| Objective:To evaluate the efficacy and safety of the intubation dilatation under flexible bronchoscopic guidance in management of benign tracheal stenosis.Methods:The clinical data about20patients with benign tracheal stenosis was analyzed,who were admitted to our department from October2007to August2011. There were9males and11females with a mean age of38±10years old (range:25～65). According to different interventional treatment,the patients were divided into two groups:group A with12patients were treated by intubation dilatation with different size under bronchoscopic guidance, and group B with10patients were treated by balloon dilatation. And metal stens were implantated when the severe airway stenosis or tracheomalocia would be occurred.Meanwhile, balloon dilatation were also performed for left or right main stem bronchial stenosis. Airway diameters, dyspnea index, blood gas analysis were evaluated in all patients and the forced expiratory volume in one second (FEV1) was tested in20cases before and after the treatment of intubation dilation, balloon dilation and others interventional therapy. Then postoperative20patients were all treated with budesonide atomization inhalation (3-6months), and amikacin were used if necessary, which can improve the bronchial inflammation.Results:1、The interventional treatment of group A and B:One to two attempts of intubation dilation were required to achieve dilatation in group A.There was immediate postoperative relief of dyspnea for12patients.And PaO2and SaO2rose markedly, but PaCO2declined after intubation dilatation. The effective rate of intubation dilation was of100%. The average airway diameter was increased from (5.9±1.2) to (12.2±2.1) mm. FEV1was improved from (0.67±0.13) to (1.73±0.37) L (P＜0.01). After one to three trials by high-pressure balloon dilation in group B,6patients were treated successfully.Dyspnea index was decreased from (3.6±0.5) to (0.4±0.5).The average airway diameter was increased from (5.8±1.6) to (10.1±2.8) mm. FEV1was improved from (0.62±0.17) to (1.36±0.41) L (P＜0.01).The results of two groups were analyzed by t-test which indicated that there were no significant differences between them (P＞0.05). 2、The short and long term curative effects and complications of group A and B:In group A,the recent clinical total efficiency was of100%,but of60%in group B.And respectively,the long-term efficacy were of81.8%,66.7%(P<0.05).Group A with12patients were all fully successful:the clinical symptoms obviously improved,but they felt more or less painful on their noses.During the operation,the spasm happened to2extremely weak patients.And3cases were suffered from the fungal infection.They were all better by the corresponding symptomatic treatment. In group B,2cases were lacerated wound of bronchea:1case with mediastinal emphysema,another one bled excessively(＞150ml). Immediately the hemostatics were used.With12-18months follow-up: In group A,10patiens were no obvious airway restenosis,but one patient’s left main bronchus dilation for many times were ineffectiveness,which demonstrated the focal area of dilated bronchi with bronchiectasis and recurrent infections,so pneumonectomy were treated.One other patient with the middle tracheal stenosis also dilated many times in vain, consequently trachea end to end anastomosis were treated.3of4cases who treated by metal stent after intubation formatted a great munber of granulation tissue around it in1-2months,then removed it by recoverer of stent, respectively, in3,6and8months under local anesthesia.One other lost follow-up,but no one was obvious narrow, collapse, softening. In group B,two patients airway pipe diameter were not stable, restenosis.One case was treated by metal stent after balloon dilatation, but a great munber of granulation tissue was formatted around the stent it, so stent was removed finally.Conclusions:The management of benign tracheal stenosis with intubation dilatation is minimally invasive, safe, effective and low cost. |
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