自膨式金屬支架對惡性氣道疾病的療效及影響術后生存的因素分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

青剛 ¹ , 鄧太兵 ¹ , 劉婷 ¹ , 劉文良 ² , 付慶萍 ¹ , 蔣鮮 ¹ , 許郭華 ¹ , 白裕英 ¹ ,  郭述良 ³

1. ;
2. ;
3. ;

Corresponding?author：

郭述良, Email: guosl999@sina.com

Keywords：

中央氣道狹窄; 氣管腫瘤; 氣管食管瘺; 自膨式金屬支架

DOI：

10.7507/1671-6205.202305012

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目的探討自膨式金屬支架（self-expandable metallic stent，SEMS）治療惡性氣道疾病的療效及影響支架置入術后生存的因素。方法 2020年2月—2022年6月在廣安市人民醫院住院治療的惡性氣道疾病患者，根據CSCO指南對患者進行抗腫瘤治療的基礎上，行SEMS置入治療，收集患者的臨床資料。數據用SPSS 23.0進行分析。P<0.05具有統計學意義。結果共納入54例患者，其中惡性中央氣道狹窄（malignant central airway obstruction，MCAO）40例和惡性氣管食管瘺（malignant tracheoesophageal fistula，MTEF）14例；咳嗽和呼吸困難為主要的臨床表現；最常見的原發疾病為食管鱗狀細胞癌、其次為肺鱗狀細胞癌；合并肺炎的患者占87%，痰培養中最常見的病原菌為革蘭陰性桿菌，其次為真菌。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，氣道狹窄程度較支架置入前明顯改善，氣促分級明顯低于支架置入前，第一秒用力呼氣容積明顯高于支架置入前（P<0.05）；SEMS置入后癥狀改善率為94.4%；3個月后總生存率為70.4%。多因素分析顯示C反應蛋白濃度［OR=1.011，95%CI（1.001～1.020），P=0.016］為SEMS置入3個月后惡性氣道疾病死亡的獨立危險因素，白蛋白水平［OR=0.883，95%CI（0.781～0.997），P=0.045］為保護性因素。結論 SEMS在惡性氣道疾病姑息性治療中起著重要作用；支架置入前感染的有效控制、營養狀況的改善對術后生存有利。

Citation： 青剛, 鄧太兵, 劉婷, 劉文良, 付慶萍, 蔣鮮, 許郭華, 白裕英, 郭述良. 自膨式金屬支架對惡性氣道疾病的療效及影響術后生存的因素分析. 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.	盧海燕, 朱輝, 劉丹, 等. 體外膜肺支持下經硬質支氣管鏡Y型金屬覆膜支架置入一例. 中國呼吸與危重監護雜志, 2020, 19(1): 81-83.
5.	王清霞, 段志紅, 劉詩琦, 等. 支架置入術治療惡性食管氣管瘺的療效及影響瘺口閉合的相關因素分析. 中華醫學雜志, 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.	北京健康促進會呼吸及腫瘤介入診療聯盟. 惡性中心氣道狹窄經支氣管鏡介入診療專家共識. 中華肺部疾病雜志(電子版), 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, 韓校鵬, 等. 纖維支氣管鏡直視下有創機械通氣中置入金屬支架治療惡性腫瘤致中心氣道狹窄的臨床應用. 中國內鏡雜志, 2020, 26(4): 14-18.
12.	占豐富, 曾惠清, 邱少釗, 等. 硬質支氣管鏡聯合電子支氣管鏡直視下置入氣管支架治療食管癌致中央氣道狹窄的臨床療效. 中國內鏡雜志, 2023, 29(1): 1-7.
13.	陶梅梅, 張楠, 鄒珩, 馬洪明, 李冬妹, 王洪武. 食管癌合并食管氣管瘺患者氣管支架置入前后肺部感染發生情況及病原學比較. 中華醫學雜志, 2019, 99(10): 764-766.
14.	Lemos EV. de la Hoz FP, Einarson TR, McGhan WF, Quevedo E, Casta?eda 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, 王文軍, 孫鼎強, 等. 血管介入聯合氣道介入治療晚期中央型肺癌中心氣道重度狹窄. 中國呼吸與危重監護雜志, 2017, 16(1): 74-77.
18.	丁銀鋒, 李付琦, 黃海東, 等. 支氣管鏡介入治療肺移植術后中心氣道狹窄的療效分析. 中國呼吸與危重監護雜志, 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. 盧海燕, 朱輝, 劉丹, 等. 體外膜肺支持下經硬質支氣管鏡Y型金屬覆膜支架置入一例. 中國呼吸與危重監護雜志, 2020, 19(1): 81-83.
5. 王清霞, 段志紅, 劉詩琦, 等. 支架置入術治療惡性食管氣管瘺的療效及影響瘺口閉合的相關因素分析. 中華醫學雜志, 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. 北京健康促進會呼吸及腫瘤介入診療聯盟. 惡性中心氣道狹窄經支氣管鏡介入診療專家共識. 中華肺部疾病雜志(電子版), 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, 韓校鵬, 等. 纖維支氣管鏡直視下有創機械通氣中置入金屬支架治療惡性腫瘤致中心氣道狹窄的臨床應用. 中國內鏡雜志, 2020, 26(4): 14-18.
12. 占豐富, 曾惠清, 邱少釗, 等. 硬質支氣管鏡聯合電子支氣管鏡直視下置入氣管支架治療食管癌致中央氣道狹窄的臨床療效. 中國內鏡雜志, 2023, 29(1): 1-7.
13. 陶梅梅, 張楠, 鄒珩, 馬洪明, 李冬妹, 王洪武. 食管癌合并食管氣管瘺患者氣管支架置入前后肺部感染發生情況及病原學比較. 中華醫學雜志, 2019, 99(10): 764-766.
14. Lemos EV. de la Hoz FP, Einarson TR, McGhan WF, Quevedo E, Casta?eda 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, 王文軍, 孫鼎強, 等. 血管介入聯合氣道介入治療晚期中央型肺癌中心氣道重度狹窄. 中國呼吸與危重監護雜志, 2017, 16(1): 74-77.
18. 丁銀鋒, 李付琦, 黃海東, 等. 支氣管鏡介入治療肺移植術后中心氣道狹窄的療效分析. 中國呼吸與危重監護雜志, 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

自膨式金屬支架對惡性氣道疾病的療效及影響術后生存的因素分析

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