Clinical Analysis Of Twenty Cases Of Tracheobronchial Stent Insertion And Balloon Dilatation In The Treatment Of Benign Tracheal Stenosis

Objective:To analyse curative effect and security of balloon dilatation and insertion of tracheobronchial covered metallic stent in the treatment of benign tracheobronchial stenosis guided by flexible bronchoscopy,to explore the more suitable method for benign tracheobronchial stenosis.Methods: The clinical data about 20 patients with benign tracheobronchial stenosis was analyzed,who were admitted to the second affiliated hospital of Hebei medical university from 2012 to 2014.There were 12 males and 8 females aged 19 to 71 years old.According to different interventional treatment,the patients were divided into two groups,which is balloon dilatation group and tracheobronchial stent insertion group,10 patients in each group.Balloon dilatation group: 6 patients after tracheotomy or tracheal intubation, 3 patients after tracheobronchial tuberculosis, 1 patient after airway burn.Stenting group:7 patients after tracheotomy or tracheal intubation,2 patients after tracheal tuberculosis,1 patient after airway burn.There were no significant statistical differences in both groups in age, sex, etiology, preoperative airway diameter and narrow area. After 6 months of follow-up, we observed airway diameter, dyspnea index, complications before and after treatment in both groups.Results: In balloon dilatation group, dyspnea symptom alleviated after treatment with balloon dilatation in 9 cases of 10 patients.It didn’t appear such as balloon blocking the airway because of sliding,mediastinitis, pneumothorax, pneumomediastinum and other serious complications in balloon dilatation group. After balloon dilatation treatment, 1 case of patients suffered chest pain, the incidence of 10%(1/10), the patient suffered chest pain intraoperatively and postoperatively, but to a less degree of chest pain, don’t need to deal with, 1-2 days after operation the pain disappeared.2 cases had wound bleeding complications, the incidence of 20%(2/10), we use 1:10 000 adrenaline in local infusion during the operation,the postoperative symptom characterized by blood in phlegm, quantity was less, the symptom of blood in phlegm disappeared after giving oral hemostatic drug in 2-3 days. The reasons of complications may be mild tear of tissues, bronchospasm by balloon dilatation, etc.We found patients can only adhere to the breathless time of 15 to 30 s during the dilatation.The patients couldn’t hold out to enough time in balloon dilatation group,Therefore the operation was limited in different degrees,its therapeutic effect was hindered. In stenting group,the procedures of tracheobronchial stent insertion were successfully performed in all of the patints. Stent migration happened in 1 case of patients,we replaced another stent after removing timely.Granulation tissue formation and pulmonary infection happened in 1 case of patients 1 month after operation. We gave cryoablation and argon plasma coagulation to remove granulation tissue as well as anti-infection,phlegm and other symptomatic treatment. However, all of patients were in stable condition,curative effect hadn’t been affected. Serious complications such as perforation in airway and stent fracture hadn’t occured.Stents were successfully removed under local anesthesia in all the patients two months later.There were statistically significant differences improvement in stricture diameter before and after treatment.Dyspnea index was also decreased in both groups. Compared with balloon dilatation group, stricture diameter was higher, dyspnea index was lower in stent insertion group.There were statistical significant differences between them.And restenosis rate in stent insertion group was lower than the balloon dilatation group,but there were no statistical significant differences between them.Patients improved respiratory symptoms and pulmonary ventilation function postoperation, the original narrow section in airway was expanded, dyspnea index was decreased, immediate effect was better. But expanded tube cavity wall has certain elasticity, will appear different degree of retraction after treatment,must be expanded repeatedly as required to keep the airway open, patients need to suffer in the process of treatment for many times, and there are some differences between long-term and short-term effect, long-term effect is difficult to maintain. In stent insertion group, there was immediate effect significantly, airway could be restored quickly, airway obstruction was elimated, curative effect was ideal for patients with respiratory symptoms and pulmonary ventilation function improved.To evaluate curative effect and complications of both groups,there was a more significant effect in stenting group than in balloon dilatation group, the restenosis rate was lower in stent placement group than in balloon dilatation group, the long-term curative effect is superior to the balloon dilatation group.Compared with balloon dilatation, covered metallic stent may has the following advantages: the stronger braced force and expansionary force.It is easier to shape in the narrow section.Expansion of time is longer.Stent insertion technique is more quick and convenient for mixed type narrow lesions and airway stenosis which is too long.Patients experience less pain,are more tolerant without choking feeling. Incidence of serious complications is lower such as pneumothorax,mediastinitis and pneumomediastinum.Conclusion: Temporary placement of covered metallic stent is safe,effective and less complications method in the treatment of benign tracheobronchial stenosis.The effect is superior to the balloon dilatation treatment.It is worthy of clinical promotion and popularization.