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目的探讨气管支架置入术联合经肿瘤供血动脉灌注术治疗恶性肿瘤引起的气管狭窄的临床疗效,并与同期仅行气管支架置入治疗的恶性气管狭窄进行比较。方法 16例恶性肿瘤致气管狭窄患者,男性10例,女性6例;年龄50～70岁,平均57.5岁。引起气管恶性狭窄的原因有肺癌7例,食管癌6例,气管肿瘤2例,纵隔肿瘤1例。联合组6例在先行气管支架置入术的基础上,3～7 d后再经肿瘤供血动脉灌注术进行治疗,对照组10例仅行气管支架置入治疗。结果 16例患者共置入Gianturco Z型金属支架8枚,镍钛合金Wallstent支架10枚,支架置入后患者呼吸困难立即缓解,血氧饱和度逐渐上升到自然呼吸时90%～95%。联合组6例患者经肿瘤动脉灌注治疗后均有轻度的消化道症状,对症处理后缓解。随访3个月～2年,联合组支架狭窄率明显低于对照组,生存期明显延长,差异具有统计学意义。结论对气管恶性狭窄患者,予以气管支架置入治疗,缓解了呼吸困难,为后续治疗提供了时机,再联合肿瘤动脉灌注治疗,临床疗效较好。
Objective To investigate the clinical effects of tracheal stent implantation combined with tumor-infusing arterial infusion in the treatment of malignant tumor-induced tracheal stenosis and compare with the malignant tracheal stenosis treated with tracheal stent only during the same period. Methods Sixteen patients with tracheal stenosis caused by malignant tumors were found in 10 males and 6 females, aged from 50 to 70 years (average 57.5 years). Malignant tracheal stenosis caused by lung cancer in 7 cases, esophageal cancer in 6 cases, 2 cases of tracheal tumor, mediastinal tumor in 1 case. In the combined group, 6 cases were treated with intratracheal intratracheal instillation on the basis of the first tracheal stent placement and 3 to 7 days later. The control group was treated with tracheal stent alone. Results Sixteen patients were treated with 8 Gianturco Z-shaped metal stents and 10 Nickel-titanium Wallstent stents. The patients with dyspnea were relieved immediately after stent implantation. The oxygen saturation gradually increased to 90% -95% of the spontaneous respiration. Six patients in the combined group had mild gastrointestinal symptoms after arterial infusion of the tumor and were relieved after symptomatic treatment. The follow-up ranged from 3 months to 2 years. The stenosis rate in the combined group was significantly lower than that in the control group, and the survival time was significantly longer. The difference was statistically significant. Conclusion For tracheal malignant stenosis patients, tracheal stenting was taken to relieve dyspnea and provide the opportunity for follow-up treatment. Combined with tumor arterial infusion, the curative effect was better.