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題名 | Preliminary Experience with Bronchotherapeutic Procedures in Central Airway Obstruction=氣管介入性治療對中央氣道狹窄之初期經驗 |
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作者 | 呂明憲; 劉永恆; 柯博仁; 吳怡成; 謝明儒; 劉會平; 林萍章; Liu, Ming-shian; Liu, Yun-hen; Ko, Po Jen; Wu, Yi-chen; Hsieh, Ming-ju; Liu, Hui-ping; Lin, Pyng-jing; |
期刊 | 長庚醫學 |
出版日期 | 20030400 |
卷期 | 26:4 2003.04[民92.04] |
頁次 | 頁240-249 |
分類號 | 416.215 |
語文 | eng |
關鍵詞 | 中央氣道狹窄; 氣管介入性治療; Central airway stenosis; Bronchotherapeutic procedure; |
中文摘要 | 背景:中心氣道狹窄的治療對醫護人員是極具挑戰性的。本文將報告我們過去8個月的治療經驗。 方法:自西元2002年1月至8月,共有21位患者接受26項的氣管鏡手術,包括4次腫瘤切除,6次狹窄撐開,13次支架置入,2次組織片檢查,1次異物取,而這些手術都是單獨或使用硬式氣管鏡輔助下所完成。疾病的原因包括4例肺癌,3例食道癌合氣道氣管廔管,6例氣管插管合併症,1例喉部外傷,1例門環狀下蹼,1例異物取除,2例不明原因氣道狹窄。 結果:17位患者藉由氣管介入性治療,臨床症狀明顯改善,同時兩患者有術併發症。一位87歲的食道癌患者。於術後第5天因肺炎及呼吸衰竭而死亡。兩位壁門嚴重狹窄接受T型?架植入的患者,因大量痰液阻塞及?架的壓迫,而必須將?架取除。另外,兩位接受腫瘤切除的患者,因術中少量出血使用氣管鏡進行壓迫止血,而得到良好的控制。在我們的經驗中,沒有因治療而導致氣管撕裂傷的病例。 結論:對於惡性腫瘤造成的氣道狹窄,我們會使用硬式氣管鏡的尖端將腫瘤切除,再依狹窄殘餘的嚴重度考慮是否植入金屬或矽製氣道支架。對於良性的氣道狹窄,常使用硬式氣管鏡制將狹窄撐開,而支架的選擇,較喜好矽製的支架。 |
英文摘要 | Background: Central airway obstruction is still challenging to physicians. We herein report on our experiences with bronchotherapeutic procedures over a recent 8-month period. Methods: From January 2002 to August 2002, 21 patients received 26 procedures (4 core outs, 6 dilations, 13 stent placements, 2 biopsies, and 1 foreign body removal). All patients were treated with or assisted using a rigid bronchoscope technique, except in 1case in which a fiber bronchoscope was used. The etiologies included 4 cases of lung cancer, 3 cases of malignancy-related tracheoesophageal fistula, 6 cases of airway intubation, 2 cases of laryngotracheal tuberculosis, 1 case of post-anastomotic stenosis, 1 case of laryngotracheal trauma, 1 case of subglottic web, 1case of foreign body, and 2 cases of unknown origin. Results: Seventeen patients receiving bronchotherapeutic plrocedures benefited form the procedures, with 2 complications occurring in our series. One patient who was 87 years old with esophageal cancer and treacheoesophageal fistula died 5 dyas after the operation. Stent-related complications occurred in 2 patients (1 collapse by compression and 1 mucous obstruction). No airway laceration occurred while performing the procedure, two instances of intraoperative bleeding were encountered, which were successfully controlled by compression of the lesion using the side of the rigid bronchoscope. Conclusions: In malignant airway obstructions, we resected the endobronchial tumor with the tip of the rigid bronchoscope. Stents were reserved for patients with residual obstruction or severe extrinsic compression. In benign airway obstructions, dilation with a rigid bronchoscope was routinely used. Silicon stents were preferred for managing benign airway obstruction. |
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