Wood Douglas E
Lung Cancer Research and General Thoracic Surgery, University of Washington, Seattle 98195, USA.
Surg Clin North Am. 2002 Jun;82(3):621-42. doi: 10.1016/s0039-6109(02)00025-7.
Malignant airway obstruction produces symptoms of dyspnea, cough, and stridor with a significant impact on quality of life. With progressive airway narrowing, a critical stenosis is life threatening, due to impending suffocation. Bronchoscopy provides the mainstay of establishing the diagnosis as well as defining the extent and degree of airway obstruction. Therapeutic bronchoscopy provides the ability to achieve prompt airway stabilization while completing a patient evaluation and workup. Patients may have malignant airway obstruction from primary tracheobronchial tumors, adjacent primary tumors with airway invasion, or metastatic disease to the airway. Surgical resection is the preferred definitive therapy for primary airway tumors. A subset of lung or thyroid malignancies that invade the airway may also be amenable to primary surgical resection, as long as a complete resection of tumor can be obtained along with primary airway reconstruction. The majority of patients with malignant airway obstruction will be unresectable due to locally advanced disease, metastatic disease, or contraindicating comorbidity. In these patients, therapeutic bronchoscopy provides a prompt and reliable palliation of the airway obstruction. The simplest and most immediately reliable strategy for endoluminal tumor is mechanical core-out of the tumor. Laser vaporization, photodynamic therapy, cryotherapy, and endobronchial brachytherapy all are adjuncts to the coring out of endoluminal tumor that may prolong the period of palliation achieved. Airway stenting is the only endoluminal therapy available for the management of malignant obstruction from extrinsic disease, and is also a useful adjunct to providing coverage of endoluminal tumor. Flexible and creative application of these techniques provides the best chance for successful airway palliation. Although the long-term outlook in these patients is often dismal, relief of airway obstruction results in a marked improvement in quality and length of life.
恶性气道阻塞会产生呼吸困难、咳嗽和喘鸣等症状，对生活质量有重大影响。随着气道逐渐变窄，严重狭窄会危及生命，因为有窒息风险。支气管镜检查是确诊以及确定气道阻塞范围和程度的主要手段。治疗性支气管镜检查能够在完成患者评估和检查的同时迅速实现气道稳定。患者可能因原发性气管支气管肿瘤、侵犯气道的相邻原发性肿瘤或气道转移瘤而出现恶性气道阻塞。手术切除是原发性气道肿瘤的首选确定性治疗方法。只要能完整切除肿瘤并进行原发性气道重建，一部分侵犯气道的肺癌或甲状腺恶性肿瘤也可进行原发性手术切除。大多数恶性气道阻塞患者由于局部晚期疾病、转移性疾病或存在禁忌的合并症而无法切除。对于这些患者，治疗性支气管镜检查能迅速且可靠地缓解气道阻塞。对于腔内肿瘤，最简单且最直接可靠的策略是机械性去除肿瘤核心。激光汽化、光动力疗法、冷冻疗法和支气管内近距离放射治疗都是去除腔内肿瘤核心的辅助手段，可能会延长缓解期。气道支架置入是治疗外源性疾病导致的恶性阻塞的唯一腔内治疗方法，也是覆盖腔内肿瘤的有用辅助手段。灵活且创造性地应用这些技术为成功缓解气道阻塞提供了最佳机会。尽管这些患者的长期预后通常不佳，但缓解气道阻塞可显著改善生活质量和延长寿命。
