. The types of the stent, intervention procedures, bronchoscopic findings, clinical outcomes and related complications were collected and analyzed.
Fifty-eight cases with severe PTBS were included in this study. Thirteen (22.4%) of the patients received bronchial silicone stent implantation immediately after dilations. For the remaining 45 (77.6%) patients, silicone stents could not be deployed after dilations and SEMSs implantation was implemented as a bridge to silicone stenting. The SEMSs were placed for an interval of 28.4 ± 11.1 days. All of the silicone stents were inserted successfully following the removal of SEMSs. No SEMS-related complication occurred. The subgroup analysis showed that patients who received transitional SEMSs had less luminal caliber but fewer transbronchial dilations before silicone stent implantation ( < 0.05).
Covered SEMS placement as a transition to silicone stenting could serve as a feasible procedure to reduce complications and improve the success rate of silicone stent implantation in patients with severe PTBS.
肺结核性支气管狭窄（PTBS）是气管支气管结核最常见的并发症之一。硅酮支架是维持气道通畅的主要治疗方法。然而，对于严重瘢痕性 PTBS 患者，硅酮支架放置仍然是一个巨大的挑战。我们的目的是评估覆盖型自膨式金属支架（SEMS）作为向硅酮支架植入过渡的方法，用于治疗严重 PTBS 的疗效和安全性。
我们回顾性分析了 2015 年 9 月至 2019 年 5 月在广东医科大学附属医院接受气道支架置入的严重 PTBS 患者的数据。收集并分析了支架类型、介入程序、支气管镜检查结果、临床结果和相关并发症。
本研究共纳入 58 例严重 PTBS 患者。13 例（22.4%）患者在扩张后立即接受支气管硅酮支架植入。对于其余 45 例（77.6%）患者，扩张后无法放置硅酮支架，故采用 SEMS 作为向硅酮支架过渡。SEMS 放置间隔 28.4±11.1 天。所有 SEMS 均成功取出后，顺利植入硅酮支架。无 SEMS 相关并发症发生。亚组分析显示，接受过渡性 SEMS 的患者在植入硅酮支架前的管腔直径较小，但经支气管扩张次数较少（<0.05）。
覆盖型 SEMS 放置作为向硅酮支架过渡的方法，可以减少并发症，提高严重 PTBS 患者硅酮支架植入的成功率。
