Diagnosis And Treatment Of 183 Cases Of Adult Airway Stenosis In Guizhou

Objective:To explore the etiology,diagnosis and treatment status of adult patients with airway stenosis admitted to a general tertiary hospital in Guizhou province,and analyze the influencing factors of airway restenosis in a short time after endoscopic interventional therapy.Methods:183 adult patients with airway stenosis diagnosed by bronchoscopy in the bronchoscopy room of the Affiliated Hospital of Guizhou Medical University from June 2019 to November 2021 were retrospectively collected.The clinical data of all patients were collected by consulting medical records.The data of 82 patients who received endoscopic interventional therapy were tracked by telephone follow-up and consulting the medical records of follow-up.Multivariate Logistic regression model was used to analyze the influencing factors of airway restenosis after endoscopic treatment.Results:Among the 183 patients with airway stenosis,there were 65 males and 118 females,aged from 16 to 87 years old,with a median age of 56 years.There were 144 cases of benign causes,including 61 cases of pulmonary tuberculosis,34 cases of stenosis after endotracheal intubation and tracheotomy,and 49 cases of other benign causes.There were 34 cases of malignant etiology,including 21 cases of bronchogenic carcinoma,5 cases of thyroid cancer and 8 cases of other malignant tumors.After endotracheal intubation and tracheotomy,airway stenosis occurred in the primary trachea,which was significantly different from that in patients without artificial airway(p<0.05).The incidence of airway stenosis caused by tuberculosis was higher in unilateral main bronchi and peripheral bronchi,which was different from other non-tuberculosis diseases(p<0.05).Among the 113 patients with central airway stenosis,there were 34 cases of endotracheal intubation and tracheotomy and34 cases of pulmonary tuberculosis.82 patients who received tracheoscopic interventional therapy received total 219 times of tracheoscopic interventional therapy,with an average of 2.67 times per person.After interventional therapy under tracheoscope,the dyspnea symptoms were relieved,the m MRCs decreased from 4(3,4)to 2(1,2),and the KPS score increased from 20(10,30)to 60(50,70)(p<0.05).The m MRCs in patients with benign etiology decreased from 2(1,2)to 1(0,2)after 3 months(p>0.05),and the KPS score increased from 60(50,70)to 70(60,90)after 3 months(p<0.05).The m MRCs in patients with malignant etiology increased from 1(1,2)to 3(2,4)after 3 months(p<0.05),and the KPS score decreased from 50(50,60)to 30(30,50)after 3 months(p<0.05).Multiple Logistic regression analysis showed that malignant etiology(OR=13.241,95%CI1.949～89.932)and scar constitution(OR=16.333,95%CI2.793～95.512)were positively correlated with airway restenosis,while regular atomization(OR=0.012,95%CI0.001～0.142)local use of triamcinolone acetonide(OR=0.307,95%CI0.109～0.863)was negatively correlated with airway restenosis within 3months.Conclusions:Tuberculosis is the most common cause of airway stenosis in our hospital,artificial airway(tracheal intubation/tracheotomy)is the second.The airway stenosis caused by tuberculosis is mainly in unilateral main bronchus and peripheral bronchus,while the airway stenosis caused by artificial airway is concentrated in the primary trachea.Among central airway stenosis,artificial airway and tuberculosis-related airway stenosis are the most common.Endoscopic interventional therapy for airway stenosis can quickly improve the symptoms of dyspnea and improve the quality of life.The benign etiology was further improved after 3 months of treatment,while the malignant etiology worsened again in a short period of time.Malignant etiology,scar constitution,regular atomization therapy and local use of triamcinolone acetonide in endoscopic therapy are important factors affecting the occurrence of airway restenosis3 months after endoscopic interventional therapy.Timely reexamination of bronchoscope can find restenosis in time and further deal with it.