【摘要】 目的探讨经纤维支气管镜(纤支镜)联合X线透视下金属支架置入术在气道狭窄治疗中的应用价值。方法选取2009年5月—2013年1月在我院住院的25例气道狭窄患者,呼吸困难程度均为4级;其中男18例,女7例。在对气道狭窄程度综合评价后,采用经纤支镜引导联合X线透视下金属支架置入术进行治疗,观察气管、支气管支架置入前后患者的呼吸困难程度及血气分析〔动脉血氧分压(PO2)、二氧化碳分压(PCO2)〕的变化,并对并发症进行分析。结果 25例患者共置入28枚支架,其中管形支架20枚;带膜支架2枚;Y型支架2枚;主气管狭窄并一侧主支气管狭窄者先置入主支气管支架,然后置入主气管支架,共4枚。患者呼吸困难程度由支架置入前的(4.0±0.0)级降至支架置入后的(2.2±0.7)级,PO2由(49.4±6.4)mm Hg升至(70.5±11.2)mm Hg,PCO2由(65.1±12.4)mm Hg降至(48.3±11.3)mm Hg(P<0.05)。术后6例有少量痰中带血,4例有短暂的咳嗽,3例胸骨后轻度疼痛,1例出现皮下气肿,1例于支架置入后1个月再次发生气道狭窄。所有患者未出现与支架有关的严重并发症。结论经纤支镜引导联合X线透视下金属支架置入术治疗气道狭窄安全、有效,能迅速解除气道狭窄,缓解呼吸困难,并为后续治疗创造条件,值得在临床推广应用。更多还原

【Abstract】 Objective To investigate the application value of the metal stent implantation with bronchofiberscope and X- ray perspective guidance in the treatment of airway stenosis. Methods From May 2009 to January 2013,25 cases( 18males,7 females) with airway stenosis,whose dyspnea degree was grade 4,were selected for stent implantation treatment. After the comprehensive evaluation of the airway stenosis degree,the cases were treated with metal stent implantation with bronchofiberscope and X- ray perspective guidance. The dyspnea degree and the results of blood- gas analyses( PO2and PCO2) were evaluated and compared before and after treatment,and complications were analyzed. Results A total of 28 stents were implanted in 25patients,including 20 tubular mesh stents; 2 membrane- covered stents; 2 Y type stents; For patients with main tracheal stenosis and side main bronchial stenosis,main bronchial stents were implanted first,then the main tracheal stents were implanted,a total of 4 stents were implanted. The dyspnea degree was decreased from( 4. 0 ± 0. 0) before treatment to( 2. 2 ± 0. 7) after treatment,PO2was increased from( 49. 4 ± 6. 4) mm Hg before treatment to( 70. 5 ± 11. 2) mm Hg after treatment,PCO2was decreased from( 65. 1 ± 12. 4) mm Hg before treatment to( 48. 3 ± 11. 3) mm Hg after treatment( P < 0. 05). After treatment,a small amount of blood in sputum was found in 6 cases,brief cough was found in 4 cases,retrosternal mild pain was found in 3cases,subcutaneous emphysema was found in 1 case,a recurrence of the disease was found in 1 case after treatment for 1month. The serious complications related to stents were not found in all cases. Conclusion In the treatment of airway stenosis,the metal stent implantation with bronchofiberscope and X- ray perspective guidance is safe and effective,which can quickly rescue patients from the airway stenosis,alleviate difficulty breathing,and create conditions for follow- up treatment,it is worth popularizing application in clinic.更多还原