Objective To identify the short ( lt;30 days) and intermediate ( 30 days to 6 months) benefits and risks of tracheobronchial stents in patients with malignant airway stenosis. Methods 55 cases with malignant airway disease who underwent tracheobronchial stents placement from January 2006 to May 2008 were followed up for 6 months. The efficacy rate, complication rate, reintervention rate, and survival were analyzed. Results There were 61 self-expanding metal stents placed in 55 patients with malignant disease, with no intraoperative mortality. The immediate efficacy rate was 100% , the short-term( lt;30 days) efficacy rate was 94. 5% , and the survival rate in 6 months was 32. 7% . The complications included tumor ingrowth, excessive granulation tissue, stent migration, and restenosis. A total of 14 cases of complicationswere observed, in which two occurred during the short-term period ( lt; 30 days ) and the remaining complications occurred after 30 days. Conclusions Tracheobronchial stents can improve symptoms immediately for the patients with unresectable malignant central airway obstruction with fairly safety. The benefit of airway stents is particularly seen in the short-termperiod and the complications occur mainly after 30 days.
Objective To explore the diagnosis and treatment of airway involvement in relapsing polychondritis. Methods The clinical data of two patients with relapsing polychondritis with airway involvement were reported and the relative literatures were reviewed. Results The two patients were both old males, with clinical manifestations of cough, dyspnea, and fever. They were misdiagnosed in a other hospital. The pulmonary function tests showed obstructive ventilatory impairemnt. On inspiratory CT, tracheal / tracheobronchial wall thickening and airway stenosis, with or without tracheal cartilage calcification were common findings. The tracheal cartilages thickeness and membranous wall were normal. On expiratory CT scans, functional abnormalities were identified such as tracheobronchomalacia. The patients were relieved by medication of corticosteroids or with immunodepressant. Conclusions The relapsing polychondritis with airway involvement is easy to be misdiagnosed. Chest CT examination is a valuable method for diagnosis of relapsing polychondritis. Corticosteroids and immunodepressant can improve the outcome.
Malignant airway stenosis generally refers to airway lumen stenosis caused by various primary and metastatic malignant tumors and restricted airflow, which can be manifested as dyspnea to varying degrees or even asphyxia and death. It seriously affects the quality of life of patients with airway stenosis. With the continuous development of bronchoscope interventional techniques, various interventional therapies such as ablation, dilation and stent implantation can be used to reventilate the airway. Among them, ablation treatment is the most commonly used method. The methods of ablation treatment include cold, heat, photodynamic, local chemoradiotherapy, etc. This article will review the new applications of various methods used in the ablation treatment of malignant airway stenosis progress.
Objective To investigate the indications, procedures, risks and efficacy of extracorporeal membrane oxygenation (ECMO) in bronchoscopic interventional surgery for patients with severe airway stenosis. Methods Retrospective analysis was performed on 6 patients with severe airway stenosis treated by bronchoscopic surgery under ECMO in West China Hospital from January 2018 to July 2021, and the experience of application was summarized in combination with 23 relevant literatures retrieved. Results Six patients on ECMO successfully completed bronchoscopic interventional surgery with satisfactory intraoperative oxygenation and no obvious hemostasis difficulties were observed. ECMO placement was as an emergency medical countermeasure in 3 patients while the other 3 patients were as preventive purpose. Following treatment, the shortness of breath index and mMRC score decreased and the patients were cured and discharged. During hospitalization, 3 patients had lower extremity deep vein thrombosis, and 1 patient with lower extremity swelling and pain, which was relieved after treatment with low molecular weight heparin. During discharge follow-up, 1 patient died due to airway stenosis, pulmonary infection, and subarachnoid hemorrhage secondary to cardiopulmonary resuscitation, while the other 5 patients did not show any worsening of dyspnea. Combined with the retrieval of 46 similar cases reported in the literature before 2020, it was concluded that these patients who met the application indications of ECMO and followed the shutdown procedure had a good prognosis and controllable risk. Conclusions ECMO can ensure the safety of patients with severe airway stenosis who need undergoing bronchoscopic interventional surgery for patients, improve the success rate of the operation and do not significantly increase the risk of bleeding. However, ECMO is difficult to operate and requires professional team management. Therefore, it is essential to master the indications of application, implement strict withdrawal procedures and necessary monitoring to improve the patient's cure rate and reduce the occurrence of adverse events.