气管与主支气管良性狭窄金属支架植入后再狭窄及处理

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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
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
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
dilatation, cryotherapy and eletrocautery are effective methods in managing restenosis after stent
imp lantation. 【Key words】 Trachea; B ronchi; Benign; Tuberculosis; Stents, metals; Restenosis
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% ,
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
【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
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 。
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
狭窄率为
9109% (χ2
= 51114,
P
<
0105, 但
χ2 c
= 31100,
P > 0105 ) 。纤维化期
Hale Waihona Puke 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。
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
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
© 1994-2010 China Academic Journal Electronic Publishing House. All rights reserved.
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
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
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