Faculty of Medicine, Pulmonology Department, Ain Shams University, Cairo, Egypt.
Interventional Pulmonology Unit, 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece.
Int J Clin Pract. 2021 May;75(5):e14058. doi: 10.1111/ijcp.14058. Epub 2021 Feb 6.
Endoluminal therapy either by dilatation, scar tissue resection or stent insertion is an established treatment for non-malignant airway stenosis although the surgical approach is still considered the "gold standard." No clear consensus exists on the structured role of each modality.
We aimed to investigate the role of bronchoscopic management in non-operable tracheal stenosis cases, evaluating the effectiveness and safety of each procedure based on a structured algorithmic approach.
This prospective study was carried out on (40) consecutive patients diagnosed between March 2017 and March 2020 with tracheal stenosis not amenable to surgery. All strictures were first evaluated by flexible bronchoscopy and classified as simple or complex. Patients were treated following a standardised therapeutic algorithm approach based on published evidence and our own expertise.
The mean age of the study population was 45.25 ± 18.79; lesions were classified as simple (14) and complex (24), while two patients had mixed type stenosis. Long term success rate was 100% in simple stenosis and 87.5% in the complex ones. Stents were deployed in 24 cases, most of which were of the complex type and only two of the simple type. Post-procedural mild to moderate complications were detected overall in 70% of the patients. All complications were non-life threatening, mostly stent-related and were effectively managed.
We conclude that after accurate classification and a structured algorithmic approach, interventional bronchoscopic management may play a crucial role in the effective treatment of benign tracheal stenosis.
腔内治疗（扩张、瘢痕组织切除或支架置入）是治疗非恶性气道狭窄的一种既定方法，尽管手术方法仍被认为是“金标准”。但每种方法的具体作用尚未达成明确共识。
我们旨在通过一项基于结构化算法的研究，调查支气管镜介入治疗在不可手术的气管狭窄病例中的作用，评估每种方法的有效性和安全性。
这项前瞻性研究纳入了 2017 年 3 月至 2020 年 3 月期间诊断为不可手术的气管狭窄的 40 例连续患者。所有狭窄首先通过柔性支气管镜进行评估，并分为单纯性或复杂性。根据已发表的证据和我们自己的专业知识，按照标准化治疗算法对患者进行治疗。
研究人群的平均年龄为 45.25±18.79 岁；病变分为单纯性（14 例）和复杂性（24 例），2 例患者为混合性狭窄。单纯性狭窄的长期成功率为 100%，复杂性狭窄的长期成功率为 87.5%。24 例患者中放置了支架，其中大多数为复杂性，仅有 2 例为单纯性狭窄。总的来说，70%的患者术后出现轻度至中度并发症。所有并发症均无生命危险，大多与支架相关，并且得到了有效管理。
我们得出结论，经过准确的分类和结构化的算法方法，介入性支气管镜治疗可能在治疗良性气管狭窄方面发挥关键作用。
