摘要
目的:观察自制叠铁饼样镍钛合金气管封堵器联合闭式引流术治疗支气管胸膜瘘的疗效,探索并发症少并能改善患者肺功能的内科介入治疗方法。方法:选择2006-07在解放军第四军医大学西京医院呼吸内科就诊的因胸腔疾病导致的支气管胸膜瘘并严重液气胸患者1例,男性,69岁,患者签署知情同意书。采用自制的内塞式“叠铁饼样”镍钛合金封堵器(1.2cm×1.0cm,外部由镍钛记忆合金丝编织成网格状支架,内部横向填充高分子聚合物薄膜),在支气管镜直视引导下对预定的患侧靶位支气管进行封堵,然后对患侧胸腔行闭式引流和甲硝唑反复冲洗,最大程度地减轻液气胸。1周后复查胸片、血气和肺功能。结果:封堵术后患者的咳脓痰症状即刻消失,术后第1天体温恢复正常。1周后复查血常规白细胞计数恢复正常,胸腔积液显著减少且细菌培养为阴性;复查胸片提示封堵器没有位移,患侧液气胸显著减轻,部分肺复张。动脉血氧分压提高(9.86kPa增至10.41kPa),肺功能指标明显改善(静态肺活量由2.05L增至2.34L)。结论:采用自制叠铁饼样镍钛合金气管封堵器联合闭式引流术能明显改善支气管胸膜瘘患者的肺功能,为支气管胸膜瘘的治疗提供了安全可靠的内科介入方法。
AIM： To observe the therapeutic effect of the combination of self-made discus-shape Ni-Ti alloy bronchus occluder and closed drainage for bronchopleural fistula （BPF）, in order to explore the way of interventional therapy for reducing complication and improving lung function in these patients.
METHODS： A male BPF patient aged 69 years combined with serious hydropneumothorax was selected from Department of Respiratory Disease, Xijing Hospital, Fourth Military Medical University of Chinese PLA in July 2006. The patient had signed the informed consent. Through bronchoscope the target bronchus was occluded with self-made discus-shape Ni-Ti alloy bronchus occluder （1.2 cmx1.0 cm, net-shape stent was knitted with Ni-Ti memory alloy line outside, and high molecular polymer film was filled breadthwise inside）. And then the sick-side thoracic cavity was treated with dosed drainage and washed repetitively with arilin to relieve hydropneumothorax to great degree. The X-ray, arterial blood gas and lung function was checked after 1 week.
RESULTS： The symptom of vomica disappeared at once after the occlusion of bronchus, and body temperature became normal at the first day alter operation. After 1 week lencocyte count recovered to normal, content of pleural effusion reduced significantly and the bacterial culture was negative; X-ray showed that the location of implantable stent had no change, hydropneumothorax was relieved significantly and part of pulmonary atelectasis recovered. Partial pressure of oxygen in artery （PaO2） increased （9.86 kPa to 10.41 kPa）, and lung capacity （static vital capacity： 2.05 L to 2.34 L） became batter obviously.
CONCLUSION： The combination of self-made discus-shape Ni-Ti alloy bronchus occluder and closed drainage can markedly improve the lung function of BPF patients, which provides a safe and effective interventional treatment for BPF.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第9期1768-1769,共2页
Journal of Clinical Rehabilitative Tissue Engineering Research
