摘要
目的探讨气道金属覆膜支架置入治疗恶性食管气管瘘的疗效及安全性。方法2018年1月—2022年9月应急总医院诊治恶性食管气管瘘患者52例,均给予气道金属覆膜支架置入治疗,比较治疗前及治疗1个月时临床症状(呛咳、咳嗽、咳痰、发热)、实验室指标(白细胞计数、中性粒细胞绝对值、C反应蛋白、白蛋白、血红蛋白)、KPS评分、气促评分。随访2~60个月,观察瘘口封堵情况、支架置入治疗相关并发症发生情况及患者生存情况。结果52例患者治疗1个月时呛咳、咳嗽、咳痰、发热发生率(5.8%、42.3%、13.5%、1.9%)及白细胞计数[(7.24±4.04)×10^(9)/L]、中性粒细胞绝对值[(5.71±4.46)×10^(9)/L]、血清C反应蛋白水平[(42.94±6.50)mg/L]均低于治疗前[88.5%、96.2%、73.1%、36.5%、(9.55±5.50)×10^(9)/L、(8.11±5.76)×10^(9)/L、(78.03±8.87)mg/L](P<0.05),白蛋白[(33.20±4.30)g/L]、血红蛋白[(108.30±18.30)g/L]水平均高于治疗前[(31.20±4.20)、(103.40±15.50)g/L](t=-3.084,P<0.001;t=-3.000,P=0.004);治疗1个月时KPS评分[70(70,80)分]高于治疗前[60(50,70)分](Z=-6.465,P<0.001),气促评分[1.5(1,2)分]低于治疗前[2.5(2,3)分](Z=-6.833,P<0.001)。末次随访时,52例患者中瘘口完全缓解1例,临床完全缓解49例,部分缓解2例;支架相关并发症为分泌物潴留(+)17例,(++)27例,(+++)8例;肉芽增生(+)~(++)45例,(+++)~(++++)7例;I形支架移位3例,Y形支架均未发生移位;生存期为(12.8±2.7)个月,中位生存期为(6.0±1.2)个月。结论气道金属覆膜支架置入治疗恶性食管气管瘘可有效改善患者临床症状,提高生存质量,延长生存时间,安全性好。
Objective To investigate the efficacy of membrane-covered metallic stent implantation on malignant tracheoesophageal fistula and its safety.Methods Fifty-two patients with malignant tracheoesophageal fistula received membrane-covered metallic stent implantation in Emergency General Hospital from January 2018 to September 2022.The clinical symptoms(choking,coughing,expectoration,fever),laboratory indicators(white blood cell count,absolute neutrophil count,C-reactive protein,albumin,hemoglobin),Karnofsky Performance Status(KPS)score,and dyspnea score were compared before and after implantation.The patients were followed up for 2 to 60 months to observe the fistula closure status,stent-related complications and survival of patients.Results The incidence rates of choking,coughing,expectoration and fever,white blood cell count,absolute neutrophil count,and serum C-reactive protein level were lower one month after implantation[5.8%,42.3%,13.5%,1.9%,(7.24±4.04)×10^(9)/L,(5.71±4.46)×10^(9)/L,(42.94±6.50)mg/L]than those before implantation[88.5%,96.2%,73.1%,36.5%,(9.55±5.50)×10^(9)/L,(8.11±5.76)×10^(9)/L,(78.03±8.87)mg/L](P0.05),the levels of albumin and hemoglobin were higher one month after implantation[(33.20±4.30),(108.30±18.30)g/L]than those before implantation[(31.20±4.20),(103.40±15.50)g/L](t=-3.084,P0.001;t=-3.000,P=0.004),the KPS score was higher one month after implantation[70(70,80)]than that before implantation[60(50,70)](t=-6.465,P0.001),and the dyspnea score was lower one month after implantation[1.5(1,2)]than that before implantation[2.5(2,3)](t=-6.833,P0.001).The efficacy at the latest follow-up was complete relief in 1 patient,clinical complete relief in 49 patients,and partial relief in 2.The stent-related complications included mucus retention(+)in 17 patients,(++)in 27 and(+++)in 8;granulation tissue hyperplasia(+)to(++)in 45 patients,and(+++)to(++++)in 7;I-stent displacement in 3 patients and no Y-stent displacement.The survival time was(12.8±2.7)months,with a median survival time of(6.0±1.2)months.Conclusion Airway membrane-covered metallic stent implantation can effectively and safely improve the clinical symptoms,enhance the quality of life,and prolong the survival time of patients with malignant tracheoesophageal fistula.
作者
牛阿男
高永平
荆蕾
黄艳
张鹏
王书方
王辉
周云芝
NIU Anan;GAO Yongping;JING Lei;HUANG Yan;ZHANG Peng;WANG Shufang;WANG Hui;ZHOU Yunzhi(North China University of Science and Technology,Tangshan,Hebei 063210,China;Department of Respiratory and Critical Care Medicine,Emergency General Hospital,Beijing 100028,China;Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of North China University of Science and Technology,Tangshan,Hebei 063210,China)
出处
《中华实用诊断与治疗杂志》
2023年第10期1042-1046,共5页
Journal of Chinese Practical Diagnosis and Therapy
关键词
食管气管瘘
恶性
气道支架
生存期
tracheoesophageal fistula
malignant
airway stent
survival time
作者简介
通信作者:周云芝,E-mail:zhouyunzhi2017@126.com。
