Monnier P, Mudry A, Stanzel F, Haeussinger K, Heitz M, Probst R, Bolliger C T
Otolaryngology, Head and Neck Surgery Department, University Hospital CHUV, Lausanne, Switzerland.
Chest. 1996 Nov;110(5):1161-8. doi: 10.1378/chest.110.5.1161.
To investigate the safety, efficacy, and tolerance of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancer.
An 8-month prospective study employing either a rigid bronchoscope or a flexible delivery system for prosthesis insertion.
Multicentric setting involving four teaching hospitals in Switzerland and Germany.
Forty patients (29 men, 11 women), average age of 62 years, presenting with an inoperable tracheobronchial cancer.
After partial airway recanalization with an Nd-YAG laser, the covered Wallstent was inserted 23 times using a rigid bronchoscope (Rigidstep device), and 27 times using a flexible delivery system (Telestep device) under fluoroscopic and endoscopic visualization.
Clinical and endoscopic examination at 1, 30, and 90 days showed improvement in the bronchial lumen and in the dyspnea index. No serious complication (death, perforation, hemorrhage, inability to remove an improperly placed prosthesis) was observed during surgery. Late complications included migration (12%), inflammatory granulations or tumor regrowth at the tip of the prosthesis (36%), and symptomatic retention of secretion (38%).
Compared with other tracheobronchial prostheses, notably the Dumon stent, the covered Wallstent presents the following advantages: insertion with visual guidance, treatment of extrinsic compressions and esophagobronchial fistulas, and little chance of migration when the prosthesis diameter is chosen correctly. The following disadvantages can be noted: high price; both repositioning and extraction of the released stent are more difficult, though certainly possible; and risk of granulations at the tips of the prosthesis and retention of secretions. Suggestions are made for potential improvements to the stent and insertion system that may result in a significant decrease in early and late complications.
探讨带膜Wallstent支架用于无法手术切除的气管支气管癌姑息治疗的安全性、有效性及耐受性。
一项为期8个月的前瞻性研究，采用硬支气管镜或可弯曲输送系统进行假体植入。
涉及瑞士和德国4家教学医院的多中心研究。
40例患者（29例男性，11例女性），平均年龄62岁，患有无法手术切除的气管支气管癌。
先用Nd-YAG激光部分开通气道，然后在荧光镜和内镜直视下，使用硬支气管镜（Rigidstep装置）植入带膜Wallstent支架23次，使用可弯曲输送系统（Telestep装置）植入27次。
术后1天、30天和90天的临床及内镜检查显示支气管腔及呼吸困难指数有所改善。手术过程中未观察到严重并发症（死亡、穿孔、出血、无法取出放置不当的假体）。晚期并发症包括移位（12%）、假体尖端炎性肉芽组织或肿瘤复发（36%）以及分泌物潴留伴症状（38%）。
与其他气管支气管假体（尤其是Dumon支架）相比，带膜Wallstent支架具有以下优点：可视引导下植入、可治疗外在压迫及食管支气管瘘，且假体直径选择正确时移位几率小。也存在以下缺点：价格高；已释放的支架重新定位和取出更困难，不过肯定可行；假体尖端有肉芽组织形成及分泌物潴留的风险。针对支架及植入系统提出了潜在改进建议，这可能会显著减少早期和晚期并发症。
