Universitat Autònoma de Barcelona, Thorax Institute, Hospital Universitari Germans Trias, Badalon, Spain.
National and Kapodistrian University of Athens, Interventional Pulmonology Unit, "Sotiria" Hospital, Athens, Greece
Eur Respir Rev. 2020 Nov 18;29(158). doi: 10.1183/16000617.0178-2019. Print 2020 Dec 31.
Over the past century rigid bronchoscopy has been established as the main therapeutic means for central airway diseases of both benign and malignant aetiology. Its use requires general anaesthesia and mechanical ventilation usually in the form of manual or high-frequency jet ventilation. Techniques applied to regain patency of the central airways include mechanical debulking, thermal ablation (laser, electrocautery and argon plasma coagulation) and cryo-surgery. Each of these techniques have their advantages and limitations and best results can be attained by combining different modalities according to the type, location and extent of the airway blockage. If needed, deployment of airway endoprostheses (stents), as either fixed-diameter silicone or self-expandable metal stents, may preserve the airways patency often at the cost of several complications. Newer generation of customised stents either three-dimensional printed or drug-eluting stents constitute a promise for improved safety and efficacy results in the near future. Treating central disease of benign or malignant aetiology, foreign body aspiration or massive bleeding in the airways requires a structured approach with combined techniques, a dedicated team of professionals and experience to treat eventual complications. Specific training and fellowships in interventional pulmonology should therefore be offered to those who wish to specialise in this field.
在过去的一个世纪中，硬质支气管镜已成为治疗良性和恶性病因的中央气道疾病的主要治疗手段。它的使用需要全身麻醉和机械通气，通常采用手动或高频喷射通气的形式。用于恢复中央气道通畅的技术包括机械清除、热消融（激光、电烙术和氩等离子体凝固）和冷冻手术。这些技术中的每一种都有其优点和局限性，通过根据气道阻塞的类型、位置和程度结合不同的方式，可以获得最佳的效果。如果需要，部署气道内支架（支架），无论是固定直径的硅酮支架还是自扩张金属支架，都可以保持气道通畅，但常常会带来一些并发症。新一代定制支架，无论是三维打印支架还是药物洗脱支架，都有望在不久的将来带来更好的安全性和疗效结果。治疗良性或恶性病因、气道异物吸入或大量出血的中央气道疾病需要采用联合技术的结构化方法，需要一支专业的团队和经验来治疗最终的并发症。因此，应该向那些希望在这个领域专业化的人提供介入性肺病学的特定培训和奖学金。
