Tempororary Tracheal Nitinol Stenting For Severe Airway Stenosis Due To A Giant Mediastinal Seminoma: A Case Report And Its Literatures' Review

Objectives:To investigate the roles of temporary tracheal nitinol stenting for the severe extrinsic tracheal stenosis due to a giant mediastinal tumor which is chemo- and radiosensitive. And moreover, the indication of stenting, the time of stent removing,the selection of a proper stent and the management of the stent-related complications would be discussed.Methord:To respectively analyze the clinical information of a 23 years-old man with severe airway stenosis due to a gigant mediastianal seminoma who had been hospitalized in the first affiliated hospital of Guangxi Medical University in Nonvember 2008 and, besides combined with other documents'review.Results:1. After partially mediastinal seminoma resection, the patient's airway remained to be stenotic and prevented the endotracheal tube from inserting into the distant part of the trachea. And because of these,he couldn't be off-line.Not until a covered self-expanding hybrid nitinol stent had been implanted under bronchofibroscope location and instruction, could his severe dyspnea be relieved and the airway resistance decrease. And several days later, he could be separated off the mechanical ventilation successfully.2. His severe pneumonia was controlled by the vigorous antibiotic therapy and the supportive treatment. Then, followed by 3 cycle tumor-specific-chemo-therapy,the giant mediastinal tumors gradually became smaller and the stent could be removed when the airway reopened enough after the second cycle chemotherapy completed.After 3 cycle chemotherapy, he took the whole body diffusion weighted imaging test and the result was an exciting one.Up to now,it is more than 15 months after stenting,he has kept healthy.Conclusions:1. This case tells us that temporary stenting is a valuable way to help the patients get off the severe tracheal stenosis caused by chemo- and radiosensitive malignant mediastinal tumors,expecially when other methods don't work.2. The covered self-expandable hybrid nitinol stent which is easily to insert and remove is a good choice for the short-term insertion. Combined with the effective chemotherapy,the stent can be removed safely when computed tomographic scan of the chest/fibrobroscopy examination shows that the tumor has shrinked and the trachea can keep open without it.