纤支镜和透视下放置支架治疗肿瘤性重度气道狭窄

目的观察纤支镜联合透视导向下放置镍钛记忆合金支架治疗晚期肿瘤导致的气道狭窄的疗效。方法选取6例因晚期肿瘤所致气管或支气管重度狭窄的患者，在纤支镜联合透视导向下放置镍钛记忆合金支架。结果6例患者置入支架后呼吸困难立即缓解，一般情况好转，收到立竿见影的效果。3～7d复查纤支镜支架无移位，管腔通畅。结论使用镍钛记忆合金支架治疗晚期肿瘤引起的气道狭窄的疗效可即刻缓解气道狭窄和改善患者生活质量，方法简单，易行，疗效可靠。     

经喉罩或气管插管连接行常规机械通气在全身麻醉介入治疗手术中的安全性

目的 探索并评价使用喉罩或气管插管联合常规机械通气在介入治疗手术中的应用价值.方法 纳入2009年7月至2010年1月收入首都医科大学附属北京天坛医院呼吸科在全身麻醉下经喉罩或气管插管联合常规机械通气条件下接受气管镜介入治疗的患者29例,其中男19例,女10例,年龄19 ～74岁,平均(47±18)岁.观察手术前后的气道压、潮气量、术中血气分析、并发症及手术时间等指标,并对影响通气效果的相关因素进行分析.结果 所有患者术中一般情况稳定,通气效果满意,无严重并发症出现.气管镜插入喉罩或气管插管后,潮气量下降27.1％,峰压升高63.1％,平台压及平均压分别升高43.7％和32.4％;使用气管插管的患者操作前后峰压升高79.3％,高于使用喉罩的患者峰压升高程度(55.3％).结论 全身麻醉下使用喉罩或气管插管联合常规机械通气条件下进行气管镜介入治疗安全可靠.操作过程中峰压明显增高,但整个气道的平均压力仍能保持较低水平;在使用喉罩或气管插管进行气管镜介入治疗时,应尽可能选用较大内径的喉罩或插管,以最大限度地降低气道压并避免内源性呼气末正压的产生.     

电子支气管镜引导镍钛记忆合金支架置入治疗恶性肿瘤致严重大气道狭窄

目的观察电子支气管镜引导下国产镍钛记忆合金支架置入治疗恶性肿瘤致严重大气道狭窄的临床疗效。方法 106例不能手术或患者拒绝手术治疗的恶性肿瘤致严重大气道狭窄患者,在电子支气管镜引导下置入国产镍钛记忆合金气管（或支气管）支架。结果 106例一次性放置支架成功,共置入113枚支架（被膜支架77枚、裸体支架36枚）。患者呼吸困难症状迅速缓解,体力状况明显提高,未发生严重相关并发症。结论电子支气管镜引导国产镍钛记忆合金支架置入治疗恶性肿瘤致严重大气道狭窄安全有效。     

经内镜置放镍钛记忆支架治疗气道狭窄

经内镜置放镍钛记忆支架治疗气道狭窄冯起校李七郎谭戈峰辛小川郑惠娥１９９６年５月初我们经纤维支气管镜（纤支镜）置入镍钛记忆合金支架（简称ＮＴ支架）治疗支气管肿瘤所致的各种气道狭窄４例，报告如下。临床资料（附表）：（１）材料：根据气道不同部位的解剖特点，...     

气管支气管支架置入的临床应用(附5例报告)

目的观察经纤维支气管镜国产镍钛记忆合金大气道支架置入的近期疗效。方法5例气管支气管狭窄,在电视透视下行经纤支镜气管支气管支架置入术。结果一次性放置成功4例。5例均扩张良好,4例呼吸困难立即缓解,缺氧症状改善;1例左主支气管内膜结核致伴左肺阻塞性肺气肿患者,复查左肺阻塞性肺气肿消失。结论经纤支镜大气道支架置入治疗大气道重度狭窄安全、有效。     

喉罩通气全麻下Y型气管支架植入的临床观察

目的 探讨喉罩通气全麻下经纤维支气管镜行Y型气管支架植入术的疗效、安全性和可行性.方法 选择隆突受累的复合气道病变6例,在行静脉全身麻醉后,再在喉罩通气下经纤维支气管镜指导和X线透视下,放置气道Y型一体化自膨胀式支架.结果 喉罩通气全麻下Y型气管支架置入均获得成功,6例患者置入内支架后症状均缓解,无一例发生严重并发症,安全性高.结论 喉罩全麻通气下气道Y型支架置入能有效解除气道复合病变,技术可行,操作简单,耐受性好,为临床治疗复合气道梗阻提供了一种新的安全的治疗手段.     

气管支气管腔内金属支架置放术的护理

气管支气管的重度狭窄严重影响通气功能 ,病因以肿瘤居多 ,患者呼吸困难 ,常因呼吸衰竭而死亡。气管支气管腔内金属支架置入可对气管支气管起支撑作用 ,使气道张开 ,通气功能即刻改善 ,为进一步治疗赢得时间 ,创造条件 ,同时也提高了患者的生命质量。我们在近二年先后为 8例气管支气管重度狭窄的患者进行了腔内镍钛记忆合金支架置放术 ,现将护理经验介绍如下 :1　临床资料8例患者中男 5例 ,女 3例 ,年龄 5 8～ 84岁 ,其中气管狭窄5例 ,右主支气管狭窄 1例 ,右主支气管并右中间支气管狭窄 2例。气道狭窄的病因中 ,3例为食管癌术后纵隔淋巴结…     

经支气管镜工作孔道释放的气道支架及置入方法

自膨胀性镍钛记忆合金气道支架适用于治疗气管或支气管的恶性或良性疾病引起的气道狭窄。一种新型的过支气管镜工作孔道的自膨胀性镍钛记忆合金气道支架,其置入器可通过电子支气管镜2.8 mm的工作孔道,在支气管镜直视下释放。本文详细阐述了该气道支架释放系统的结构特点、置入方法以及释放时的注意事项。     

经纤维支气管镜放置支架治疗气道狭窄的临床应用

近年来,有文献报道气管支气管内安置支架治疗气道狭窄,取得了较好效果［１３］。１９９４年１２月至１９９９年１月,我们经纤维支气管镜（纤支镜）放置国产镍钛记忆合金支架（简称ＮＴ支架）治疗各种气道狭窄２３例,取得了满意的效果,现报道如下。对象与方法　２３例住院患者,男１６例,女７例。年龄３９～８２岁,平均６０岁。气管狭窄１５例,其中食管癌气管内转移８例,气管癌２例,甲状腺癌及纵隔淋巴结压迫致气管狭窄３例,气管平滑肌瘤１例,气管切开处肉芽及疤痕增生致气管狭窄１例。左右主支气管及隆突狭窄２例,左主支气管…     

LMA-Unique喉罩用于气道Y型覆膜内支架植入术的麻醉

气道Y型覆膜内支架作为一种治疗隆突部位良恶性病变的国产新型镍钛记忆合金支架,支架的放置都是在表面麻醉下完成^[1]。本文旨在介绍一种喉罩通气全麻下放置气道Y型覆膜内支架的方法。     

Dumon stent placement via endotracheal tube]

We conducted a Dumon stent placement via endotracheal tube for 10 patients with airway stenosis. The conventional endotracheal tube is inserted beyond the stenosis site; this procedure is conducted with the use of a flexible bronchoscope under general anesthesia. The Dumon stent is folded and inserted into the endotracheal tube and is then introduced into the stenosis site with the use of a cylindrical-tipped stainless steel wire as a pusher. Although the Dumon stents were placed using a rigid bronchoscope for the first 7 patients, the present procedure was used for the latest 10 patients. Compared with the rigid bronchoscope technique, this procedure is suitable for the placement of a larger stent for a shorter time. It has the following advantages over the rigid bronchoscope technique: (1) the use of an endotracheal tube and flexible bronchoscope makes the stent placement easier for the practitioner and less stressful for the patient; (2) because of the flexibility of the endotracheal tube, a Dumon stent can be placed easily, even in the left main bronchus or in a markedly shifted trachea or bronchus, and also in a patient who has difficulty in expanding the neck; (3) a stent can be placed safely in a patient with severe tracheal stenosis and orthopnea. The present procedure does, however, have the disadvantage that it is difficult to control the direction of the tip of the endotracheal tube. We concluded that the present procedure could be a useful method for Dumon stent placement.     

An unusual way to use an endobronchial blocker

The techniques for lung isolation in infants are, endobronchial intubation and bronchical blockade with Fogarty catheter or a univent tube. Unlike endobronchial intubation, bronchial blockade has the advantage that lung can be segregated at will. Endobronchial blocker is usually placed as a planned procedure just after induction of anaesthesia either under vision with the help of a fibreoptic bronchoscope or alternatively a rigid bronchoscope is used to position it in either bronchus and later the trachea. We report here a rather unusual and desperate way of using a Fogarty catheter halfway through the surgery due to unforeseen bleeding during thoracotomy. The pros and cons of attempting selective segregation and regional ventilation of lung under these circumstances is discussed.     

Placement of an ultraflex nitinol stent for severe tracheobronchial obstruction in a case of relapsing polychondritis]

A 59-year-old man, who had been treated for bronchial asthma since 2000, was hospitalized with high fever and productive cough in November 2003. Chest radiography on admission showed consolidations in both lower lung fields, and computed tomography demonstrated anteroposterior narrowing of both main bronchi. A physical examination revealed deformity of auricular cartilage and saddle nose, and we diagnosed him relapsing polychondritis (RP). When he was readmitted 4 months later because of severe tracheobronchial stenosis and respiratory failure he required mechanical ventilation, but it was difficult to wean him from the ventilator. Self-expandable metallic stents were placed in the left main bronchus and the trachea. After the procedure, he was successfully weared from mechanical ventilation. Since airway complications of RP can be fatal, stent implantation should be considered in the management of RP with airway manifestations.     

Endoscopic removal of metallic airway stents

BACKGROUND: Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. METHODS: We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. RESULTS: Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), re-obstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). CONCLUSIONS: Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.     

声门下气管狭窄患者Montgomery T管植入术的麻醉管理

目的:探讨声门下气管狭窄患者行Montgomery T管植入术的麻醉管理。方法:回顾并分析20例因"声门下气管狭窄"行Montgomery T管植入术患者的一般情况、临床特征、麻醉方法、手术操作及术后恢复等资料。结果:狭窄原因:气管插管12例,颈部气管外伤4例,气管内外肿瘤等3例。狭窄程度:Myer-Cotton分级Ⅰ级1例,Ⅱ级3例,Ⅲ级9例,Ⅳ级7例;9例患者术前气管镜检查显示气管塌陷。所有病例术前行气管切开,术中经硬镜操作,采用全凭静脉麻醉,麻醉过程平稳,麻醉通气方式转换顺利。术后出现咳嗽(80%)、咽痛(45%)、发热(45%)、排痰困难(40%)、呼吸困难(25%)、感染(10%)、气道梗阻(5%)和误吸(5%)等并发症,经积极处理均可改善。结论:声门下气道狭窄行Montgomery T管植入术时,全凭静脉麻醉能够维持稳定的麻醉深度和循环;根据手术步骤转换气管切开管、T管、喉罩控制通气或高频通气可保证氧气供应;围术期密切沟通、积极处理术后并发症有利于手术安全和患者康复。     

Airway stabilization with silicone stents for treating adult tracheobronchomalacia: a prospective observational study

Rationale: It is postulated that in patients with severe tracheobronchomalacia (TBM), airway stabilization with stents may relieve symptoms. OBJECTIVES: To evaluate the effect of silicone stents (tracheal, mainstem bronchus, or both) on symptoms, quality of life, lung function, and exercise capacity in these patients. METHODS: A prospective observational study in which baseline measurements were compared to those obtained 10 to 14 days after stent placement. Measurements and main results: Of 75 referred patients, 58 had severe disease and underwent therapeutic rigid bronchoscopy with stent placement. Mean age was 69 years (range, 39 to 91 years), 34 were men, 33 had COPD, and 13 had asthma. Almost all patients (n = 57) had dyspnea as a sole symptom or in combination with cough and recurrent infections; four patients required mechanical ventilation for respiratory failure. In 45 of 58 patients, there was reported symptomatic improvement; quality of life scores improved in 19 of 27 patients (p = 0.002); dyspnea scores improved in 22 of 24 patients (p = 0.001); functional status scores improved in 18 of 26 patients (p = 0.002); and mean exercise capacity improved from baseline, although not significantly. The 49 complications included mainly 21 partial stent obstructions, 14 infections, and 10 stent migrations. Most patients with concomitant COPD also improved on most measures. CONCLUSIONS: In the short term, airway stabilization with silicone stents in patients with severe TBM can improve respiratory symptoms, quality of life, and functional status. Coexisting COPD is not an absolute contraindication to a stenting trial in this population. Stenting is associated with a high number of short-term and long-term but generally reversible complications.     

Removal of covered self-expandable metallic airway stents in benign disorders: indications, technique, and outcomes

STUDY OBJECTIVES: To describe the technique and outcome of removal of self-expandable metallic airway stents (SEMAS) in a series of patients who underwent stenting for benign airway stenoses.Design and setting: A retrospective cohort analysis of patients with benign airway disorders treated with SEMAS between 1997 and 2003, who presented with an indication for stent removal in a tertiary-care hospital, and referral interventional pulmonology clinic. PATIENTS AND METHODS: During the study period, 49 SEMAS were inserted in 39 patients for treatment of benign airway disorders. Ten of these 39 patients (25.6%), bearing 12 covered stents, presented with an indication for stent removal. Data of these cases were extracted from electronic files kept in our institution archive. RESULTS: Indications for stent removal included excessive or recurrent granuloma formation (five cases), recurrence of stenosis after stent failure (one case), stent fracture (two cases), and accomplishment of treatment (two cases). In all of these cases, covered versions of SEMAS had been placed either in the trachea or in a main bronchus. In contrast to many previous reports, these stents proved to be absolutely retrievable even if some difficulties were encountered. In all cases, however, removal was successful without major complications. All patients resumed normal spontaneous ventilation postoperatively, and follow-up was uneventful. Average duration of stenting before removal was 16.2 +/- 17.5 months (+/- SD) [range, 1 to 60 months]. CONCLUSIONS: We conclude that although placement of SEMAS is assumed to be permanent in patients with benign airway disorders, an indication for stent removal is often observed (25.6% in our series). The covered SEMAS can be effectively and safely removed if needed without major sequelae. Nevertheless, new technical improvements in metallic stent design and materials may help reinforce the concept of a retrievable metallic airway stent, which may offer significant clinical advantages.     

气管支气管支架置入术治疗气管狭窄178例临床分析

目的探讨气管支气管支架置入术治疗气管狭窄的临床疗效。方法选择我院2001年9月至2011年9月治疗的178例气管狭窄患者,在对气道状况进行综合评估的基础上,采用气管支气管支架置入术进行治疗,并对治疗效果、并发症、死亡情况进行分析。结果共放置支架192个,裸支架120个,覆膜支架72个。支架的放置于气管支架103个,右主支气管48个,左主支气管41个。患者在治疗前的气促症状评级为3～4级,治疗后显著改善(P<0.05)。体力状况也得到了明显的恢复(P<0.05)。术后发生气道感染29例,10例患者因肿瘤扩散导致气管再次堵塞,呼吸困难症状加重,重新安装支架。随访观察6个月,死亡62人,死亡原因包括呼吸衰竭、肺部感染、大咯血等,存活率为65.2%(116/178)。大部分存活患者的纤维支气管镜复查结果显示,支架可较好的上皮化,未发生脱落。结论气管支气管支架置入术治疗气管狭窄安全有效,为气管狭窄的治疗提供了一个新的选择。     

Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses

STUDY OBJECTIVE: To assess the uncovered Ultraflex nitinol stent (Boston Scientific; Natick, MA) for its efficacy and safety. DESIGN, SETTING, AND PATIENTS: Between October 1997 and October 1998, we carried out a prospective multicenter study at six hospitals in Japan. Fifty-four Ultraflex stents were inserted in 34 patients with inoperable malignant airway stenosis using a flexible and/or a rigid bronchoscope under fluoroscopic and endoscopic visualization. MEASUREMENTS AND RESULTS: Clinical, endoscopic examination, and pulmonary function on days 1, 30, and 60 after stent implantation showed improvement. In 19 patients (56%), stent implantation was performed as an emergency procedure because of life-threatening tracheobronchial obstruction. Immediate relief of dyspnea was achieved in 82% of the patients. The dyspnea index improved significantly after implantation (before vs. days 1, 30, and 60; p<0.001). Significant improvements were observed in obstruction of airway diameter (81+/-15% before vs. 14+/-17% on day 1, 12+/-12% on day 30, and 22+/-28% on day 60; p<0.001). Vital capacity (VC), FEV(1), and peak expiratory flow (PEF) increased significantly after stent implantation: before vs immediately after VC (p<0.01), FEV(1) (p<0.001), and PEF (p<0.05). The main complications were tumor ingrowth (24%) and tumor overgrowth (21%). After coagulation with an Nd-YAG laser or argon plasma coagulation, mechanical coring out using the bevel of a rigid bronchoscope was necessary in patients showing tumor ingrowth or overgrowth. Removal and reposition were possible in case of misplacement. There were no problems with migration and retained secretions. The median survival time of patients was 3 months. The 1-year survival rate was 25.4%. CONCLUSIONS: In this study of the Ultraflex nitinol stent, we have demonstrated that patients were relieved from dyspnea, which contributed to improved quality of life, with minimal complications. This stent can be used safely, even in the subglottic region. Owing to its excellent flexibility and biocompatibility, the stent is also indicated in certain complicated situations, eg, narrow stenosis, hourglass stenosis, curvilinear stenosis, bilateral mainstem bronchial stenoses, and long stenosis of varying diameters.