The Effect And Safety Of Bronchoscopic Injection With Triamcinolone Acetonide Combined With Convention Interventional Modalities For Refractory Benign Central Airway Stenosis

Background and Objective:Benign central airway stenosis means ststenosis caused by benign lesions in central airways (include tracheacen, left main bronchi,right main bronchi and right middle bronchial). Its etiology is complex, with benign hyperplastic scar stenosis is the most common type. The underlining etiologies for benign airway stenosis (BAS) were tuberculosis(TB),prolonged orotracheal intubation or tracheotomy,inhalation burns etc. balloon dilatation(BD), laser photo-resection(LPR), self-expanding metal stent placement (MSP) are frequently-used treaments for BAS.Utilization of interventional methods through flexible bronchoscopy is effective in treating BAS in the near future,whereas the forward curative effect decreased due to restenosis by local tissue proliferation, repair and scar formation and demanded further interventional therapy.Triamcinolone Acetonide is a synthetic glucocorticoid with strong and long-lasting anti-inflammation effect and anti-allergy effect. It can effectively restrain white blood cell and macrophages transitions to vascular lesions, against the local allergy and inflammation, and the adverse reactions such as fibroblasts DNA replication, granulation tissue and scarring. Local injection of TA makes drug directly role in the target site and the pathological mechanism of TA inhibits scar tissue growth is that it restrains fibroblasts hyperplasia, reduces collagen synthesis, also increases the collagen enzyme activity, accelerates the collagen fiber and matrix-degrading. At present TA used in cosmetology, esophagus and rectal stenosis, treatment of ophthalmology disease by prevention and control of scar tissue has achieved remarkable results.TA injection therapy provides a new hope for treatment of benign central airway stenosis.With the continuous development of interventional techniques, combined multiple interventional procedures are used for benign central airway stenosis. This research is the first application of TA injection in local lesion therapy combined traditional interventional techniques for BAS. To evaluate the efficacy of local injection of TA combined multiple interventional procedures through flexible bronchoseop observation for curative effect and possible side effects. The results will help exploring a new method of BAS therapy, and solve the BAS restenosis after treatments, reduce the patients suffering, medical expenses, save social medical resources ,which have widely application value.Methods:20 patients with intractable benign central airway restenosis after treated by repeatedly traditional interventional treatment in our hospital between January 2008 to December 2010 were retrospectively analyzed. Stenosis causes,types,position,degree and duration,or functions of distal lung tissue and airway were evaluated by bronchoscopy, bronchial spiral CT 3D reconstruction, Clinical manifestations. Local injection of TA was uesd to cover entire stenosis lesions. Two or more procedures (including laser photo-resection, high-frequency electrotome and argon plasma coagulation, freezing, balloon dilatation) were combined to manage complicated airway stenosis. After a 6 months follow-up, compared to before and after the treatment of airway diameter, airway stricture rate, dyspnea score, interphase of interventional treatment and clinical stabilization, fasting blood glucose, plasma cortisol, injection local mucosal and clinical symptoms, evaluated its curative effect and side effect . Result:20 cases of patients with intractable benign central airway stenosis (including post-endotracheal intubation 5 cases, tuberculous granuloma stenosis 6 case, restenosis after stent placement 3 cases, trauma 2 cases, post-tracheostomy 2 cases, bronchial stenosis after surgery 2 cases) were treated and the total short-term effective rate in the 20 patients was 100%.The airway diameter was increased from (3.10±1.83)mm before operation to (9.30±2.34)mm after operation (P<0.01). Stricture rate was decreased from(77.08±13.63)% to (26.82±12.69)% (P<0.01). Dyspnea score was decreased from (3.45±0.51) before operation to (0.35±0.49) after operation (P<0.01). A 6 months follow-up, 16 patients remain stable after treatment , besides 4 patients appear restenosis. 16 patients, did not appear restenosis; Four patients appear restenosis. Restenosis interphase time or Clinical stationary time was increased from (10.95±5.49)days before the therapy to(98.75±55.58)days after therapy of local injection of TA(P<0.01). None of the twenty patients appear local injections related complications, observation period, cortisol levels remain normal without glucocorticoids related serious complications.Conclusions:Local injections of TA therapy combined with traditional interventional techniques (including laser photo-resection, high-frequency electrotome and argon plasma coagulation, frozen, balloon dilatation) for BAS has good curative effect. It shows advantages of few side-effects, and good safety. It would be a new hope to solve intractable benign airway stenosis. And its long-term efficacy and related mechanism need further observation and study.