| BackgroundsAirway stenosis often have severe respiratory difficulties, even in patients with life-threatening. It usually induced by tracheal tumors, trauma, tuberculosis, long-term endotracheal intubation, as well as oppression and invasion of adjacent organs and caused tumors.It commonly used treatment methods over the past tracheal stenosis sleeves cut end to end anastomosis, tracheotomy ostomy, T-silicone tube implantation, etc., but the T-silicone tube implantation due to complications such as granulation hyperplasia incidence of restenosis, a very Gao, clinical use has been relatively small. At present more than ostomy tracheotomy to ease severe breathing difficulties as a contingency measure. The obstruction removal, reconstruction is the tracheal airway smooth operation purposes. In the past 40 years in the airway stenosis sleeve cut right side anastomosis has been formed, this procedure worked well, complications and mortality is very low. The past 20 years with the continuous improvement of endoscopic techniques, tracheal stent implantation, balloon dilation, laser resection, cryotherapy and other tracheal lumen stent-graft treatment has been gradually used in clinical treatment. Tracheal lumen stent-graft treatment has a short operating time, pain is relatively small, can quickly relieve shortness of breath and hypoxic condition and so on. But there are also reported in the literature because it can not fundamentally resolve the airway obstruction, and prone to restenosis, in which long-term efficacy is not ideal. This study was retrospective analysis of use of end to end anastomosis and endoscopic treatment of 53 cases of tracheal lumen stent-graft stenosis in patients with airway was to explore these two broad categories of pre-treatment methods in the treatment of the efficacy of airway stenosis.Objectives1. Investigate airway stenosis sleeve cut right-side anastomosis and endoscopic balloon dilatation and stenting in bronchoscope interventional treatment such as short-term efficacy and the long-term efficacy.2. we will be airway stenosis sleeve cut right-side anastomosis and endoscopic balloon dilatation and stenting in bronchoscope interventional treatment such as short-term efficacy and long-term efficacy in comparison, respectively, thereby to guide clinical decision-making process.Methods1. we collected in our hospital from February 1990 to February 2008 18 years end to end anastomosis and the use of tracheal lumen stent-graft treatment of a total of 53 cases of airway stenosis in patients with clinical data. And conduct follow-up retrospective analysis using a narrow-cut sleeve segment and the right-side anastomosis of endoscopic balloon dilation and stent implantation and so the prognosis of patients treated with tracheal lumen stent-graft.2. Through the operative mortality, airway open conditions (stenosis degree and shortness of breath immediately lift the index), as well as the incidence of early complications (hemoptysis, pneumothorax, pulmonary infection, chest pain, anastomotic fistula, pneumomediastinum, tracheal softening, throat dysfunction, etc.) to evaluate their short-term effect. Through the follow-up of patients after 1～204 (44.94±54.56) months, survival, breathing to improve the situation (dyspnea index) and restenosis rate (excluding tumor recurrence caused by restenosis), etc. to evaluate the long-term effect of them.3. Using SPSS 13.0 software, sleeve resection of the narrowed segment of the right-side anastomosis, and balloon dilation, stent placement treatment of three kinds of operative mortality, acute airway open and efficient, the recent incidence of complications, survival and re-stenosis rate of statistical analysis, usingχ2 test, P< 0.05 for the difference statistically significant.Results1. Three kinds of treatment of early postoperative airway and opening up The group of 53 cases of airway stenosis surgery in patients with no death cases. 26 cases with stenosis resection of right-side sleeve anastomosis in patients with postoperative anastomotic diameter of the airway near the normal difficulty breathing symptoms, shortness of breath index of 0-1 grade, immediate airway open and efficient 100%.14 cases with balloon angioplasty in patients with airway stenosis, in the anti-tuberculosis anti-infective after passing through the expansion of 1-5 times, in addition to two cases of recurrence of the original is still the airway restenosis, more than 12 cases of shortness of breath improved (0-1 grade), compared with the preoperative diameter stenosis increased (both "normal caliber 50%), instantly effective rate was 85.7%(12/14).13 patients with stent implantation in patients with postoperative airway diameter stenosis significantly increased than that before operation (both "normal caliber 50%), difficulty in breathing symptoms were significantly improved (shortness of breath index 0-1 grade), immediate airway an open and efficient 100%.Three kinds of treatment of early postoperative airway open and efficient were higher (x 2=3.899, P=0.123>0.05, no significant difference).2. Early postoperative complications of three treatment methods 26 cases with a narrow sleeve resection of right-side anastomosis of the patients 11.5%(3/26) occurred after pulmonary infection; 3.8%(1/26), anastomotic leakage occurred; 3.8%(1/26) appeared at the side of recurrent laryngeal nerve injury caused by drinking water, choking, hoarse voice; 11.5%(3/26) appeared pneumomediastinum.14 cases with balloon angioplasty in patients with airway stenosis,35.7%(5/14) occurred in patients with early postoperative small amount of bloody sputum; 28.6% (4/14) patients showed mild to moderate chest pain; 7.1%(1/14) appeared to soften the trachea.13 patients with stent implantation in patients with airway stenosis,7.7%(1/13) occurred after stent displacement; 7.7%(1/13) occurred after bloody sputum; 15.4% (2/13) after lung infection occurs; 7.7%(1/13) postoperative chest pain; 7.7%(1/ 13) occurred after tracheal softening; 7.7%(1/13) occurred after a hoarse voice, drinking water, choking, recurrent laryngeal nerve, etc. damage the performance.The above three kinds of treatment of early postoperative complications after the corresponding treatment and symptomatic treatment were quickly brought under control, no further development, and the low incidence of severe complications.3. Long-term efficacy of three treatment methodsLetters, phone calls and outpatient follow-up, follow-up 1 to 204 months (44.94±54.56).53 cases lost to follow-8 (anastomosis in 5 cases, balloon dilation in 2 cases, stent implantation 1 case), follow-up rate 84.9%(45/53).With end to end anastomosis in 21 cases(lost to 5 cases) of airway stenosis,1 tracheal squamous cell carcinoma of the next segment after 12 months in patients with multiple metastases died due to tumor; 2 cases (9.5%,2/21) after 3～3.5 (3.25±0.35) months in anastomotic scar restenosis.12 cases(lost to 2 cases) of use of transluminal balloon dilatation of airway stenosis, 6 patients (50%,6/12) after 1～2 (1.42±0.49) months in scar restenosis.12 cases (lost to 1 case) with stent implantation in patients with airway stenosis,3 patients (25%,3/12) at postoperative 1 month,1 month,3 months due to malignant airway Airway tumor progression of restenosis, death,6 patients (50%,6/12) after 1～36 (8.92±13.41) months, there stent placement at restenosis caused by granulation tissue hyperplasia.Three kinds of treatment methods (tracheal stenosis resection end to end anastomosis, balloon angioplasty and stent implantation) restenosis rate was 9.5%, 50%,50%, x2 test, the difference has a significant (x 2=8.869, P=0.012<0.05). Cut sleeve anastomosis stenosis surgery restenosis rate was significantly lower than stenting and balloon angioplasty of these two bronchoscope interventional therapy.ConclusionsBy 53 example uses a patient for the sleeves cut out the end of the art and in the intervening therapy the patient is the narrow passages of the analysis, we found: 1,Narrow section of sleeve cut on the end anastomosis, endoscopic balloon dilatation and stenting of the three treatments than narrow immediate lifting of a significant degree, chest tightness, shortness of breath and other symptoms can immediately ease, and early postoperative severe low complication rate. Term efficacy of three treatments were significant.2,With the improvement of surgical techniques can be used to fit absorption lines, to avoid the long line of junction formation in chronic inflammatory granulation stimulation, so that on the end anastomosis without complications in cases of long-term patency rate of almost 100%, the current airway narrow resection anastomosis restenosis rate was significantly lower than balloon angioplasty and stenting Endovascular treatment of these two methods, which is more ideal long-term efficacy. Balloon dilatation of the lumen as easily retracted, usually the first treatment is difficult to achieve the best therapeutic effect, and stent placement for airway is open access, dust, bacteria and other easily deposited on both ends of the stent and tracheal mucosa chimeric Department, so that it had infected inflammation, then stand becomes infected foreign body, airway inflammation repeatedly stimulated easily lead to support both ends of the excessive proliferation of granulation tissue causing luminal restenosis and other reasons, including long-term efficacy is not ideal. Therefore, we believe that airway resection anastomosis in treatment of airway stenosis should be the first choice.
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