Takenaka H, Choh S, Ikoma Y, Narita N, Nishiyama K, Otsuji H, Ide K, Maeda M, Uchida H
Second Department of Internal Medicin, Nara Medical University, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Jan;36(1):106-10.
A 66-year-old man was admitted to Saiseikai Suita Hospital with stridor and dyspnea. The flow-volume curve showed central airway obstruction pattern. Although a P-A chest roentogenogram was normal, chest tomogram demonstrated a tumor shadow in the lower portion of the trachea. Chest CT examination demonstrated a tumor arising from the posterior wall of the lower portion of the trachea and stenosis with wall thickening extending from the lower portion of the trachea to both main bronchi. Bronchofiberscopic examination revealed polypoid tumors obstructing the lower portion of the tracheal lumen, and biopsy was subsequently performed. On the night immediately after the bronchofiberscopic examination, the patent suddenly choked, and emergency intubation was performed. Adenoid cystic carcinoma was diagnosed on biopsy and we decided to place a spiral Z-stent. A reversed gamma-type stent placement was used. The first spiral Z-stent extended from the trachea to the right main bronchus and the second spiral Z-stent was placed in the left main bronchus through the first stent. Following the spiral Z-stent placement radiotherapy was performed. Spiral Z-stent placement resulted in dilation of the stenotic trachea and both main bronchi.
一名66岁男性因喘鸣和呼吸困难入住关西医疗大学吹田医院。流量-容积曲线显示为中央气道阻塞型。虽然正位胸部X线片正常，但胸部断层扫描显示气管下部有肿瘤阴影。胸部CT检查显示肿瘤起源于气管下部后壁，狭窄并伴有管壁增厚，从气管下部延伸至双侧主支气管。纤维支气管镜检查发现息肉样肿瘤阻塞气管腔下部，随后进行了活检。在纤维支气管镜检查后的当晚，患者突然窒息，遂进行了紧急插管。活检诊断为腺样囊性癌，我们决定放置螺旋Z形支架。采用了反向伽马型支架置入法。第一个螺旋Z形支架从气管延伸至右主支气管，第二个螺旋Z形支架通过第一个支架置入左主支气管。放置螺旋Z形支架后进行了放射治疗。螺旋Z形支架置入使狭窄的气管和双侧主支气管得以扩张。
