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新型三维打印金属分段跨气管支架治疗不可手术切除的恶性喉气管狭窄的初步经验

Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis.

作者信息

Shan Qungang, Huang Wei, Wang Ziyin, Xue Qingsheng, Shi Zhihong, Zhou Jianping, Wu Zhiyuan, Ding Xiaoyi, Mao Aiwu, Shang Mingyi, Wang Zhongmin

机构信息

Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Front Oncol. 2021 Jul 26;11:619781. doi: 10.3389/fonc.2021.619781. eCollection 2021.

Abstract

BACKGROUND

This study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent.

METHODS

This was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient's airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated.

RESULTS

Ten patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting.

CONCLUSIONS

The individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.

摘要

背景

本研究旨在评估一种经三维(3D)打印改良的新型金属分段跨声带支架治疗不可切除的恶性喉气管狭窄的可行性及该支架的耐受性。

方法

这是一项回顾性研究。借助3D打印模型,根据每位患者气道的解剖特征对支架进行个体化定制。该支架由对应于喉部和气管上段的两个独立节段组成。支架近端呈桶状以防止移位。支架近端位于声带稍上方。评估支架置入手术的技术和临床成功率、患者耐受性以及与支架相关的并发症。

结果

10例因恶性喉气管狭窄导致呼吸困难的患者接受了此类支架植入。所有患者均实现了支架置入手术的技术和临床成功。对所有患者而言,通过轻声说话可维持基本的生活交流。随访期间,1例患者对支架不耐受,支架置入后2周取出。1例患者出现支架移位,对支架位置进行了重新调整。2例患者发现肉芽组织增生,通过支气管镜下冷冻治疗。未发生与支架置入相关的死亡病例。

结论

个体化定制的金属分段跨声带支架对于不可切除的恶性喉气管狭窄患者是可行且耐受性良好的。该支架植入可为不适合手术或气管切开的患者提供一种新的替代治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65ab/8350761/4e78143def1b/fonc-11-619781-g001.jpg

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