背景與目的：
造成氣管及支氣管狹窄的病因，可能是良性或者惡性的，通常病情會呈現呼吸困難及窘迫的症狀。臨床上對於此類呼吸道狹窄的治療選擇考量較為複雜，除了外科手術切除切除狹窄的病灶及重建呼吸道的手術之外，介入性氣管鏡的治療是常見的方法，呼吸道支架的置入術是治療此類呼吸道狹窄的選擇。我將在此論文中提出使用呼吸道支架來治療氣管及支氣管狹窄的病例系列報告。
病人與方法：
從民國88年7月起至95年6月止共有32位氣管及支氣管狹窄的病人，兩性分布為17位男性及15位女性，平均年齡51.8 ± 17.1歲（範圍為17到77歲），接受了呼吸道支架置入術的治療。其中10位為惡性的病因，22位為良性病因。治療前所有病人皆呈現嚴重呼吸窘迫的症狀。在全身麻醉下，使用硬氏支氣管鏡來置入呼吸道的支架。術後以呼吸困難指標來評估呼吸窘迫症狀的改善情況，並觀察併發症的發生及追蹤病人存活和長期的結果。
結果：
32位病人共置入35個呼吸道支架，其中31個杜蒙氏矽質支架（包括5個Y型），4個艾佛士金屬質支架。沒有發生與支架置入術有關的死亡病例。28位（87.5%）病人接受支架置入術後呼吸窘迫的症狀有明顯的改善情況。但是有3位（9.4%）病人發生了立即性的併發症，其中1位發生了支氣管裂傷，2位發生了聲帶下氣管水腫。有10位（31.3%）病人發生晚期的併發症，包括6位支架移位，2位肉芽腫阻塞及2位因吸入食物造成支架阻塞的情況。10位為惡性的病因造成的氣管及支氣管狹窄的病人經呼吸道支架的置入術後中位數存活達6.6個月；22位良性病因的病人中，19位病人經支架的置入術後長達中位數11.25個月（百分之25至75區間範圍為7.7到14.4個月）之久後移除，其中17位（89.5%）達到了良好的呼吸道暢通的結果，但有2位再度復發狹窄。
結論：
不論是良性或惡性病因造成的氣管及支氣管狹窄，使用呼吸道支架的置入術可提供安全、有效的治療選擇，立即緩解呼吸窘迫的症狀。對於惡性狹窄的病人，呼吸道支架的置入可改善病人的生活品質並延長存活；對於良性狹窄的病人，呼吸道支架的置入可得到良好的治療結果。 Background and Purpose: The tracheobronchial stenoses might be caused by the benign or malignant etiologies, presenting respiratory distress symptoms. Clinical management is complicated for such patients. Surgical resection and airway reconstruction is considered as a preferred therapy for the resectable lesions. Interventional bronchoscopic treatment modalities have been commonly employed for the inoperable lesions and airway stenting is one of the treatment modalities. We shall present a case-series study with the use of the airway stents in my thesis.
Patients and Methods: From July 1999 to June 2006, thirty-two patients (15 women, 17 men) with a mean age of 51.8 ± 17.1 years（range 17 to 77 years）had tracheobronchial airway stents insertion. Ten patients had malignant stenoses and twenty-two patients had benign ones. Severe respiratory distress was present in all patients. Stents were placed through a rigid bronchoscope under general anesthesia. Change in the dyspnea index was assessed after stenting. Post-stenting complications were observed. Survival and long-term result were recorded in the follow-up.
Results: Thirty-five stents were placed in thirty-two patients, thirty-one Dumon silicone (five Y-shaped included) and four Ultraflex metallic. No procedure-related mortality was observed. Significant improvement of respiratory distress was seen in twenty-eight (87.5%). Immediate complications occurred in three patients (9.4%), one stenting-related left main bronchial injury and two stent intolerance due to marked subglottic edema. Late complications were observed in ten patients (31.3%), including six stent migrations, two granuloma obstructions and two stent obstructions due to aspiration of ingested food materials. In ten patients with malignant stenoses after stenting, the median survival was 6.6 months. Seventeen patients (89.5%) with benign stenoses had good results with a patent airway after a median stenting period of 11.25 months (IQR 25%-75%: 7.7-14.4 ). Stenosis recurred in two patients.
Conclusions: The insertion of the airway stents can provide a safe and effective method to immediately relieve respiratory distress for both benign or malignant tracheobronchial stenoses. The use of airway stents can improve life of quality and prolong survival in malignant stenoses and also can yield good results in the treatment of benign stenoses.
