江苏大学学报(医学版)AcademicJournalofJiangsuUniversity(medicine),August2003,13(4)·297·国产镍钛支架治疗恶性气管支气管狭窄狄镇海,李坚(江苏大学附属医院l。介入放射科;2。肺科,江苏镇江212001)[摘要】目的:评价国产镍钛支架治疗恶性肿瘤引起的气管支气管狭窄的可行性和疗效。方法:20例肺癌、食管癌等恶性肿瘤压迫或侵犯气管、支气管,引起气道狭窄和呼吸困难,安放支架术在x线透视下由纤支镜配合进行,分别经口(3例)或经鼻(17例)植入国产镍钛自扩型支架。7例患者进行了后续的支气管动脉灌注化疗或放疗。结果:12例狭窄位于主气管,置人支架12个;8例狭窄位于气管.支气管(4例)或支气管(4例)置入支架13个。所有患者呼吸困难得到立即缓解。1例术后60天死于严重肺部感染;1例术后45天死于支架移位、再狭窄。3例失访。8例未进行后续抗肿瘤治疗者生存时间60~90天,平均73天。7例术后进行全身化疗或支气管动脉灌注化疗者生存时间110天~1年6个月,平均12个月。结论:在X线透视下由纤支镜配合行气道支架放置术优越性较多。国产气管支气管支架能缓解晚期恶性肿瘤引起的呼吸困难,改善生活质量。需结合后续的抗肿瘤治疗才能延长生存时间。[关t词】气管支气管狭窄;支架;放射学,介入性[中圈分类号】R562.1[文献标识码】A[文章编号】1671—7783(2003)04—0297—04TreatmentofMalignantTracheobronchialStenosisbyHomemadeNitinolStentsDIZe7l—hal。LJJian(1.DepartmentofInterventionalRadiology-2.DepartmentofRespiratory。theAffiliatedHospimlofJiangsuUniversity-ZhenjiangJiangsu212001。China)【Abstr~t】Objective:Toappraisethefeasibilityandefficacyofhomemadenitinolstentinthetreatmentofmalignanttracheobronchialstenosis.Methods:Twentypatientswithlungcancerandesophagealcancerunder—wentplacementofnitinolendotrachealand/orbronchialstentsforrespiratorydistresscausedbytrachcobronchialstenosis.Amongthem7patientsunderwentadditionaltherapy.Results:Thestenosedsites1ocatedintrachea-tracheobronchiormainbronchusin12,4and4cases,respectively.Twentyfivestentshadbeensuccessivelyplacedthroughoralcavity(3cases)ornasalcavity(17cases)underx—rayguidancewithfibertracheo.bronchoscopywithdyspnearapidlyimproved.Onepatientdied60daysafterstentingwithseverepulmonaryin—fect商-arid鲫洳died45daysafterstentingduetothemigrationofstentandreatenosis.Threepatientswerelostfollow-up.~Eig.htpatientswithoutadditionaltherapylivedfrom60to90days(meansurvival:73days)afterstentpLacE瓣啪.Sevenpatientswithadditionalanti—cancertherapylivedfrom110daysto1yearand6months(rn咖aurvival:12months)afterstenting.Conclusion:Itisanpracticablemethodtoplaceairwaystentunderx—rayguidancewithfibert~eheobronchoscopy.Althoughnitinolstentsareusefulforrelievingrespiratorydistressandimprovinglifequalityin.patientswithmalignanttracheobronchialstenosis-additionalanti—cancertherapyshouldbeconsidered..【Keywords】Tradheobmnchialstenosis;Stent;Radiology;Interventional近年来,随着介入放射学蓬勃兴起,一些早期应用于血管的金属支架也逐渐用于气管、支气管狭窄的治疗nql。1998年5月-2002年12月期间,对气管、支气管狭窄的20例患者,笔者采用国产镍钛支架置入的方法,取得了较好的治疗效果,现报告如下。●1材料与方法1.1一般情况本组20例,男性14例,女性6例。年龄50~82岁,平均64岁。因严重的呼吸困难、喘鸣、声音嘶哑就诊。经临床、影像或(和)纤维支气管镜(简称纤支镜)活检诊断,气管鳞状上皮癌4例;中央型肺癌7例,其中侵犯气管分叉4例,纵隔转移3例;食管癌8例,均为鳞状细胞癌,位于食管上胸段,纵隔转移或直接侵犯气管,其中5例为食管癌行胃食管术后吻合口周围复发;甲状腺癌1例。17例需吸氧维持,吸氧前脉搏氧饱和度(Sp02)检测80%~94%,吸氧中SpO2上升至≥95%,...