Ravikumar Nakul, Ho Elliot, Wagh Ajay, Murgu Septimiu
Interventional Pulmonology, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA.
Interventional Pulmonology, Division of Pulmonary & Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, USA.
J Thorac Dis. 2023 Jul 31;15(7):3998-4015. doi: 10.21037/jtd-22-1734. Epub 2023 Jun 28.
Benign tracheal stenosis can cause dyspnea, wheezing, and cough mimicking other obstructive lung diseases which often leads to a delay in the diagnosis. Risk factors and etiologies for tracheal strictures include autoimmune diseases, infection, gastro-esophageal reflux disease (GERD), radiation injury and iatrogenic factors such as post-intubation and post-tracheostomy. Once suspected, tracheal strictures are diagnosed by performing a thorough evaluation involving clinical exam, laboratory workup, pulmonary function test, chest imaging and bronchoscopy. Bronchoscopy plays a pivotal role in the diagnosis of stenosis and along with the imaging and physiologic assessments leads to a proper description of the stenosis based on all parameters that matters for management. Surgical resection provides a definitive management in most patients with idiopathic or post intubation/tracheostomy stenosis, however, factors such as severe co-morbidities, length and location of the stricture can preclude patients from undergoing curative surgery. Several bronchoscopic interventions including mechanical or laser assisted dilation, electrosurgery (ES), airway stenting and pharmacological treatment with mitomycin C (MMC) and intralesional steroid have been reported in the literature for management of patients who are not surgical candidates. Herein, we review the role of bronchoscopy and illustrate the importance of a multi-disciplinary team (MDT) approach comprising of interventional pulmonologists, thoracic surgeons and otorhinolaryngologists in the diagnosis and management of patients with benign tracheal stenosis.
良性气管狭窄可导致呼吸困难、喘息和咳嗽，症状与其他阻塞性肺病相似，常导致诊断延误。气管狭窄的危险因素和病因包括自身免疫性疾病、感染、胃食管反流病（GERD）、放射损伤以及诸如插管后和气管切开术后等医源性因素。一旦怀疑有气管狭窄，需通过全面评估进行诊断，包括临床检查、实验室检查、肺功能测试、胸部影像学检查和支气管镜检查。支气管镜检查在狭窄诊断中起关键作用，结合影像学和生理评估，可根据对治疗至关重要的所有参数对狭窄进行恰当描述。手术切除为大多数特发性或插管/气管切开术后狭窄患者提供了确定性治疗，然而，严重合并症、狭窄长度和位置等因素可能使患者无法接受根治性手术。文献报道了几种支气管镜干预措施，包括机械或激光辅助扩张、电外科手术（ES）、气道支架置入以及丝裂霉素C（MMC）和病灶内类固醇的药物治疗，用于治疗不适合手术的患者。在此，我们回顾支气管镜检查的作用，并说明由介入肺科医生、胸外科医生和耳鼻喉科医生组成的多学科团队（MDT）方法在良性气管狭窄患者诊断和治疗中的重要性。
