Hanaoka Jun, Ohuchi Masatugu, Kaku Ryosuke, Okamoto Keigo, Ohshio Yasuhiko
Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
Department of Thoracic Surgery, National Hospital Organization Shiga Hospital, Shiga, Japan.
Respir Med Case Rep. 2019 Jul 30;28:100917. doi: 10.1016/j.rmcr.2019.100917. eCollection 2019.
Airway stenosis after bronchial tuberculosis may reduce the patient's activities of daily living owing to various respiratory symptoms. Thus, it is necessary to treat the condition. Various treatment modalities, such as balloon dilatation, are attempted in cases where radical surgical resection is difficult to perform; however, the best treatment method remains unknown. Although balloon dilatation is relatively easy to perform and effective, there are not many cases reporting successful treatment of tracheal stenosis as compared to that of bronchial stenosis.
We report a case involving a 63-year-old man who presented with dyspnea on effort and stridor for 6 months. He was diagnosed with bronchotracheal stenosis due to endobronchial tuberculosis. A chest computed tomography scan showed thickening of the tracheal lumen and deformation of the tracheal cartilage from the annular cartilage to the middle trachea, and severe stenosis in the left main bronchus. Good patency of the trachea and the left main bronchus was obtained after two rounds of balloon dilatation with laser cauterization, which resulted in improvement of symptoms over a relatively long period.
Our study shows that balloon dilatation combined with laser cauterization can be easily repeated and may be effective for treatment of patients with bronchotracheal stenosis, wherein radical treatment cannot be performed.
支气管结核后的气道狭窄可能因各种呼吸道症状而降低患者的日常生活活动能力。因此,有必要对该病症进行治疗。在难以进行根治性手术切除的情况下,尝试了多种治疗方式,如球囊扩张术;然而,最佳治疗方法仍不明确。尽管球囊扩张术相对容易实施且有效,但与支气管狭窄相比,报道成功治疗气管狭窄的病例并不多。
我们报告一例63岁男性患者,该患者因劳力性呼吸困难和喘鸣6个月前来就诊。他被诊断为支气管气管狭窄,病因是支气管内膜结核。胸部计算机断层扫描显示气管腔增厚,从环状软骨到气管中部的气管软骨变形,左主支气管严重狭窄。经过两轮激光烧灼联合球囊扩张术后,气管和左主支气管通畅良好,症状在较长时间内得到改善。
我们的研究表明,球囊扩张术联合激光烧灼术易于重复操作,对于无法进行根治性治疗的支气管气管狭窄患者可能有效。