癌性气道梗阻腔内冷冻及支架治疗

目的：探讨中晚期癌灶侵犯气管、支气管导致大气道梗阻、呼吸困难的姑息性救治方法。方法：21例气管、支气管癌性梗阻伴呼吸困难患者，6例伴声音嘶哑，8例伴左或右全肺不张，21例均伴肺部感染及呼吸困难。经纤支镜插入CO2冷冻软探针冷冻摘除肿瘤和／或植入带膜钛合金网状内支架救治。结果：17例气道梗阻、呼吸困难及两肺感染患者获完全缓解；2例气道梗阻获部分缓解，呼吸困难及两肺感染减轻；1例患者于等待定做内支架过程中死亡，1例气管重度梗阻，于表面麻醉、纤支镜观察中出现窒息，经呼吸机支持24小时后死亡。结论：癌肿转移、侵入气管、支气管后于腔内生长迅速，短期即可导致气道阻塞、呼吸困难死亡。对终末期患者，经纤支镜插入CO2冷冻软探针冷冻摘除肿瘤和／或植入带膜钛合金网状内支架救治方法，虽然风险大，但仍提供了一条有效的救治途径，为继续治疗赢得了宝贵时间。

Remedy to the main airway carcinosis obstruction with acute respiratory failure

Objective:To study the palliation treatment to minddle-advanced carcinoma patient with airway obstruction or respiratory failure which lead by carcino-encroachment of trachea in right or left principal bronchus.Methods:We had 21 minddle-advanced carcinoma patient with airway obstruction or respiratory failure lead by carcino-encroachment of trachea in right or left principal bronchus, 6 of them with hoarse voice,8 of them with right or left total pulmonary atelectasis,all of them with pulmonary infection and respiratory failure. The tumor was extirpated by liquid CO2 flexibility cryoprobe and whereafter the Ni-Ti alloy shape memory covered stent was inserted to the trachea or bronchus through the bronchofibroscope to relief the airway obstruction.Results:Seventeen of them airway obstruction,respiratory failure and pulmonary infection was completely relieved, 2 of them airway obstruction was partially relieved of which respiratory failure and pulmonary infection to be eased. One of them died when the covered stent was delivered, 1 of them died for apnoea after breathing machine supported for 24 hours which caused by the operating of bronchofibroscop.Conclusion:The tumor aversion and the intrusion of trachea or bronchus would grow up rapidly,and wuold obstruct the main airway in short time which would lead to the respiratory failure and death. Although with high risk of death,the tumor extirpation by liquid CO2 flexibility cryoprobe and the insertion of the Ni-Ti alloy shape memory covered stent,which were operated under the bronchofibroscop,would be to provide effective remedy to the terminal stage patients like this,and same time,would win the opportunities for waiting for more effective anticancer therapy