Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Endobronchial Occlusion Stent: A Preliminary Experimental Study

기관지 폐쇄 스텐트: 예비 실험 연구

  • Choi, Yo-Won (Department of Radiology, Hanyang University Medical School) ;
  • Jeong, Woo-Kyoung (Department of Radiology, Hanyang University Medical School) ;
  • Lee, Seoung-Hoon (Department of Radiology, Hanyang University Medical School) ;
  • Heo, Jeong-Nam (Department of Radiology, Hanyang University Medical School) ;
  • Jeon, Seok-Chol (Department of Radiology, Hanyang University Medical School) ;
  • Ko, Gi-Young (Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Song, Ho-Young (Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 최요원 (한양대학교 의과대학 영상의학과) ;
  • 정우경 (한양대학교 의과대학 영상의학과) ;
  • 이승훈 (한양대학교 의과대학 영상의학과) ;
  • 허정남 (한양대학교 의과대학 영상의학과) ;
  • 전석철 (한양대학교 의과대학 영상의학과) ;
  • 고기영 (울산대학교 의과대학 영상의학과) ;
  • 송호영 (울산대학교 의과대학 영상의학과)
  • Received : 2010.05.06
  • Accepted : 2010.05.21
  • Published : 2010.08.01
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Abstract

Purpose: To evaluate the safety and the technical feasibility of the use of an endobronchial occlusion stent and to get preliminary data for the development of the optimal material required for endobronchial occlusions. Materials and Methods: A commercialized, self-expandable tracheobronchial stent was modified; one half had a polyurethane cover with an occluded end and the other half was uncovered with a flaring configuration. The occluded end was placed such that it would face the distal lung. Under fluoroscopic guidance, seven stents were placed at the lower lobar bronchus in 6 mini-pigs. The bronchial obstruction was examined immediately after stent placement. Chest radiographs were taken at days 1, 7, 14, and 28 after stent placement and the removed airways from two, two, one, and one mini-pigs sacrificed on corresponding days were examined for the maintenance of bronchial obstruction. Results: Stents were successfully placed and induced the immediate bronchial obstruction in all mini-pigs. Five of seven airways with occlusion stents maintained an obstruction until the mini-pigs were sacrificed. Proximal stent migration occurred in two mini-pigs (29%), and pulmonary consolidations were observed distal to four of the stents (57%). Conclusion: The placement of an endobronchial occlusion stent and the obstruction of targeted bronchi seem to be feasible, but an add-on check valve should be considered to prevent stent migration and obstructive pneumonia.

목적: 반이 덮인 기관지 폐쇄 스텐트가 안전하고 실제로 삽입 가능하며, 궁극적인 기관지 폐쇄 물질의 개발에 예비 자료를 얻기 위하여 연구를 시행하였다. 대상과 방법: 상용화된 자발성 팽창 기도기관지 스텐트의 디자인을 변형하여, 한쪽 끝과 그에 연결된 반쪽은 폴리우레탄으로 덮었으며, 나머지 반쪽은 폴리우레탄으로 덮지 않아 스텐트 철사가 노출되고 끝으로 가면서 벌어지도록 하였다. 스텐트의 막힌 끝은 설치할 때 원위부의 폐를 향하도록 하였다. 이 스텐트 7개를 투시 하에 6마리 돼지의 하엽 기관지에 설치하여 설치 직후 기관지 폐쇄 여부를 보았다. 설치 후 1일, 7일, 14일, 28일에 흉부단순촬영을 하였고, 각 날자마다 희생된 2, 2, 1, 1마리의 돼지에서 제거된 기관지가 계속 폐쇄되어 있는지 보았다. 결과: 7개의 스텐트 모두 성공적으로 설치되었고, 시술 직후 모두에서 기관지 폐쇄가 확인되었다. 7개중 5개 스텐트에서 희생 당시까지 기관지 폐쇄가 유지되고 있었다. 추적 중 2개의 스텐트가 상부 기관지로 이동되었고(29%) 4개의 스텐트 후방에 폐경결이 생겼다(57%). 결론: 기관지 폐쇄 스텐트 설치와 이로 인한 기관지의 폐쇄는 가능성이 충분히 보였지만 스텐트 이동과 폐쇄성 폐렴을 막기 위해 스텐트 내에 역류저지판막을 고려해야 할 것이다.

Keywords

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