| Purpose:Endoscopic removal of airway stents is one of the difficult and risky procedures in interventional respiratory medicine,with many complications.Endotracheal stent removal procedure should be considered when Stent related complications that cannot be relieved by conventional interventional respiratory therapy or when the stents lose its therapeutic effect.At present,the methodology of the procedure,the influencing factors that may affect the number of stent removal methods,the correlation factors of the methods and the complications related to the procedures are not in-depth research.The study aimed to investigate the methodology of airway stents removal and the complications related to the procedure with the retrospective study.Methods:A total of 104 patients who received airway stents removal procedure in Public Health Clinical Center Affiliated to Shandong University from April 2015 to March 2021 in this study.Based on the elucidating of the procedure method of airway stent removal,to investigate the influencing factors that may affect the number of stent removal methods,the correlation factors of the methods were explored through statistical analysis of the demographic data,endotracheal stent characteristics,stentrelated complications of the included patients.A predictive model for the number of airway stent removal methods was developed,and the Bootstrap method(selfsampling 1000 times)was used to internal verification of the model,and the external data set was used to external verification of the model to test the prediction ability of the model.Results:The 104 patients in this study,including 56 males(53.80%)and 48 females(46.20%):The age distribution was 15～84 years old,and the median age was 54 years old(34.50,64.50).The patients were divided into two groups:≤2 methods used to remove the airway stent successfully was 71 cases(68.27%)and>2 methods used to remove the airway stent successfully was 33 cases(31.73%).The cause of patients with airway stenosis was benign airway stenosis in 57 cases(54.81%)and malignant airway stenosis in 47 cases(45.19%).The median time of indwelling airway stent in the body was 131.00 days(54.50,369.00).The metallic airway stents were 67 cases(64.42%)and silicone stents were 37 cases(35.58%).There were 86 cases(82.70%)of straight-barreled(1-shaped)stents in the airway and 18 cases(17.30%)of bifurcated(Y-shaped)stents.There were 26 cases(25.00%)of non-fully coated stents and 78 cases(75.00%)of fully covered stents.There were 23 patients(22.12%)with stent migration and 81(77.88%)without stent migration.There were 3 cases(2.88%)of stent structure damage,and 101 cases(97.12%)of no damage.The granulation tissue or tumor tissue formation degree score of the stent was 3.00(1,00,4.00).The stent-related cicatricial tissue formation score was 0.00(0.00,1.00).The variables of P<0.05 in univariate analysis were included in Logistic multivariate regression analysis,and it was found that the granulation tissue or tumor tissue formation degree score of the stent and the stent-related cicatricial tissue formation score were the influencing factors of the number of airway stent removal methods.The variables of P<0.05 in univariate analysis were included in Logistic multivariate regression analysis,and the backward stepwise regression method was used to develop the predictive model for the number of airway stent removal methods.The AUC value of the ROC curve was 0.975(95%CI 0.941-0.997)for internal verification of the model using the Bootstrap method,and the AUC value of the ROC curve was 0.935(95%CI:0.856-0.995)for external verification,and the calibration and clinical applicability of the model were good.The study of the factors related to the types of airway stent removal methods showed that the types of removal methods were positively correlated with stent related complications and stent characteristics.In this study,104 patients had airway mucosal bleeding during stent removal,18 cases(17.31%)had stent distortion and deformation,2 cases(1.92%)had airway cartilage damage,56 patients(53.85%)had airway collapse,and 45 cases(43.27%)had hypoxemia.In this study,104 patients had airway collapse(27.88%),80(76.92%)had airway mucosal necrosis formation within three days after stent removal,and 0 patients had airwayassociated fistula.Conclusion:1、The degree of granulation tissue or tumor tissue formation and the degree of stentrelated cicatricial tissue formation significantly influenced the number of airway stents removal methods.The predictive model developed by univariate analysis of this study performed well in predicting the number of methods of airway stent removal,calibration,and clinical applicability.2、The degree of granulation tissue or tumor tissue formation and the degree of stent associated scar tissue formation were the key factors determining the type of stent removal method.3、The statistical analysis of complications related to stent removal found that the most commonly intraoperative complications of airway stent removal was airway mucosal hemorrhage,and the occurrence of intraoperative complications was related to the material of the stent,the degree of granulation tissue or tumor tissue formation of the stent,the degree of scar tissue formation associated with the stent and the type of method used in stent removal.4、The most commonly postoperative complications that occurred within three days after the procedure was airway mucosal necrosis. |
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