Objective To analyze the influencing factors of short-term curative effect and long-term survival time of patients with tumor-induced malignant central airway obstruction (MCAO) after airway stent implantation. Methods A total of 120 patients with tumor-induced MCAO who underwent airway stent implantation in the hospital from January 2017 to June 2019 were enrolled. According to the cause of stenosis, the patients were divided into two groups: external pressure stenosis group (n=72) and non-external pressure stenosis group (n=48). The general data such as types and staging of tumor, differentiation degree, sites of airway obstruction, obstruction degree and preoperative level of lactate dehydrogenase (LDH). Before and at 7d after stent implantation, partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2) and saturation of arterial blood oxygen (SaO2) were detected. Before and at 1 month after stent implantation, diameter at airway obstruction segment, degree of airway obstruction and forced expiratory volume in the first second (FEV1) were detected. Dyspnea index (DI) and scores of Karnofsky performance status (KPS) were evaluated. The survival status at 1 year after surgery was followed up. The survival at 1 year after surgery was analyzed by Kaplan-Meier. The influencing factors of survival after stent implantation were analyzed by COX proportional hazard regression analysis. Results After stent implantation, PaO2, SaO2, diameter at airway obstruction segment, FEV1 and KPS score were significantly increased (P<0.05), while PaCO2, degree of airway obstruction and DI were significantly decreased in external pressure stenosis group and non-external pressure stenosis group (P<0.05). After stent implantation, the KPS score was significantly higher in external pressure stenosis group than that in non-external pressure stenosis group, and the shortness of breath index was significantly lower than that in non-external pressure stenosis group (P<0.05). The survival rate of patients with external pressure stenosis group was 29.17%, and the median survival time was 7.35 months, the survival rate and median survival time in non-external pressure stenosis group was 22.92%, and the median survival time was 6.10 months, and there was no significant difference between the two groups (log-rank χ2=1.542, P=0.214). COX proportional hazard regression analysis showed that tumor staging at stage IV (OR=2.056, P=0.020), preoperative KPS score lower than 50 points (OR=2.002, P=0.027) and no postoperative chemoradiotherapy (OR=4.292, P=0.039) were independent influencing factors of 1-year survival time after stent implantation in MCAO patients. Conclusions The clinical curative effect of airway stent implantation is good on patients with tumor-induced MCAO. Tumor staging at stage IV, preoperative KPS score lower than 50 points and no postoperative chemoradiotherapy are risk factors that affect survival time.
Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.
ObjectiveTo compare the clinical efficacy of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the treatment of patients with carotid artery stenosis, and to provide a more abundant evidence-based medicine for the treatment of CEA and CAS in patients with carotid artery stenosis. MethodsForty patients with carotid artery stenosis were randomly divided into CEA group and CAS group based on the operative indication. Patients in CEA group were given carotid endarterectomy treatment and those in CAS group were given carotid artery stenting treatment. Then clinical efficacy of the two groups were observed and compared. ResultsIn terms of the occurring rate of perioperative complications, cardiovascular events in 3 months after operation, and some major end events such as stroke, death and so on, the comparative difference between the two groups was of no statistical significance (P > 0.05). Through the followed-up visits of 12 months, the comparative difference between the two groups was also of no statistical significance (P > 0.05) in terms of the occurring rate of carotid artery restenosis and disabling or fatal stroke. ConclusionsFor patients with severe extracranial carotid stenosis under indication of operation treatment, carotid endarterectomy and carotid artery stenting are of equivalent clinical efficacy, and both of them are of high security, although further study with large-amount and evidence-based medical data in long term from multiple centers is still in need.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
ObjectiveTo investigate the clinical efficacy of sarpogrelate hydrochloride in preventing restenosis after femoral artery stent implantation. MethodsTwo hundreds and fifty-one cases of ischemic disease of lower extremity (286 affected limbs in total) who got treatment in our hospital were collected, and were divided into prevention group(125 cases with 146 affected limbs) and control group(126 cases with 140 affected limbs) according kinds of medicine. At the basement of medicine in control group, cases of prevention group got treatment of sarpogrelate hydrochloride in addition. Comparison of related indexed was performed by SPSS 17.0 software. ResultsCompared with before treatment in prevention group, only foot skin ulcer and gangrene score decreased(P<0.05), and there were no significant difference on other indexes included visual anafogue scales(VAS), intermittent claudication distance score, ankle brachial index (ABI), and vascular stenosis score(P>0.05). But in control group, compared with before treatment, foot skin ulcer and gangrene score and ABI value decreased(P<0.05), the VAS score, intermittent claudication distance score, and vascular stenosis score increased(P<0.05). There were significant difference on the difference between after treatment and before treatment of all 5 indexes(P<0.05), that the changed value of foot skin ulcer and gangrene score was higher in prevention group, but lower on other 4 indexes. There were no untoward effect happened during treatment. ConclusionClinical effect of sarpogrelate hydrochloride in the prevention of restenosis of the femoral artery after stent implantation was significantly, and it can keep related indexes stable.