Ozgul Mehmet A, Cetinkaya Erdogan, Cortuk Mustafa, Iliaz Sinem, Tanriverdi Elif, Gul Sule, Ozgul Guler, Onaran Hilal, Abbasli Kenan, Dincer Huseyin E
*Department of Pulmonary Medicine, Yedikule Education and Research Hospital for Chest Diseases and Thoracic Surgery‡Department of Chest Disease, Koc University Faculty of Medicine§Department of Chest Diseases, Bagcilar Education and Research Hospital, İstanbul†Department of Chest Diseases, Karabuk University Faculty of Medicine, Karabuk∥Department of Chest Diseases, Merzifon Karamustafa Paşa State Hospital, Amasya, Turkey¶Department of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN.
J Bronchology Interv Pulmonol. 2017 Apr;24(2):104-109. doi: 10.1097/LBR.0000000000000346.
Expiratory central airway collapse (ECAC) is abnormal central airway narrowing during expiration. ECAC involves 2 different pathophysiological entities as tracheobronchomalacia and excessive dynamic airway collapse (EDAC). Although the exact cause is unknown, chronic obstructive pulmonary disease (COPD) is frequently accompanied by ECAC. Although there are various publications on the relationship between COPD and ECAC, there are very few data for stent placement in patients with tracheobronchomalacia accompanied severe COPD. We share our results for stenting in ECAC among patients with severe COPD.
The data in this case series were collected retrospectively. The ECAC diagnosis was made during flexible bronchoscopy with severe COPD. Silicone Y-stents were placed via rigid bronchoscopy under general anesthesia.
A total of 9 patients' (7 men) data were evaluated with an average age of 67±10.73 years. One patient experienced stent migration on the second day of stenting prompting stent removal. Another patient died 1 month after stenting. Consequently, we evaluated the follow-up data of remaining 7 patients. The changes in forced expiratory volume 1 was not significant for these 7 cases (P=0.51). The modified Medical Research Council (mMRC) score improvement was statistically significant (P=0.03). Functional status improvement was observed in 4 of 7 patients. Of the 7 patients, mean additional follow-up bronchoscopic interventions requirement was 2.2 times.
Our study showed significant decrease in mMRC score with stenting for ECAC in severe COPD. For 2 patients, we experienced severe complications during short-term follow-up period after stenting. Additional follow-up bronchoscopic interventions were required.
呼气期中央气道塌陷（ECAC）是指呼气时中央气道出现异常狭窄。ECAC涉及气管支气管软化和过度动态气道塌陷（EDAC）这两种不同的病理生理实体。尽管确切病因尚不清楚，但慢性阻塞性肺疾病（COPD）常伴有ECAC。虽然有众多关于COPD与ECAC关系的文献，但针对伴有严重COPD的气管支气管软化患者进行支架置入的数据却非常少。我们分享重度COPD患者ECAC支架置入的结果。
本病例系列的数据为回顾性收集。在伴有重度COPD的情况下，通过可弯曲支气管镜检查做出ECAC诊断。在全身麻醉下经硬支气管镜置入硅胶Y形支架。
共评估了9例患者（7例男性）的数据，平均年龄为67±10.73岁。1例患者在支架置入后第二天出现支架移位，遂将支架取出。另1例患者在支架置入后1个月死亡。因此，我们评估了其余7例患者的随访数据。这7例患者的第l秒用力呼气容积变化不显著（P=0.51）。改良医学研究委员会（mMRC）评分改善具有统计学意义（P=0.03）。7例患者中有4例观察到功能状态改善。7例患者中，平均额外的随访支气管镜干预需求为2.2次。
我们的研究表明，重度COPD患者ECAC支架置入后mMRC评分显著降低。对于2例患者，我们在支架置入后的短期随访期内出现了严重并发症，需要额外的随访支气管镜干预。
