Résumé
Objective To investigate the feasibility and therapeutic efficacy of inverted Y-shaped silicone airway stent for complex airway diseases (stenosis or fistula). Methods According to the particular anatomic structure and the pathological changes of complex airway diseases, the inverted Y-shaped silicone airway stents were designed. 7 stents were implanted in 7 cases of airway complex diseases with the guidance of interventional rigid bronchoscope under general anesthesia. Results The Y-shaped silicone stents were placed successfully followed with the result of immediate relieves of the symptoms. Dyspnea grade was improved significantly from Ⅲ~Ⅳ to 0 ~Ⅱ , and oxygen saturation elevated from ( 84.1 ± 4.5 ) % in inspiring high concentration oxygen to ( 94.1 ± 2.9 ) % in breathing ambient air (P = 0.000). The main complications were cough, foreign body sensation, chest pain, granulation, sputum retention, et al. Conclusion Placement of Y-shaped silicone airway stent is a feasible and safe treatment for complex airway disease, the recent curative effect is reliable, it is worth further promoting.
Résumé
Objective To investigate the feasibility and primary therapeutic effect of Dumon Y-shaped airway stent for complex airway disease (stenosis or fistula). Methods Seven patients with complex airway disease underwent placement of Dumon Y-shaped airway stent via rigid bronchoscope, and selected stent depend on carefully measuring the diameter and length of the stenosis or fistula. We retrospectively analyzed the therapeutic efficacy of the patients placed Dumon Y-shaped airway stent. Results All the Dumon Y-shaped airway stent placed successfully. The diameter of the narrowest tracheal stenosis under the carina was improved significantly from (8.03 ± 5.45) mm to (13.08 ± 3.41) mm after the operation. Medical Research Council dyspnea grade improved significantly from Ⅲ~Ⅳ to Ⅰ~Ⅱ and the oxygen saturation improved significantly from (93.86 ± 1.07) % to (98.14 ± 1.07) %. There is no treatment-related complication and death in the seven patients. Conclusion As a new choice, the technique of Dumon Y-shaped airway stent is feasible and safety for the complex airway disease (stenosis or fistula), and worthy of widely promoting.
Résumé
Objective To discuss the technical points and the clinical application of single wire-guided inverted Y-shaped tracheal stent implantation under general anesthesia in treating complex tracheal diseases. Methods During the period from January 2014 to October 2014 at authors’ hospital, a total of 6 patients with complex tracheal diseases received inverted Y-shaped tracheal stent implantation. The diseases included trachea-pleural fistula(n=1), trachea-esophageal fistula(n=2) and complex tracheal stenosis(n=3). Under general anesthesia and guided by DSA, inverted Y-shaped tracheal stent implantation was carried out in all the 6 patients. The results were analyzed. Results A total of 6 Y-shaped tracheal stents were used in the 6 patients, and single wire-guided implantation technique was employed in all procedures. In one case , the right branch of the Y-shaped tracheal stent was placed in the right upper lobe bronchus by mistake , and in the remaining 5 cases the stent implantation was successfully accomplished with single manipulation. Conclusion Under general anesthesia, Y-shaped tracheal stent implantation can effectively obstruct the trachea-pleural fistula and left main bronchus-esophageal fistula, and it can also quickly and significantly relieve the complex airway stenosis located at the tracheal carina region. This treatment is safe and reliable with satisfactory short-term effect. Moreover, single wire-guided manipulation is technically simpler, easier and faster than dual wire-guided manipulation. Therefore, this technique should be recommended in the clinical practice.
Résumé
Objective To investigate the pathological changes of local airway tissue after inserting Y-shaped titanium-nickel memory alloy stent in carina, and to evaluate CT three-dimensional reconstruction technique in postoperative and follow-up observation. Methods Twelve healthy adult canines were enrolled in this study. Based on the information of the carina obtained from CT three-dimensional reconstruction images, the preparation of Y-shape netlike stent was made by knitting method with single Ni-Ti memory alloy wire. The stent was then inserted in canine's carina with the help of a releasing system. After the operation fiberbronchoscopy and CT three-dimensional reconstruction were performed. The animals were sacrificed 12 weeks after the procedure and the bronchus of the stenting segment was removed and sent for histopathologic examination. Results Technical success was achieved in all canines with the stent fight in the carina. The airway remained unobstructed 12 weeks after the procedure. Histopathologic examination revealed that the stent became partial epithelialization. Conclusion The Y-shaped titanium-nickel memory alloy stent has good histecompatibility and physicochemical stability and no re-stenosis of the airway develops in the follow-up period of three months. The stent-releasing technique is easy and simple. As a non-invasive and convenient exam, CT three-dimensional reconstruction technique is of great value in postoperative follow-up observation.