Tojo T, Iioka S, Kitamura S, Maeda M, Otsuji H, Uchida H, Mori T, Furuse K
Department of Surgery III, Nara Medical College, Japan.
Ann Thorac Surg. 1996 Apr;61(4):1074-8. doi: 10.1016/0003-4975(96)00010-0.
Tracheobronchial stenosis caused by malignancy is a life- threatening problem. Stenting is one of the treatment modalities and recently has been used widely for the management of such stenosis, but we do not have a clear guide as to which stent should be selected.
We evaluated 25 patients (19 men, 6 women; mean age, 60.7 years; range, 34 to 77 years) received 24 metal stents (four covered with silicone rubber) and three Dumon stents. All 25 patients had severe dyspnea because of airway stenosis caused by malignant tumors.
Among the 25 patients, airway obstruction due to extrinsic compression by tumor developed in 11 and was treated with a bare metal stent. The airway remained patent in 10 patients. In 16 patients with intraluminal tumor invasion, nine lesions were treated with a bare metal stent, four lesions with a covered metal stent, and the remaining three lesions with a Dumon stent. Recurrent stenosis did not occur in any patient with a covered metal stent or a Dumon stent. However, restenosis occurred in 4 patients with a bare metal stent, all of whom received laser therapy. In all patients, stenting immediately relieved dyspnea. Six patients lived for 32 days to 53 months after stenting, and 19 patients died of primary malignancies with a mean survival of 131.9 days.
Metal stents are effective in treating malignant extrinsic tracheobronchial compression. The use of covered metal stents or Dumon stents is preferable for intraluminal stenosis due to malignant growth.
恶性肿瘤导致的气管支气管狭窄是一个危及生命的问题。支架置入是治疗方法之一，最近已广泛用于此类狭窄的治疗，但对于应选择哪种支架我们尚无明确的指导。
我们评估了25例患者（19例男性，6例女性；平均年龄60.7岁；范围34至77岁），他们接受了24个金属支架（4个覆盖硅橡胶）和3个杜蒙支架。所有25例患者均因恶性肿瘤导致气道狭窄而出现严重呼吸困难。
25例患者中，11例因肿瘤外压导致气道阻塞，采用裸金属支架治疗。10例患者气道保持通畅。在16例腔内肿瘤侵犯患者中，9个病变采用裸金属支架治疗，4个病变采用带膜金属支架治疗，其余3个病变采用杜蒙支架治疗。带膜金属支架或杜蒙支架治疗的患者均未发生再狭窄。然而, 4例裸金属支架治疗的患者发生了再狭窄，所有这些患者均接受了激光治疗。所有患者支架置入后呼吸困难立即缓解。6例患者在支架置入后存活32天至53个月，19例患者死于原发性恶性肿瘤，平均生存期为131.9天。
金属支架对治疗恶性肿瘤引起的气管支气管外压有效。对于恶性生长导致的腔内狭窄，使用带膜金属支架或杜蒙支架更为可取。
