Ivanick Nathaniel, Mahoney William, Pachimatla Akhil Goud, Yendamuri Sai, Gesthalter Yaron
Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, USA.
J Thorac Dis. 2025 Jul 31;17(7):4701-4712. doi: 10.21037/jtd-2025-307. Epub 2025 Jul 29.
Malignant central airway obstruction (MCAO) is a common and deadly complication of both lung cancer and non-lung cancers that have metastasized to the lungs. Tumors affecting the main carina offer a particular challenge and often require a specialized tracheobronchial Y stent placement. Historically, silicone Y stents have been the only Y stents available, however, newer hybrid metal Y stents have emerged as potential treatment options. We sought to compare various technical factors of silicone and hybrid Y stent placement.
Patients diagnosed with primary or secondary lung cancer who underwent bronchoscopic stenting for MCAO at Roswell Park Comprehensive Cancer Center between 2014 and 2024 were included in this study. Data were collected on demographics, disease characteristics, bronchoscopy procedures, associated complications, and subsequent interventions. Procedure duration, complication rates, and the need for future interventions were compared between silicone and hybrid Y stents using the Mann-Whitney test, Fisher's exact test, and the Chi-squared test.
After a thorough review, 34 patients were included in the study, with 14 receiving hybrid metal stents and 20 receiving silicone stents. The procedure time for hybrid stents was significantly shorter than that for silicone stents (56 91 minutes, P=0.001). Additionally, patients with hybrid metal stents required fewer repeat bronchoscopies (mean: 0.21 1.15, P=0.03). There were no significant differences between the two groups in terms of early or late complications, 30-day mortality rates, or the degree of obstruction improvement.
Hybrid metal Y stents may have an advantage in speed of placement and the need for repeat bronchoscopies while having a similar degree of improvement in obstruction and complication rates.
恶性中央气道阻塞（MCAO）是肺癌和已转移至肺部的非肺癌常见且致命的并发症。影响主隆突的肿瘤带来了特殊挑战，通常需要放置专门的气管支气管Y形支架。从历史上看，硅胶Y形支架是唯一可用的Y形支架，然而，新型混合金属Y形支架已成为潜在的治疗选择。我们试图比较硅胶和混合Y形支架置入的各种技术因素。
本研究纳入了2014年至2024年期间在罗斯威尔帕克综合癌症中心因MCAO接受支气管镜支架置入术的原发性或继发性肺癌患者。收集了有关人口统计学、疾病特征、支气管镜检查程序、相关并发症和后续干预措施的数据。使用曼-惠特尼检验、费舍尔精确检验和卡方检验比较硅胶和混合Y形支架之间的手术时间、并发症发生率以及未来干预的必要性。
经过全面审查，34例患者纳入研究，其中14例接受混合金属支架，20例接受硅胶支架。混合支架的手术时间明显短于硅胶支架（56±91分钟，P = 0.001）。此外，接受混合金属支架的患者需要重复支气管镜检查的次数更少（平均：0.21±1.15，P = 0.03）。两组在早期或晚期并发症、30天死亡率或阻塞改善程度方面无显著差异。
混合金属Y形支架在置入速度和重复支气管镜检查需求方面可能具有优势，同时在阻塞改善程度和并发症发生率方面相似。
