Efficacy Evaluation Of Nd:YAG Laser Thermal Ablation In Tracheal Stenosis After Intubation

Objective: To compare and analyze the efficacy and safety of Nd:YAG(Neodymium Yttrium Aluminium Garnet)laser thermal ablation and traditional high-frequency electrothermal ablation combined with balloon dilation and cryotherapy respectively in the treatment of stenosis after endotracheal intubation.To investigate the clinical effect of laser thermal ablation on the treatment of tracheal stenosis after intubation.METHODS: The clinical data of 30 patients with post-intubation stenosis who underwent laser thermal ablation or high-frequency electrothermal ablation interventional therapy in the Second Affiliated Hospital of Guangxi Medical University from January 2016 to May 2020 were analyzed.According to the different ablation methods,the patients were divided into two groups: the laser group(14 patients)underwent laser thermal ablation combined with balloon dilation and cryotherapy under fiberoptic bronchoscope,and the high-frequency electrosurgical group(16 patients)underwent high-frequency electrothermal ablation combined with balloon dilation and cryotherapy under fiberoptic bronchoscope.The score of shortness of breath,degree of tracheal stenosis,complications,efficacy evaluation and follow-up were compared and analyzed between the two groups before and after interventional treatment.Results: A total of 57 times of interventional therapy were performed among the 30 patients,including 22 males and 8 females,aged 17-75 years.After interventional treatment,dyspnea was significantly improved,and the narrow tracheal diameter in the laser group increased from(0.54±0.18)cm preoperatively to(1.23±0.12)cm(P<0.001);The score of shortness of breath decreased from(2.78±0.58)to(0.14±0.36)(P<0.001);FEV1 increased from(1.26±0.66)L to(2.11±0.52)L(P<0.001);Pa O2 increased from(77.93±9.02)mm Hg to(94.50±3.99)mm Hg(P<0.001).The inner diameter of the trachea in the high-frequency electrosurgical group increased from(0.41±0.14)cm to(1.13±1.08)cm(P<0.001);The score of shortness of breath decreased from(2.75±0.68)to(0.25±0.44)(P<0.001);FEV1 increased from(1.09±0.34)L to(2.22±0.61)L(P<0.001);Pa O2 increased from(82.94±9.64)mm Hg to(94.50±5.05)mm Hg(P<0.001).The short-term effective rate of the two groups was 100%,and the long-term overall effective rate of the two groups was 90%after 12 months follow-up.A total of(1.50±0.52)times of thermal ablation intervention was performed in the laser group,and(2.38±1.31)times of thermal ablation intervention was performed in the high-frequency electrotome group,which was significantly lower in the laser group than in the high-frequency electrotome group,and the difference was statistically significant.Laser or high-frequency electrosurgical thermal ablation combined with balloon dilation and cryotherapy has a good effect on the treatment of airway stenosis caused by endotracheal intubation.Compared with traditional high-frequency electrosurgical ablation,laser thermal ablation has fewer times of treatment and lower incidence of complications.Therefore,it is an interventional technique worthy of clinical application.