恶性呼吸道狭窄的介入合并放疗的临床研究
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| 时间：2009-02-04 16:57:04 来源： 作者： |
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The treatment of stent combined with radiotherapy for malignant airway stenosis
XU Xiang-ying,Hiroyuki Tajima,Michihiro Ishioh,et al.
Department of Radiotherapy,Tumour Hospital,Harbin Medical University,Harbin 150040，China
【Abstract】 Objective The purpose of this study is to clarify the clinical usefulness of Z stent combined with radiotherapy for the management of malignant tracheobronchial stenosis.Methods Sixty-nine stents were used in 29 patients.The technical success rates,clinical condition,respiratory status,blood gas analysis,survival rate,and complications were reviewed on the basis of the patients medical records and radiographies.Results All stents were successfully placed in the appropriate position.After the procedure,respiratory status improved in 97%（28/29） of the patients.PaO2 increased statistically （P＜0.05）,and PaCO2 decreased one week after the treatment.Mean survival of 29 patients after stent placement was 123 days.Mean survival in 9 patients treated in combination with radiotherapy （182days） was statistically longer （P＜0.01） than in those treated without radiotherapy （65days）.No severe complications were encountered during and after the procedure.Only 3 minor complications were observed.1 stent migration,1 partial rupture of the stent,and 1 stent deformation were observed.Conclusion Stent treatment in combination with radiotherapy is useful for palliation of malignant tracheobronchial stenosis,and would contribute to improve the life quality of patients with advanced cancer.
【Key words】 stent and prostheses；tracheal;bronchial stenosis or obstruction;complication
自张型金属支架（expandabl metallic stent，EMS）具有良好的扩张力，尤其在临床上治疗晚期恶性肿瘤所致呼吸道狭窄方面取得了良好的治疗效果而受到关注［1～3］。本研究的目的在于对临床治疗结果进行全面总结和分析，正确评价治疗效果及并发症，以寻找最佳治疗方法。
1 资料与方法
1.1 一般资料
1994年5月～1999年9月收治的经病理证实的29例恶性肿瘤影响致呼吸道狭窄患者。男23例，女6例，年龄30～87岁（平均62岁）。原发病：肺癌20例，食管癌4例，原发灶不明纵隔淋巴结转移2例，甲状腺癌1例，恶性淋巴瘤1例，下咽癌1例。以Hugh-Jones（H-J）分类作为评价呼吸状态改善的指标，见表1。29例治疗前5级23例，4级6例。具体狭窄部位为：气管6例，气管及左右支气管6例，左右支气管3例，气管及右支气管4例，左支气管及下叶8例，右支气管2例。表1 Hugh-Jones分类（略）
1.2 治疗方法
1.2.1 金属支架选择原则
气管病变：扩张径为2.0cm，长度为5.0cm；支气管病变：扩张径为1.5cm，长度为5.0cm的Giantruco Z型支架，共使用了69个支架。对20例患者实施了支架套叠（stent-in-stent）留置方法。并对食管支气管瘘等6例患者使用了共9个自制被膜支架。
1.2.2 支架留置方法
全组于全麻下施行支架留置术。首先在纤维支气管镜下观察病变，于透视下从活检孔将长200cm、直径0.038in的引导丝插入并穿过狭窄部位后，留置引导丝同时将支气管镜退出。随后将10～12Fr的导管沿引导丝插至病变部位后将金属支架插入导管内。用推进器将支架推至狭窄部位后拔出导管及推进器，扩张了的支架则留置于狭窄部位。最后在透视下再次确认支架的位置及扩张状态。
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