Rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WU Xiuxiu , WANG Ting , WANG Juan , JIN Beibei , QIU Xiaojian ,  ZHANG Jie

Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, P. R. China;

Corresponding author：

ZHANG Jie, Email: zhangjie6218@163.com

Keywords：

Emergency bronchoscope; interventional therapy; malignant airway stenosis; rescue process

DOI：

10.7507/1671-6205.202209042

Video：

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Objective To explore the rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis and to share the treatment experience. Methods The critical patients with malignant airway stenosis who needed urgent bronchoscopic interventional therapy from January, 2007 to January, 2022 in Beijing Tiantan Hospital Affiliated to Capital Medical University were selected. The demographic and clinical data of intra-and-post the operation were collected. The rescue value and safety of emergency bronchoscopic intervention in the critical patients with malignant airway stenosis were evaluated, and the rescue process was summarized. Results Forty-three patients were enrolled in the study, including 26 males and 17 females, with an average age of (61.6±11.4) years, including 20 cases of primary lung cancer and 23 cases of other malignant tumors; The main type of stenosis was endogenous (26 cases, 61.90%), followed by external pressure (12 cases, 28.57%) and mixed (4 cases, 9.52%) type. The stenosis site was almost the central airway (41 cases, 95.35%), and the main anesthesia method was general anesthesia (37 cases, 86.05%); Emergency bronchoscopic interventional therapy included local resection in 27 cases (62.79%), stent implantation in 12 cases (27.91%), exploration in 2 cases (4.65%), tumor biopsy in 1 case (2.33%), and adjustment of stent position in 1 case (2.33%); The dyspnea score and the degree of airway stenosis decreased significantly after interventional therapy (P<0.01); intraoperative complications occured in 21 cases and bleeding (19 cases) was the commonest one, short term postoperative complications occurred in 3 cases, including respiratory depression, glottic edema and airway spasm, respectively. Conclusions Emergency bronchoscopic interventional therapy can quickly and effectively alleviate the severe airway obstruction caused by malignant tumor, and win time for the follow-up comprehensive treatment of tumor, but it needs close team cooperation and standardized rescue process.

Citation： WU Xiuxiu, WANG Ting, WANG Juan, JIN Beibei, QIU Xiaojian, ZHANG Jie. Rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(10): 715-719. doi: 10.7507/1671-6205.202209042 Copy

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2.	Aktaş Z, Öztürk A, Yılmaz A, et al. Complications of silicone Y stents placed due to malignant airway stenosis. Tuberk Toraks, 2019, 67(1): 22-30.
3.	Gershman E, Guthrie R, Swiatek K, et al. Management of hemoptysis in patients with lung cancer. Ann Transl Med, 2019, 7(15): 358.
4.	Guibert N, Mhanna L, Droneau S, et al. Techniques of endoscopic airway tumor treatment. J Thorac Dis, 2016, 8(11): 3343-3360.
5.	孙凤英, 龚正华. 经支气管镜冷冻治疗良、恶性气道狭窄的护理配合. 山东医药, 2014, 54(20): 107-108.
6.	中华医学会呼吸病学分会. 良性中心气道狭窄经支气管镜介入诊治专家共识. 中华结核和呼吸杂志, 2017, 40(6): 408-418.
7.	Scarlata S, Fuso L, Lucantoni G, et al. The technique of endoscopic airway tumor treatment. J Thorac Dis, 2017, 9(8): 2619-2639.
8.	Wood DE. Management of malignant tracheobronchial obstruction. Surg Clin North Am, 2002, 82(3): 621-642.
9.	Okiror L, Jiang L, Oswald N, et al. Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival. Ann Thorac Surg, 2015, 99(5): 1725-1730.
10.	Tanigawa N, Kariya S, Komemushi A, et al. Metallic stent placement for malignant airway stenosis. Minim Invasive Ther Allied Technol, 2012, 21(2): 108-112.
11.	Routila J, Herhi E, Korpi J, et al. Tracheobronchial stents in patients with malignant airway disease: Finnish tertiary care experience. Interact Cardiovasc Thorac Surg, 2021, 33(4): 557-563.
12.	Chen YC, Xian ZX, Han SH, et al. A first-aid fast track channel for rescuing critically ill children with airway foreign bodies: our clinical experience. BMC Emerg Med, 2021, 21(1): 85.
13.	裴迎华, 张杰, 党斌温, 等. 经气管镜介入治疗气管腺样囊性癌. 国际呼吸杂志, 2011, 31(4): 249-251.

1. Colchen A, Fischler M. Emergency interventional bronchoscopies. Rev Pneumol Clin, 2011, 67(4): 209-213.
2. Aktaş Z, Öztürk A, Yılmaz A, et al. Complications of silicone Y stents placed due to malignant airway stenosis. Tuberk Toraks, 2019, 67(1): 22-30.
3. Gershman E, Guthrie R, Swiatek K, et al. Management of hemoptysis in patients with lung cancer. Ann Transl Med, 2019, 7(15): 358.
4. Guibert N, Mhanna L, Droneau S, et al. Techniques of endoscopic airway tumor treatment. J Thorac Dis, 2016, 8(11): 3343-3360.
5. 孙凤英, 龚正华. 经支气管镜冷冻治疗良、恶性气道狭窄的护理配合. 山东医药, 2014, 54(20): 107-108.
6. 中华医学会呼吸病学分会. 良性中心气道狭窄经支气管镜介入诊治专家共识. 中华结核和呼吸杂志, 2017, 40(6): 408-418.
7. Scarlata S, Fuso L, Lucantoni G, et al. The technique of endoscopic airway tumor treatment. J Thorac Dis, 2017, 9(8): 2619-2639.
8. Wood DE. Management of malignant tracheobronchial obstruction. Surg Clin North Am, 2002, 82(3): 621-642.
9. Okiror L, Jiang L, Oswald N, et al. Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival. Ann Thorac Surg, 2015, 99(5): 1725-1730.
10. Tanigawa N, Kariya S, Komemushi A, et al. Metallic stent placement for malignant airway stenosis. Minim Invasive Ther Allied Technol, 2012, 21(2): 108-112.
11. Routila J, Herhi E, Korpi J, et al. Tracheobronchial stents in patients with malignant airway disease: Finnish tertiary care experience. Interact Cardiovasc Thorac Surg, 2021, 33(4): 557-563.
12. Chen YC, Xian ZX, Han SH, et al. A first-aid fast track channel for rescuing critically ill children with airway foreign bodies: our clinical experience. BMC Emerg Med, 2021, 21(1): 85.
13. 裴迎华, 张杰, 党斌温, 等. 经气管镜介入治疗气管腺样囊性癌. 国际呼吸杂志, 2011, 31(4): 249-251.

Chinese Journal of Respiratory and Critical Care Medicine

Rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis

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