自膨式金属支架对恶性气道疾病的疗效及影响术后生存的因素分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

青刚 ¹ , 邓太兵 ¹ , 刘婷 ¹ , 刘文良 ² , 付庆萍 ¹ , 蒋鲜 ¹ , 许郭华 ¹ , 白裕英 ¹ ,  郭述良 ³

1. ;
2. ;
3. ;

Corresponding author：

郭述良, Email: guosl999@sina.com

Keywords：

中央气道狭窄; 气管肿瘤; 气管食管瘘; 自膨式金属支架

DOI：

10.7507/1671-6205.202305012

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目的探讨自膨式金属支架（self-expandable metallic stent，SEMS）治疗恶性气道疾病的疗效及影响支架置入术后生存的因素。方法 2020年2月—2022年6月在广安市人民医院住院治疗的恶性气道疾病患者，根据CSCO指南对患者进行抗肿瘤治疗的基础上，行SEMS置入治疗，收集患者的临床资料。数据用SPSS 23.0进行分析。P<0.05具有统计学意义。结果共纳入54例患者，其中恶性中央气道狭窄（malignant central airway obstruction，MCAO）40例和恶性气管食管瘘（malignant tracheoesophageal fistula，MTEF）14例；咳嗽和呼吸困难为主要的临床表现；最常见的原发疾病为食管鳞状细胞癌、其次为肺鳞状细胞癌；合并肺炎的患者占87%，痰培养中最常见的病原菌为革兰阴性杆菌，其次为真菌。共置入支架58枚，其中直筒支架42枚、Y型支架16枚；支架置入后，气道狭窄程度较支架置入前明显改善，气促分级明显低于支架置入前，第一秒用力呼气容积明显高于支架置入前（P<0.05）；SEMS置入后症状改善率为94.4%；3个月后总生存率为70.4%。多因素分析显示C反应蛋白浓度［OR=1.011，95%CI（1.001～1.020），P=0.016］为SEMS置入3个月后恶性气道疾病死亡的独立危险因素，白蛋白水平［OR=0.883，95%CI（0.781～0.997），P=0.045］为保护性因素。结论 SEMS在恶性气道疾病姑息性治疗中起着重要作用；支架置入前感染的有效控制、营养状况的改善对术后生存有利。

Citation： 青刚, 邓太兵, 刘婷, 刘文良, 付庆萍, 蒋鲜, 许郭华, 白裕英, 郭述良. 自膨式金属支架对恶性气道疾病的疗效及影响术后生存的因素分析. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(2): 117-121. doi: 10.7507/1671-6205.202305012 Copy

1.	Murgu SD, Egressy K, Laxmanan B, et al. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest, 2016, 150(2): 426-441.
2.	Kim HS, Khemasuwan D, Diaz-Mendoza J, et al. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev, 2020, 29(158): 200094.
3.	Ong P, Grosu HB, Debiane L, et al. Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction. Thorax, 2019, 74(2): 141-156.
4.	卢海燕, 朱辉, 刘丹, 等. 体外膜肺支持下经硬质支气管镜Y型金属覆膜支架置入一例. 中国呼吸与危重监护杂志, 2020, 19(1): 81-83.
5.	王清霞, 段志红, 刘诗琦, 等. 支架置入术治疗恶性食管气管瘘的疗效及影响瘘口闭合的相关因素分析. 中华医学杂志, 2023, 103(2): 111-116.
6.	Wang Y, Lu J, Guo JH, et al. A novel tracheobronchial stent loaded with ¹²⁵I seeds in patients with malignant airway obstruction compared to a conventional stent: a prospective randomized controlled study. EBioMedicine, 2018, 33: 269-275.
7.	Kim MJ, Shin JH, Park JH. Covered airway stent placement for malignant tracheobronchial strictures in patients with an endotracheal tube. Clin Radiol 2016 Nov; 71(11): 235-238.
8.	Marchese R, Poidomani G. Fully covered self-expandable metal stent in tracheobronchial disorders: clinical experience. Respiration 2015; 89(1): 453-437.
9.	北京健康促进会呼吸及肿瘤介入诊疗联盟. 恶性中心气道狭窄经支气管镜介入诊疗专家共识. 中华肺部疾病杂志(电子版), 2017, 10(6): 647-654.
10.	Crosta C, Spaggiari L, De Stefano A, et al. Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstructions: early results in 47 cases. Lung Cancer, 2001, 33(2): 75-80.
11.	周正, 王林梅, 韩校鹏, 等. 纤维支气管镜直视下有创机械通气中置入金属支架治疗恶性肿瘤致中心气道狭窄的临床应用. 中国内镜杂志, 2020, 26(4): 14-18.
12.	占丰富, 曾惠清, 邱少钊, 等. 硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌致中央气道狭窄的临床疗效. 中国内镜杂志, 2023, 29(1): 1-7.
13.	陶梅梅, 张楠, 邹珩, 马洪明, 李冬妹, 王洪武. 食管癌合并食管气管瘘患者气管支架置入前后肺部感染发生情况及病原学比较. 中华医学杂志, 2019, 99(10): 764-766.
14.	Lemos EV. de la Hoz FP, Einarson TR, McGhan WF, Quevedo E, Castañeda C, Kawai K: Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and metaanalysis. Clin Microbiol Infect. (2014) 20: 416–23.
15.	Breitenbücher A, Chhajed PN, Brutsche MH, et al. Long-term follow-up and survival after Ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration. (2008)75: 443–9.
16.	Shin JH, Song HY, Ko GY, et al. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. (2004)232: 252–9.
17.	李多, 王文军, 孙鼎强, 等. 血管介入联合气道介入治疗晚期中央型肺癌中心气道重度狭窄. 中国呼吸与危重监护杂志, 2017, 16(1): 74-77.
18.	丁银锋, 李付琦, 黄海东, 等. 支气管镜介入治疗肺移植术后中心气道狭窄的疗效分析. 中国呼吸与危重监护杂志, 2020, 19(3): 276-280.
19.	Kim HS, Khemasuwan D, Diaz-Mendoza J, et al. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev. (2020) 29(158).
20.	Grotberg JC, Hyzy RC, De Cardenas J, et al. Bronchopleural fistula in the mechanically ventilated patient: a concise review. Crit Care Med. (2021) 49: 292–301.
21.	Premkumar M, Loganathan S, Kajal K, et al. COVID-19-related dynamic coagulation disturbances and anticoagulation strategies using conventional D-dimer and point-of-care Sonoclot tests: a prospective cohort study. BMJ Open, 2022, 12(5): e051971.

1. Murgu SD, Egressy K, Laxmanan B, et al. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest, 2016, 150(2): 426-441.
2. Kim HS, Khemasuwan D, Diaz-Mendoza J, et al. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev, 2020, 29(158): 200094.
3. Ong P, Grosu HB, Debiane L, et al. Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction. Thorax, 2019, 74(2): 141-156.
4. 卢海燕, 朱辉, 刘丹, 等. 体外膜肺支持下经硬质支气管镜Y型金属覆膜支架置入一例. 中国呼吸与危重监护杂志, 2020, 19(1): 81-83.
5. 王清霞, 段志红, 刘诗琦, 等. 支架置入术治疗恶性食管气管瘘的疗效及影响瘘口闭合的相关因素分析. 中华医学杂志, 2023, 103(2): 111-116.
6. Wang Y, Lu J, Guo JH, et al. A novel tracheobronchial stent loaded with ¹²⁵I seeds in patients with malignant airway obstruction compared to a conventional stent: a prospective randomized controlled study. EBioMedicine, 2018, 33: 269-275.
7. Kim MJ, Shin JH, Park JH. Covered airway stent placement for malignant tracheobronchial strictures in patients with an endotracheal tube. Clin Radiol 2016 Nov; 71(11): 235-238.
8. Marchese R, Poidomani G. Fully covered self-expandable metal stent in tracheobronchial disorders: clinical experience. Respiration 2015; 89(1): 453-437.
9. 北京健康促进会呼吸及肿瘤介入诊疗联盟. 恶性中心气道狭窄经支气管镜介入诊疗专家共识. 中华肺部疾病杂志(电子版), 2017, 10(6): 647-654.
10. Crosta C, Spaggiari L, De Stefano A, et al. Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstructions: early results in 47 cases. Lung Cancer, 2001, 33(2): 75-80.
11. 周正, 王林梅, 韩校鹏, 等. 纤维支气管镜直视下有创机械通气中置入金属支架治疗恶性肿瘤致中心气道狭窄的临床应用. 中国内镜杂志, 2020, 26(4): 14-18.
12. 占丰富, 曾惠清, 邱少钊, 等. 硬质支气管镜联合电子支气管镜直视下置入气管支架治疗食管癌致中央气道狭窄的临床疗效. 中国内镜杂志, 2023, 29(1): 1-7.
13. 陶梅梅, 张楠, 邹珩, 马洪明, 李冬妹, 王洪武. 食管癌合并食管气管瘘患者气管支架置入前后肺部感染发生情况及病原学比较. 中华医学杂志, 2019, 99(10): 764-766.
14. Lemos EV. de la Hoz FP, Einarson TR, McGhan WF, Quevedo E, Castañeda C, Kawai K: Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and metaanalysis. Clin Microbiol Infect. (2014) 20: 416–23.
15. Breitenbücher A, Chhajed PN, Brutsche MH, et al. Long-term follow-up and survival after Ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration. (2008)75: 443–9.
16. Shin JH, Song HY, Ko GY, et al. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. (2004)232: 252–9.
17. 李多, 王文军, 孙鼎强, 等. 血管介入联合气道介入治疗晚期中央型肺癌中心气道重度狭窄. 中国呼吸与危重监护杂志, 2017, 16(1): 74-77.
18. 丁银锋, 李付琦, 黄海东, 等. 支气管镜介入治疗肺移植术后中心气道狭窄的疗效分析. 中国呼吸与危重监护杂志, 2020, 19(3): 276-280.
19. Kim HS, Khemasuwan D, Diaz-Mendoza J, et al. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev. (2020) 29(158).
20. Grotberg JC, Hyzy RC, De Cardenas J, et al. Bronchopleural fistula in the mechanically ventilated patient: a concise review. Crit Care Med. (2021) 49: 292–301.
21. Premkumar M, Loganathan S, Kajal K, et al. COVID-19-related dynamic coagulation disturbances and anticoagulation strategies using conventional D-dimer and point-of-care Sonoclot tests: a prospective cohort study. BMJ Open, 2022, 12(5): e051971.

Chinese Journal of Respiratory and Critical Care Medicine

自膨式金属支架对恶性气道疾病的疗效及影响术后生存的因素分析

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