气管与主支气管良性狭窄金属支架植入后再狭窄及处理

·886·
中华内科杂志 2005年 12月第 44卷第 12期 Chin J Intern M ed, December 2005, Vol 44, No. 12
management, the lumen diameter of stenotic segment in the tracheal stenting restenosis patients increased from ( 3133 ±1163) mm to ( 9133 ±3198) mm ( P < 0102 ) , the dyspnea index decreased from ( 3167 ± 0152) to (1150 ±1164) ( P < 0102) , the vital capacity (VC) increased from (1139 ±0117) L to (2143 ± 0170) L ( P < 0101) , the forced exp iratory volume in one second ( FEV1 ) increased from ( 1102 ±0115) L to (2100 ±0172) L ( P < 0102). After management, the lumen diameter of stenosis segment in the bronchial stenting restenosis patients increased from ( 3100 ±0176 ) mm to ( 7138 ±2100 ) mm ( P < 01001 ) , the dyspnea index decreased from (1163 ±0152) to (0150 ±0176) ( P < 01005) , VC increased from (1174 ± 0116) L to (2174 ±0141) L ( P < 01001) , FEV1 increased from (1141 ±0119) L to (2136 ±0137) L ( P < 01001). Conclusion Restenosis occurred in some patients w ith benign tracheal and tuberculous bronchial
eletrocautery were used to manage the restenosis. The lumen of stenotic segment, dyspnea index and pulmonary function were measured before management and after the patient′s condition became stable. Results Restenosis occurred in 6 of the 30 patients receiving tracheal stenting and in 8 of the 35 patients
张 、冷冻 、高频电凝对再狭窄的疗效 。方法 对 30例良性气管狭窄 (A组 ) 、35例支气管结核 ( EBTB )
性主支气管狭窄 (B 组 )者行金属支架植入术 ,随访观察再狭窄的发生情况 ,对再狭窄者行球囊扩张 、
冷冻和高频电凝联合治疗 。评价治疗前及病情稳定后狭窄段气道内径 、气促指数和肺通气功能 。
【Abstract】 O bjective To observe the occurrence of restenosis after metallic stents imp lantation in
benign tracheal and main bronchial stenosis, and to evaluate the therapeutic effects of balloon dilatation, cryotherapy and electrocautery. M ethods Thirty patients w ith benign tracheal stenosis and 35 patients w ith
dilatation, cryotherapy and eletrocautery are effective methods in managing restenosis after stent
imp lantation. 【Key words】 Trachea; B ronchi; Benign; Tuberculosis; Stents, metals; Restenosis
狭窄率为
9109% (χ2
= 51114,
P
<
0105, 但
χ2 c
= 31100,
P > 0105 ) 。纤维化期
EBTB 再 狭 窄 率 为
16167% ,炎症反应期
EB TB 再狭窄率为
60% (χ2
= 41564,
P
<
0105,
但
χ2 c
= 21437,
P > 0105) 。 (2) A
组再狭窄治疗有效率为 4 /6,其中上段和中下段分别为 2 /4 和 2 /2。B 组再狭窄治疗有效率为 7 /8。
receiving bronchial stenting, the restenosis rates were 20% and 22186% , respectively. In total, 30 Chinese2
made stents and 36 U ltraflex stents were imp lanted, and the restenosis rate was 20% and 2212% ,
P < 0105,
bu
t
χ2 c
= 31100,
P > 0105 ).
The
restenosis rate was 16167% in the fibrotic stage of endobronchial tuberculosis ( EBTB ) , and was 60% in the
inflammatory reaction stage of EBTB (χ2 = 41564, P < 0105, butχ2c = 21437, P > 0105). The effective rate
main bronchial stenosis caused by tuberculosis were treated w ith metallic stents imp lantation and a follow2up
was carried out to observe the occurrence of restenosis. Combined balloon dilatation, cryotherapy and
中华内科杂志 2005年 12月第 44卷第 12期 Chin J Intern M ed, December 2005, Vol 44, No. 12
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·论著 ·
气管与主支气管良性狭窄金属支架植入后 再狭窄及处理
姚小鹏 李强 白冲 黄怡 董宇超 刘忠令 王琴
【摘要 】 目的 观察良性气管 、主支气管狭窄金属支架植入后再狭窄的发生情况 ,评价球囊扩
respectively ( P > 0105 ). The restenosis rate was 4 /9 in the upper segmental tracheal stents, and was
9109%
in the m iddle2lower segmental stents
(χ2源自文库
= 51114,
(3) 2组患者病情稳定后与治疗前相比 ,狭窄段内径均增加 ,气促指数均下降 ,肺活量均升高 ,第 1秒
钟用力呼气容积均上升 。结论 良性气管狭窄 、结核性主支气管狭窄金属支架植入后有部分患者发
生再狭窄 。气管上段再狭窄发生率高于中下段 ,对这部分患者行金属支架植入术时应慎重 。处于炎
症反应期的 EBTB再狭窄发生率高于纤维化期 ,应尽量避免对这部分患者行金属支架植入术 。球囊
ling, WAN G Q in. D epa rtm en t of R espira tory, Changha i Hospita l, S econd M ilita ry M ed ica l U n iversity,
S hangha i 200433, Ch ina
Correspond ing au thor: L I Q iang, Em a il: L iqres@ sh163. net
was 4 /6 in the tracheal stenting restenosis patients, and was 2 /4 and 2 /2 in the upper and m iddle2lower
segment group s, respectively. The effective rate was 7 /8 in the bronchial stenting restenosis patients. After
结构和功能的特殊性使纤维瘢痕或肉芽增生导 致的气管 、主支气管良性狭窄手术治疗的范围和效 果受到很大的制约 。为此 ,人们开始尝试金属支架 植入治疗 。由于对疗效和远期并发症还缺乏全面的 观察及对照研究 ,目前对这种治疗方法还存在争议 。 我科于 1996 年 7 月至 2003 年 12 月 ,对 30 例良性 气管狭窄和 35例支气管结核 ( EBTB )导致的主支气 管狭窄患者实施了可膨胀式金属支架植入 ,观察了 支架植入后再狭窄的发生及经支气管镜介入治疗的 效果 ,现报告如下 。
结果 (1) A 组发生再狭窄者 6例 , B 组发生再狭窄者 8例 ,再狭窄率分别为 20%和 22186%。共植
入国产支架 30枚 , 6例发生再狭窄 ,再狭窄率为 20% ( 6 /30) ;共植入 U ltraflex支架 36枚 , 8例发生再
狭窄 ,再狭窄率为 2212% (8 /36) ( P > 0105) 。气管上段支架植入再狭窄率为 4 /9,中下段支架植入再
part of the trechea. The restenosis rate was higher in the inflammatory reaction stage of EBTB than in the
fibrotic stage. Effort should be made to avoid p lacing metallic stents at this stage of the disease. Balloon
扩张 、冷冻和高频电凝是治疗支架植入后再狭窄的有效方法 。
【关键词 】 气管 ; 支气管 ; 良性 ; 结核 ; 支架 ,金属 ; 再狭窄
Restenosis and its managem en t after m eta llic sten ts im plan ta tion in ben ign trachea l and ma in bronch ia l stenosis YAO X iao2peng, L I Q iang, BA I Chong, HUAN G Y i, DON G Yu2chao, L IU Zhong2
stenosis after metallic stent imp lantation. The restenosis rate was higher in the upper tracheal stenosis than
that in the m iddle2lower tracheal stenosis. Caution should be taken when metallic stents are p laced in this
作者单位 : 200433 上海 ,第二军医大学长海医院呼吸内科 通信作者 :李强 , Email: L iqres@ sh163. net
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