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目的 :评价镍钛合金支气管封堵器对支气管瘘实施封堵的疗效及安全性。方法 :选择 2例胆道支气管瘘的患者为研究对象 ,经支气管镜以及胆管造影确定瘘道部位和拟封堵的靶位支气管。局麻后在支气管镜引导下 ,将导引钢丝插入拟封堵的靶位支气管腔内 ;留置导丝撤出支气管镜 ;沿导丝将封堵器外鞘管送至拟封堵的靶位支气管 ,撤出导丝 ;通过外鞘管将携有封堵器的推送装置送至靶位支气管 ;在支气管镜以及 X线透视下释放封堵器 ,将靶位支气管完全封堵。术后 1周内每天观察咳嗽、咯痰等症状及体温变化 ,术后 1、7、30 d分别复查支气管镜及 X线胸片。术前及术后 3d预防性使用抗生素。结果 :镍钛合金支气管封堵器均一次置入成功。术后当天咯出胆汁样痰量明显减少 ,术后 7d咯胆汁样痰症状完全消失 ;术后 1、7、30 d X线胸片显示封堵器均位于靶位 ,且逐渐膨胀完全 ;支气管镜检查显示术后 1 d封堵区支气管黏膜轻度充血、水肿 ,术后 7d可见封堵器局部肉芽组织增生明显 ;术后 30 d时肉芽及上皮组织完全将封堵器覆盖。 2例患者围术期及术后随访至今 (分别为 1 0、1 4个月 ) ,均未发生封堵器移位、脱落以及与手术相关的感染。结论 :本组病例中所采用的镍钛合金支气管封堵器及其推送装置是一种置入方便、安全有效的支气管专用
OBJECTIVE: To evaluate the curative effect and safety of nitinol bronchial occluder in blocking bronchial fistula. Methods: Two patients with biliary tract bronchial fistula were selected as the study object. The bronchial fistula site and the targeted target bronchus were identified by bronchoscopy and cholangiography. After local anesthesia under the guidance of the bronchoscope, the guiding wire is inserted into the bronchial lumen of the target to be occluded; the indwelling guide wire is withdrawn from the bronchoscope; and the outer sheath of the occlusion device is sent along the guide wire to the target to be occluded Bronchus, evacuate the guide wire; through the outer sheath to push the device with the occluder sent to the target bronchus; bronchoscopy and X-ray release occluder, the target bronchial completely blocked. One week after operation, cough, expectoration and other changes of body temperature were observed. Bronchoscope and X-ray were reviewed at 1, 7 and 30 days after operation. Preoperative and postoperative 3d prophylactic antibiotics. Results: Nitinol bronchial occluder were successfully implanted once. On the day after operation, the amount of bile sputum was significantly reduced, and the symptoms of bile-like sputum completely disappeared on the 7th day after operation. X-ray showed that the occluder was located at the target site at 1, 7 and 30 days after operation and gradually expanded completely. Bronchus Microscopic examination revealed mild bronchial mucosal hyperemia and edema in the occluded area 1 day after operation. The local granulation tissue hyperplasia was observed at 7 days after operation. Granulation and epithelial tissue completely covered the occluder at 30 days after operation. Perioperative and postoperative follow-up was performed in 2 patients (10 and 14 months, respectively). No occlusion, displacement or surgery-related infections occurred. Conclusion: The nitinol bronchus occluder and its pushing device used in this group of patients is a kind of special bronchial tube which is easy to insert, safe and effective