Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Laryngology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Am J Otolaryngol. 2021 Sep-Oct;42(5):103040. doi: 10.1016/j.amjoto.2021.103040. Epub 2021 Apr 13.
Tracheobronchial stent placement for malignant airway strictures has been proved to improve respiratory function, but experience for benign tracheobronchial stenoses is limited. The purpose of our study is to investigate the efficacy of covered expandable metallic stents, inserted through a suspension laryngoscope, treating tracheal stenosis following intubation or tracheostomy.
From 2010 to 2018, 67 adult patients with the benign tracheal stenosis, underwent stent placement, using a suspension laryngoscope. According to the date of stent placement and stent caliber, these patients have been subdivided into two groups: Group 1 (from 2010 to 2013, stent caliber ranging from 16 to 20 mm) and Group 2 (from 2014 to 2018, stent caliber ranging from 18 to 22 mm). Complications, related reinterventions, and long-term prognosis were retrospectively evaluated.
Primary successful stent placement was achieved and symptoms were improved in all patients. Complications occurred in 27 (40.3%) cases. Among these, there were 14 (20.9%) cases with stent migration, 10 (14.93%) with granulation tissue formation and 3 (4.48%) with pneumonia. Stent migration in Group 1 was nearly 30% higher than that in Group 2 (P = 0.002). Five of the 8 patients who had placement of 16 mm stents had stent migration, more often than with 20 mm stents (P = 0.002). Ten patients' trachea had slight narrowing but without any symptoms. Six patients still had granulation tissue but without any growth at least two-year follow-up (2 patients whose stents were removed more than 1 year after placement). Even without tracheal narrowing and granulation tissue, 5 patients felt persistent shortness of breath. 92.5% of the patients reported to be satisfied with significant improvement in symptoms.
Patients with tracheal obstruction secondary to intubation or tracheostomy can benefit from tracheal stents. Placing 16 mm stents might lead to stent migration more easily than 20 mm stents. Tracheal stents placed by a suspension laryngoscope provide a reasonable alternative to open surgery for patients with benign tracheal stenosis or obstruction.
气管支气管支架置入术已被证明可改善恶性气道狭窄患者的呼吸功能，但良性气管支气管狭窄的经验有限。我们的研究目的是研究通过悬雍垂喉镜插入的覆盖可扩张金属支架治疗气管插管或气管切开后气管狭窄的疗效。
2010 年至 2018 年间，67 例成人良性气管狭窄患者采用悬雍垂喉镜行支架置入术。根据支架置入日期和支架口径，将这些患者分为两组：组 1（2010 年至 2013 年，支架口径 16-20mm）和组 2（2014 年至 2018 年，支架口径 18-22mm）。回顾性评估并发症、相关再次干预和长期预后。
所有患者均成功置入支架，症状得到改善。27 例（40.3%）出现并发症。其中支架移位 14 例（20.9%），肉芽组织形成 10 例（14.93%），肺炎 3 例（4.48%）。组 1 支架移位发生率高于组 2（20.9%比 4.48%，P=0.002），接近 30%。8 例 16mm 支架置入患者中，有 5 例支架移位，多于 20mm 支架（P=0.002）。10 例患者气管轻度狭窄，但无任何症状。6 例患者仍有肉芽组织，但至少在 2 年随访期内未见生长（2 例支架置入后 1 年以上取出）。即使没有气管狭窄和肉芽组织，5 例患者仍感到持续呼吸困难。92.5%的患者报告症状显著改善，满意度高。
气管插管或气管切开后气管阻塞的患者可从气管支架中获益。放置 16mm 支架比 20mm 支架更容易发生支架移位。通过悬雍垂喉镜放置的气管支架为良性气管狭窄或阻塞患者提供了一种合理的替代开放手术的方法。
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