Management Of Benign Tracheal Stenosis By Small-Diameter Tube-Assisted Bronchoscopic Balloon Dilatation

Purpose:To assess the efficacy and safety of management of benign tracheal stenosis by small-diameter tube-assisted bronchoscopic balloon dilatation(BBD).Methods:Small-diameter tube-assisted BBD was performed in 26 patients with benign tracheal stenosis at the first affiliated hospital of Guangxi Medical University from Junaury 2011 to October 2014. The tracheal diameter, dyspnea index, blood gas analysis results and complications were evaluated before and after BBD at each procedure. Some endoscopic interventional techniques, such as electrocautery, argon plasma coagulation(APC), cryotherapy, stent implantation, were needed when necessary. To prevent restenosis, aerosol inhalation of budesonide or local injection of triamcinolone acetonide, removal of necrotic tissue and anti-infection were recommended during each procedure.Results:Twenty-six patients with benign tracheal stenosis following small-diameter tube-assisted BBD were included into our present study. Sixty-three(Range 1-7 times, mean 2.4 ± 1.4 times) BBD procedures were performed in 26 patients: Dyspnea immediately improved in all patients after BBD. The tracheal diameter significantly increased from [5.53 ± 1.51 to 12.96±1.32mm (p< 0.001)], and the dyspnea index significantly decreased from[3.43±0.82 to 0.48±0.56 (p< 0.001)]. There was no significant change in the partial pressure of oxygen during the operation [before,102.50 ±27.47mmHg; during,96.92±30.39 mmHg; and after, 97.19±21.52 mmHg; (p= 0.364)], but there was slight, temporary retention of carbon dioxide during the operation [before,43.54± 4.19mmHg; during,49.39±6.83 mmHg; and after,40.07±3.89mmHg; (p< 0.001)]. The initial cure rate of the 63 procedures was 100%. During a 12 months’follow-up after the last dilatation procedure, the final outcome of BBD showed a cure rate of 46.2%(12 patients), effective rate of 34.6%(9 patients), and failure rate of 19.2%(5 patients), theiong-turn overall effective rate was 80.8%. Three of the fine treatment failed patients received surgical treatment of trachea resection and end-to-end anastomosis, two patients still receive repeat BBD and stent placement alternately.Conclusions:1.Small-diameter tube-assisted BBD is an effective and safe method for the management of benign tracheal stenosis.2.Carbon dioxide retention was existed temporarily during procedures and close attention must be payed to possible development of adverse effects caused by carbon dioxide retention.