Implantation of Silmet Stents for Malignant Airway Stenosis

目的：如果硬性支气管镜不能触及狭窄，或者很难预先扩张或激光切除狭窄，金属支架是有用的，但存在诸如支架移除、支架更换和长期放置的恶化等缺点。Silmet Stent(Novatech，法国)是一种新型金属(镍钛)可膨胀支架，具有完全覆盖的聚酯膜。本研究旨在评价Silmet支架的有效性和安全性。方法：2006年3月至2007年10月，在透视和内窥镜下，应用软性和/或硬性支气管镜对10例不能手术的恶性肿瘤所致的中心气道狭窄患者置入16枚Silmet支架。患者组男7例，女3例，平均年龄65.9岁。结果：支架置入后，7例患者呼吸困难即刻缓解。MRC评分评估的呼吸困难指数显示支架置入后有明显改善。(前与后P&lt；0.05)。此外，FEV1有显著改善(P&lt；0.05)，而血流容量环在支架置入后虽然不显著，但也有一些改善。支架置入过程中未出现并发症，但支架置入后出现肿瘤过度生长(1)和支架两端肉芽组织再狭窄(1)等并发症。1例患者放化疗后可取出支架。结论：在本研究中，Silmet支架的置入可以缓解患者的呼吸困难，并发症极少。

Purpose :Metallic stents prove useful if the stenosis is inaccessible by rigid bronchoscope or if prior dilation or laser resection of stenosis is difficult However, disadvantages such as the removal of stents, replacement of stents, and the deterioration of long-term placements exist. Silmet stent (Novatech, France), a new metallic (nitinol) expandable stent with fully covered polyester membrane, has been developed. This study was undertaken to assess the Silmet stent for its efficacy and safety.Methods :Between March 2006 and October 2007, 16 Silmet stents were placed in 10 patients with inoperable central airway stenosis due to malignant tumors using flexible and/or rigid bronchoscope under fluoroscopy and endoscopy. Patient population consisted of 7 males and 3 females(mean age 65.9 years) and stenting was performed under intraveneous anesthesia in operating rooms.Results :After implantation of the stent, immediate relief of dyspnea was achieved in 7 patients. The dyspnea index evaluated by the MRC scale, showed significant improvements after stenting. (pre vs. post P<0.05). Also, FEV1 showed a marked improvement (P<0.05), and flow volume loops, although not remarkable, showed some improvements after stenting. No complications presented during stenting, however complications such as tumor overgrowth (1) and restenosis from granulations at both ends of the stent (1) occurred post-stenting. In 1 case, stent removal was possible after radio-chemotherapy.Conclusions :In this study, the placement of Silmet stents demonstrated dyspnea relief could be achieved in patients with minimal complications.