Castellanos Paul, Mk Manjunath, Atallah Ihab
Department of Otolaryngology, University of Alabama at Birmingham, Boshell Building 563, Birmingham, AL, 35233, USA.
Colombia Asia Referral Hospital, Yeshwanthpur, Bangalore, India.
Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1601-1607. doi: 10.1007/s00405-016-4349-y. Epub 2016 Oct 20.
The management of tracheobronchomalacia is a very challenging problem with few treatment options. This study aims to evaluate the outcomes of a novel surgical treatment for membranous tracheobronchomalacia. A consecutive series of patients with tracheobronchomalacia were treated with two to three holmium laser scarring surgeries of the hyperdynamic tracheal and bronchial walls for the purpose of stiffening them through fibrosis. Patients filled out a Dyspnea Index questionnaire before and after treatment. Ten patients were treated for their tracheobronchomalacia with a mean age of 54 years. Symptoms included severe dyspnea, dry cough, recurrent pulmonary infections, and respiratory failure. Fifty percent of patients presented with wheezing refractory to traditional treatment. Tracheobronchomalacia was associated with gastroesophageal reflux disease (n = 8), obstructive sleep apnea (n = 5), and tracheal stenosis (n = 3). Only 50 % of patients presented with morbid obesity. All cases showed significant improvement of their respiratory symptoms with a mean postoperative difference of 22.3 out of a maximum impairment score of 40 (P < 0.01) on the Dyspnea Index. The mean number of procedures was 2.3 per patient with the average laser energy delivered per procedure of 1600 J. Laser tracheobronchoplasty is a safe, easy to adopt, and effective technique for the treatment of membranous tracheobronchomalacia. It presents a simple alternative to the commonly used procedures like endoluminal stenting and open tracheobronchoplasty.
气管支气管软化症的治疗是一个极具挑战性的问题，治疗选择有限。本研究旨在评估一种针对膜性气管支气管软化症的新型手术治疗效果。对一系列连续性气管支气管软化症患者进行了两到三次钬激光瘢痕手术，作用于气管和支气管壁动力过强部位，目的是通过纤维化使其变硬。患者在治疗前后填写了呼吸困难指数问卷。10例气管支气管软化症患者接受了治疗，平均年龄54岁。症状包括严重呼吸困难、干咳、反复肺部感染和呼吸衰竭。50%的患者出现对传统治疗无效的喘息。气管支气管软化症与胃食管反流病（n = 8）、阻塞性睡眠呼吸暂停（n = 5）和气管狭窄（n = 3）相关。仅50%的患者患有病态肥胖。所有病例的呼吸道症状均有显著改善，呼吸困难指数术后平均差异为22.3（满分40分）（P < 0.01）。每位患者平均手术次数为2.3次，每次手术平均输送激光能量1600 J。激光气管支气管成形术是一种治疗膜性气管支气管软化症的安全、易于采用且有效的技术。它为腔内支架置入和开放性气管支气管成形术等常用手术提供了一种简单的替代方法。
