The efficacy of interventional therapy for post-intubation tracheal stenosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZENG Zongding , SU Zhuquan , SUN Wan ,  LI Shiyue

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R.China;

Corresponding author：

LI Shiyue, Email: lishiyue@188.com

Keywords：

Tracheal stenosis; Intubation; Interventional therapy; Efficacy; Influential factors

DOI：

10.7507/1671-6205.201703034

Video：

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Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.

Citation： ZENG Zongding, SU Zhuquan, SUN Wan, LI Shiyue. The efficacy of interventional therapy for post-intubation tracheal stenosis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 367-370. doi: 10.7507/1671-6205.201703034 Copy

1.	Lorenz RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6): 467-472.
2.	李时悦, 苏柱泉. 插管后气管狭窄的危险因素及其处理. 中华结核和呼吸杂志, 2014, 37(8): 561-562.
3.	Wain JC. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg, 2009, 21(3): 284-289.
4.	叶俊, 方正, 李兵, 等. 经支气管镜介入治疗中心性气道狭窄. 中国呼吸与危重监护杂志, 2011, 10(4): 408-410.
5.	李多, 王文军, 孙鼎强, 等. 血管介入联合气道介入治疗晚期中央型肺癌中心气道重度狭窄. 中国呼吸与危重监护杂志, 2017, 16(1): 74-77.
6.	金发光, 傅恩清, 谢永宏, 等. 难治性中心气道狭窄的综合介入治疗. 中华结核和呼吸杂志, 2010, 33(1): 21-24.
7.	李时悦. 良性中央气道狭窄的介入治疗方法选择. 中华结核和呼吸杂志, 2011, 34(5): 329-332.
8.	LSMA. Textbook of respiratory medicine[M]. Philadelphia: Saunders, 1994.
9.	Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
10.	Bergler W, Honig M, Gotte K, et al. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation. J Laryngol Otol, 1997, 111(4): 381-384.
11.	谢冬, 姜格宁, 徐志飞, 等. 插管后气管狭窄的治疗进展. 中华胸心血管外科杂志, 2013, 29(3): 180-182.
12.	苏柱泉, 魏晓群, 钟长镐, 等. 良性气管狭窄 158 例病因及介入治疗疗效分析. 中华结核和呼吸杂志, 2013, 36(9): 651-654.
13.	Nouraei S A, Ghufoor K, Patel A, et al. Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope, 2007, 117(6): 1073-1079.
14.	Abbasidezfouli A, Shadmehr MB, Arab M, et al. Postintubation Multisegmental Tracheal Stenosis: Treatment and Results. Ann Thorac Surg, 2007, 84(1): 211-214.
15.	Nouraei SA, Petrou MA, Randhawa PS, et al. Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1086-1090.
16.	Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg, 2002, 22(3): 352-356.
17.	Wain JC. Postintubation tracheal stenosis. Chest Surg Clin North Am, 2003, 13(2): 231-246.
18.	Nouraei SA, Singh A, Patel A, et al. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope, 2006, 116(8): 1417-1421.

1. Lorenz RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6): 467-472.
2. 李时悦, 苏柱泉. 插管后气管狭窄的危险因素及其处理. 中华结核和呼吸杂志, 2014, 37(8): 561-562.
3. Wain JC. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg, 2009, 21(3): 284-289.
4. 叶俊, 方正, 李兵, 等. 经支气管镜介入治疗中心性气道狭窄. 中国呼吸与危重监护杂志, 2011, 10(4): 408-410.
5. 李多, 王文军, 孙鼎强, 等. 血管介入联合气道介入治疗晚期中央型肺癌中心气道重度狭窄. 中国呼吸与危重监护杂志, 2017, 16(1): 74-77.
6. 金发光, 傅恩清, 谢永宏, 等. 难治性中心气道狭窄的综合介入治疗. 中华结核和呼吸杂志, 2010, 33(1): 21-24.
7. 李时悦. 良性中央气道狭窄的介入治疗方法选择. 中华结核和呼吸杂志, 2011, 34(5): 329-332.
8. LSMA. Textbook of respiratory medicine[M]. Philadelphia: Saunders, 1994.
9. Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
10. Bergler W, Honig M, Gotte K, et al. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation. J Laryngol Otol, 1997, 111(4): 381-384.
11. 谢冬, 姜格宁, 徐志飞, 等. 插管后气管狭窄的治疗进展. 中华胸心血管外科杂志, 2013, 29(3): 180-182.
12. 苏柱泉, 魏晓群, 钟长镐, 等. 良性气管狭窄 158 例病因及介入治疗疗效分析. 中华结核和呼吸杂志, 2013, 36(9): 651-654.
13. Nouraei S A, Ghufoor K, Patel A, et al. Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope, 2007, 117(6): 1073-1079.
14. Abbasidezfouli A, Shadmehr MB, Arab M, et al. Postintubation Multisegmental Tracheal Stenosis: Treatment and Results. Ann Thorac Surg, 2007, 84(1): 211-214.
15. Nouraei SA, Petrou MA, Randhawa PS, et al. Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1086-1090.
16. Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg, 2002, 22(3): 352-356.
17. Wain JC. Postintubation tracheal stenosis. Chest Surg Clin North Am, 2003, 13(2): 231-246.
18. Nouraei SA, Singh A, Patel A, et al. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope, 2006, 116(8): 1417-1421.

Chinese Journal of Respiratory and Critical Care Medicine

The efficacy of interventional therapy for post-intubation tracheal stenosis

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