覆膜Y型单子弹头气道支架治疗左主支气管胸膜瘘12例

发布时间：2018-07-30 06:26

【摘要】：目的评估应用Y型单子弹头覆膜气道支架封堵残端较短的左主支气管胸膜瘘的临床效果。方法回顾性分析2010年8月—2013年9月收治的12例残端较短的左主支气管胸膜瘘患者,根据这类患者支气管残端较短的解剖结构特点,个体化定制Y型单子弹头覆膜气道内支架。在X线监视下,12例患者共置入12枚Y型单子弹头内支架。观察患者支架置入后瘘口愈合情况。结果 12枚支架均一次性置入成功,内支架置入后瘘口即刻完全封堵,随访3~17个月;6例瘘口封堵良好,支架置入后3个月取出,瘘口愈合、残腔消失;5例复查胸部多排螺旋CT(MSCT)显示支架子弹头部周围软组织较薄,残腔较前明显缩小,未取出支架,继续负压引流,带支架生存至今。1例高龄患者,支架置入前已存在重度肺部感染,支架置入后瘘口虽即刻完全封堵,但术后未能控制原有肺部感染,加之体质虚弱,术后2周死于肺部重度感染和机体衰竭。结论应用Y型单子弹头覆膜自膨式内支架封堵残端较短的左主支气管胸膜瘘患者的瘘口,近期临床效果可靠,值得推广应用。
[Abstract]:Objective to evaluate the clinical effect of Y-type single-bullet-coated airway stent in the treatment of left main bronchus pleural fistula with short stump. Methods from August 2010 to September 2013, 12 cases of left main bronchus pleural fistula with short stump were analyzed retrospectively. According to the anatomical characteristics of the short stump of bronchial stump, the Y-type single-bullet endobronchial stent was individualized. A total of 12 Y-type single-bullet stents were implanted in 12 patients under X-ray surveillance. The healing of fistula was observed after stent implantation. Results all the 12 stents were successfully implanted at one time. The fistula was completely occluded immediately after stent implantation. The fistula was well occluded in 6 cases after 3 ~ 17 months follow-up. The fistula healed 3 months after stent implantation. The residual cavity disappeared in 5 cases. The multiple row spiral CT (MSCT) showed that the soft tissue around the head of the stent bullet was thinner, the residual cavity was obviously smaller than before, the stent was not removed, the drainage was continued under negative pressure, and 1 cases of elderly patients survived with the stent up to now. There was severe pulmonary infection before stent implantation. Although the fistula was completely occluded immediately after stent implantation, the original pulmonary infection could not be controlled after the stent implantation. In addition, the body was weak and died of severe pulmonary infection and body failure 2 weeks after the stent implantation. Conclusion the application of Y type single bullet self-expandable stent to the closure of fistula in patients with left main bronchopleural fistula with short stump is a reliable clinical effect in the near future and is worth popularizing.
【作者单位】：郑州大学第一附属医院介入科;郑州大学介入治疗研究所河南省介入治疗与临床研究中心;
【分类号】：R561

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