Study On The Role Of Montgomery T Tube In The Postintubation Tracheal Stenosis

Backrounds and aims:Benign airway stenosis refers to the variety of tumor diseases with airway stenosis caused by damage to the airway wall,which can lead to different degree of symptoms such as cough,sputum,dyspnea and so on.It seriously affects the patients' quality of life,and even results in death because of the respiratory failure.The leading causes include:long-term endotracheal intubation and tracheotomy,trachea-bronchial tuberculosis,trauma,and so on.With the advancement of critical care medicine,surgical operation technology,more and more patients require respiratory support.It leads to increased benign airway stenosis secondary to endotracheal intubation and tracheotomy.Long-term tracheostomy tends to increase the risk of respiratory infections,trachea hemorrhage,airway restenosis,atresia of airway and aphasia.Formerly the treatment for these diseases is mainly limited to surgical resection of involved tracheal followed with reconstruction.But only the selected patients with good conditions can be safely surgically operated.They have to get over many perioperative complications.It also takes longer time for those patients to recover,especially that with pulmonary infection,or central nervous system dysfunction.So this traditional surgery is not suitable for those patients.With the rapid development of interventional therapy,many endoscopic interventional treatments are prevailing,such as laser,balloon expansion,freezing,stents and so on.This means benign airway stenosis patients after tracheotomy can reveive safer and effective treatments.But these methods could only solve part of patients' benign center airway stenosis.For endotracheal intubation or tracheotomy patients that have subglottic airway stenosis,limited benefits have been witnessed.So we need to find a new treatment which is minimally invasive,well-tolerated,with a good prognosis.Montgomery T tube is gradually applied in clinical due to its high safety,good histocompatibility,and low incidence of airway restenosis.But because its placement should be under the rigid bronchoscope,and needs to be combined with cutting of granulation tissues,tracheal balloon expansion,or rigid bronchoscope mechanical expansion.So the interventional therapy requires high skills,and is limited to some qualified medical centers.This research summarized the application of Montgomery T tube in the treatment of benign airway stenosis after endotracheal intubation or tracheotomy in one hospital,with focus on preoperative evaluation,surgical risks,surgical procedure,complications and clinical outcomes.Methods:This study retrospectively reviewed 15 patients with benign airway stenosis after endotracheal intubation or tracheotomy.They underwent Montgomery T-tube implantation therapy between September 2015 and May 2017 in Sir Run Run Shaw Hospital,affiliated with Zhejiang University.Their ages range from 20 to 71 years old,including 10 male and 5 female in sex.The diagnosis is based on chest CT scan and bronchoscopy.The clinical data including clinical features,efficacy,complications and the prognosis were retrospectively assessed.Complete airway atresia was seen in 7/15 patients,all the seven patients were unable to speak.Partial stenosis presented in 8/15 patients.The majority of patients had different degrees of anxiety.Hamilton anxiety rating scale,6MWT,mMRC were adopted to evaluate patients' preoperative status.All the 15 cases underwent the treatment of Montgomery T tube under the rigid bronchoscope.There were 10/15 patients had airway granuloma and endoscopic granulation resection was performed.Endoscopic balloon dilatation was performed in 12/15 patients with scar stenosis.The seven patients with airway completely atresia were implanted with the T tube assisted by otolaryngology doctors.Vocalization ability,HAMA,6MWT,mMRC score were assessed again after the therapy.Results:There were 15 benign airway stenosis cases of Montgomery T-tube placement.Repatency and vocalization were successful in 14/15 patients.Only 1/15 remained dysphonia because of the vocal cord paralysis.Finally 5/15 cases successfully had the T-tube removed,and airway restenosis was occurred in 1 case after the removal.The rest of the 4 cases were in a good sustainsable condition.During the follow-up period 10/15 cases remained stable after the T-tube placement.There were no significant differences in 6MWT,mMRC score between T-tube and tracheotomy groups.While HAMA score of T-tube group decreased significantly from 22.7±5.7 to 13.0±2.8,p<0.01.Conclusion:Montgomery T-tube placement under rigid bronchoscope is a minimally invasive and safe procedure,with a high success rate and good tolerance.Compared with the traditional tracheostomy tube,the advantages of Montgomery T-tube placement are obvious,including improving the patient dysphonia,relieving the patients' anxiety.Meanwhile our research suggested that T-tube patients' exercise tolerance and dyspnea index degree were not inferior to the tracheotomy patients.More clinical researches are needed to improve and extend the Montgemery T-tube application in patients with benign airway stenosis.