Martinez-Ballarin J I, Diaz-Jimenez J P, Castro M J, Moya J A
Unidad de Laser, Servicio de Neumologia, Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Spain.
Chest. 1996 Mar;109(3):626-9. doi: 10.1378/chest.109.3.626.
To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction.
Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study.
Tertiary-referral teaching hospital.
Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients.
In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia.
Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients).
Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.
评估将杜蒙硅酮支架植入非肿瘤性气道梗阻患者体内的耐受性及早期效果。
在一项回顾性研究中对用于姑息性或治愈性恢复气道狭窄的气管支气管支架置入术进行了评估。
三级转诊教学医院。
1991年5月至1994年9月期间，64名平均年龄为52岁的患者因良性气管狭窄接受了支气管内硅酮支架置入术（82%继发于插管或气管造口术损伤）。25例患者为单纯纤维性狭窄，38例为纤维炎性狭窄。48例有望治愈的患者在18个月内使用假体进行气道临时支架置入，其余15例患者则作为姑息性治疗手段。
所有病例均在全身麻醉下通过硬质支气管镜植入杜蒙气管支气管支架。
5例患者死亡（4例死于无关原因）；1例是由于支架置入后20天紧急气管造口时出现分泌物过多和气道梗阻。并发症包括11例（17.5%）患者假体移位、4例（6.3%）患者形成肉芽肿以及4例（6.3%）患者因分泌物过多导致气道梗阻。在48例期望治愈而接受硅酮支架的患者中，21例取出了支架。17例患者治疗成功，平均随访259±173天，4例复发。16例患者的支架仍留存，平均留存时间为364±119天。在15例植入硅酮支架进行姑息治疗的患者系列中，11例永久性置入了假体，平均随访486±260天。其余4例气管造口患者，2例在T形管上肢无法扩张后使用了硅酮支架，2例在T形管耐受性差时将硅酮支架置于气管造口上方以维持喉气管通畅并保留发声功能。
硅酮气管支气管支架在维持气道通畅方面有效，耐受性良好，并发症少见，很少危及生命。
