Clinical Evaluation Of Bronchoscopic Interventional Treatment In Post-Intubation Or Post-Tracheostomy Tracheal Stenosis

Objective:To investigate the way of bronchoscopic interventions,efficacy and safety of bronchoscopic interventional treatment for patients with tracheal stenosis after tracheal intubation and tracheotomy with granulation hyperplasia and scar stenosis.Methods:We retrospectively analyzed the clinical data and the bronchoscopic interventions of 53 patients who underwent bronchoscopic interventional treatment in post-intubation or post-tracheostomy tracheal stenosis between July 2010 and July 2020 in our hospital.Firstly,General information(age,gender,smoking history and primary disease),the degree of stenosis,the type of stenosis and the bronchoscopic interventions were collected.Then,the change of oxygen saturation,heart rate,respiratory rate,tracheal diameter,m MRC scores and KPS scores was collected before and after the treatment.Finally,we elevated the efficacy and safety of this treatment.Results:We found the interventional treatment using bronchoscopy is different for those patients with different type of tracheal stenosis by the retrospective analyzing of the clinical data and the bronchoscopic interventions of 53 patients.The cryoablation was applied to hyperplasia of granulation tissue(the degree of stenosis<50%;Group A1),and thermal ablation,cryoextraction and cryoablation were applied to hyperplasia of granulation tissue(the degree of stenosis>50%;Group A2).Scar hyperplasia(Group B)was treated by the combine balloon dilatation with cryoablation,thermal ablation and local drug therapy(Triamcinolone).In short-term,trachea diameter(4.82±2.07 mm to 9.71±1.92mm)and SpO2(94.09±3.83% to97.17±2.00%)had increased,and respiratory rate(22.98±3.67 /min to19.58±1.20 /min)and heart rate(97.25±22.34 /min to 81.79±10.59 /min)had decreased before and after treatment.In long-term,trachea diameter and KPS score(27.71±18.71 to 60.00±21.33)had increased,and m MRC score(3.29±0.78 to 1.25±0.76)had decreased.20 cases(37.7%)and 11cases(20.8%)occurred restenosis after 1 and 3 months(3 cases and 1 case in Group A1,5 cases and 2 cases in Group A2,12 cases and 8 cases in Group B).After 1 year,19,22,4 and 8 cases were effective,partly effective,mild effective and ineffective,respectively.In these cases,the overall effective rate is 84.9%(100% in Group A1,83.3% in Group A2 and 80.6%in Group B).During treatment,3 patients suffered bleeding on the wound surface,and 2 cases suffered decreased blood oxygen saturation.No obvious drop in blood pressure and arrhythmia occurred.Conclusion:The suitable way of interventional treatment using bronchoscopy should depend on stenosis type.Ablation is suitable for hyperplasia of granulation tissue(the degree of stenosis<50%)and thermal ablation,cryoextraction and cryoablation are also suitable for hyperplasia of granulation tissue(the degree of stenosis>50%).As for scar hyperplasia,balloon dilatation is the first choice.Sometime,the combine balloon dilatation with cryoablation and thermal ablation maybe achieve a good outcome.However,the longterm results and reducing the stenosis after treatment deserve further study.