Susanto I, Peters J I, Levine S M, Sako E Y, Anzueto A, Bryan C L
Department of Medicine, The University of Texas Health Science Center at San Antonio and The South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, 78284-7885, USA.
Chest. 1998 Nov;114(5):1330-5. doi: 10.1378/chest.114.5.1330.
Bronchial stenosis (BS) and bronchomalacia (BM) are often associated with lung allograft rejection or infection in lung transplant (LT) recipients. We reviewed our experience using balloon-expandable metallic (Palmaz) stents in the management of BS and BM in LT.
Retrospective review of cases.
LT recipients with bronchoscopic and spirometric evidence of BS and BM.
Serial balloon dilation was performed for BS. Stent placement was done for refractory or recurrent BS, or persistent focal BM.
Twelve of 129 LT bronchial anastomoses at risk (9.3%) had complications, which included 11 BS and 5 BM. Four BS were accompanied by BM either concurrently or subsequently. The only isolated BM was associated with acute rejection and resolved after appropriate medical therapy. Balloon dilations alone were successful in relieving BS in three cases. Seven patients received a total of 11 stents. Stents were placed under conscious sedation using a flexible bronchoscope. Five of the seven patients had spirometric improvements after stent placements. One patient had no spirometric improvement, and another died before a follow-up study was done. There were no complications during stent placements. However, complications after stent placements included partial dehiscence of the stent from the bronchial wall, stent migration, partial obstruction of a segmental bronchial orifice by a stent in the main bronchus, and longitudinal stent collapse. One stent was successfully removed using a flexible bronchoscope in the endoscopy suite, and two others were removed by rigid bronchoscopy in the operating room.
Endobronchial placement of the Palmaz stent in LT recipients is relatively easy, and it can be removed if needed. However, because there are significant potential complications, the future use of this stent as an airway prosthesis in LT remains unclear.
支气管狭窄（BS）和支气管软化（BM）常与肺移植（LT）受者的肺移植排斥反应或感染相关。我们回顾了使用球囊扩张金属（Palmaz）支架治疗LT中BS和BM的经验。
病例回顾性研究。
有支气管镜和肺功能检查证据显示存在BS和BM的LT受者。
对BS进行系列球囊扩张。对难治性或复发性BS，或持续性局灶性BM进行支架置入。
129例有风险的LT支气管吻合术中12例（9.3%）出现并发症，其中包括11例BS和5例BM。4例BS同时或随后伴有BM。唯一的孤立性BM与急性排斥反应相关，经适当药物治疗后缓解。仅球囊扩张在3例中成功缓解了BS。7例患者共置入11枚支架。使用可弯曲支气管镜在清醒镇静下置入支架。7例患者中有5例在置入支架后肺功能得到改善。1例患者肺功能未改善，另1例在随访研究前死亡。支架置入过程中无并发症。然而，支架置入后的并发症包括支架与支气管壁部分裂开、支架移位、主支气管内支架部分阻塞段支气管开口以及支架纵向塌陷。1枚支架在内镜室使用可弯曲支气管镜成功取出，另外2枚在手术室通过硬支气管镜取出。
在LT受者中经支气管置入Palmaz支架相对容易，且必要时可取出。然而，由于存在重大潜在并发症，该支架未来在LT中作为气道假体的应用仍不明确。
