Okiror Lawrence, Jiang Li, Oswald Nicola, Bille Andrea, Rajesh Pala, Bishay Ehab, Steyn Richard, Naidu Babu, Kalkat Maninder
Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
Department of Thoracic Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
Ann Thorac Surg. 2015 May;99(5):1725-30. doi: 10.1016/j.athoracsur.2015.01.061. Epub 2015 Mar 25.
Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival.
This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method.
Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death.
Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival.
介入性支气管镜检查对于有症状的气道阻塞患者，无论是恶性还是良性疾病，在治疗中都很有效。本研究的主要目的是报告我们在有症状气道阻塞患者中进行紧急介入性支气管镜检查的经验，并确定生存的预后因素。
这是一项对在4年期间接受紧急介入性支气管镜检查的患者进行的回顾性观察研究。采用Kaplan-Meier方法分别分析良性和恶性气道阻塞患者的生存时间。
2009年6月至2013年7月期间，对112例气道阻塞患者进行了168次紧急介入性支气管镜检查。中位年龄为63岁（范围20至86岁），91例（54%）患者为女性。72例（43%）因恶性疾病导致气道阻塞。有3例住院死亡（2.7%）。研究人群的中位生存期为5.6个月（范围0至51个月），中位随访时间为7.3个月（范围0至51个月）。恶性气道阻塞患者的中位生存期为3.5个月（范围0至21个月），良性疾病患者为9.8个月（范围0.1至51个月）。气道干预使32例（44%）恶性气道阻塞患者能够接受姑息化疗。在恶性气道阻塞患者的多变量分析中，喘鸣的存在（风险比1.919，95%置信区间：1.082至3.404，p = 0.026）和术后未接受化疗（风险比2.05，95%置信区间：1.156至3.636，p = 0.014）是死亡的独立预后因素。
用于气道阻塞的紧急介入性支气管镜检查是安全的，可缓解症状，并有助于姑息化疗，从而改善生存。
