Li Yifan, Li Yahua, Li Zongming, Ren Jianzhuang, Li Xin, Han Xinwei, Wang Changran, Jin Tengfei, Li Zhen, Ren Kewei
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Peripheral Vascular, Zhoukou Chinese Medicine Hospital, Zhoukou, China.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6352-6361. doi: 10.21037/qims-24-187. Epub 2024 Aug 22.
Airway obstruction due to tumor invasion or concurrent respiratory distress and hemoptysis poses a significant challenge in clinical management, often requiring prompt and effective intervention to alleviate symptoms and improve patient outcomes. This study aimed to evaluate the efficacy and safety of selective transcatheter arterial embolization (TAE) as a preparatory measure to mitigate airway obstruction before bronchoscopic debulking as an approach to address this clinical challenge.
The data of patients with airway obstruction due to tumor invasion or concurrent respiratory distress and hemoptysis treated at The First Affiliated Hospital of Zhengzhou University from January 2018 to August 2022 were analyzed. After computed tomography (CT) scans and bronchoscopic findings were assessed, selective TAE was performed as a preparatory measure to alleviate airway obstruction before bronchoscopic debulking, and the occurrence of hemorrhage-related complications, Karnofsky Performance Status (KPS) score, breathlessness index, and the extent of airway obstruction were evaluated.
All 22 patients underwent selective TAE before bronchoscopic tumor debulking. The overall efficacy rate was 100%, with a significant improvement in the KPS score from preoperative (60.45±14.63) to postoperative (74.55±9.63) levels (t=-6.891; P<0.001). Similarly, there was a considerable reduction in the shortness of breath score from preoperative (2.91±0.81) to postoperative (1.73±0.63) levels (t=6.973; P<0.001). Airway obstruction decreased substantially from preoperative (79.14%±14.56%) to postoperative (21.27%±7.19%) levels (t=26.857; P<0.001). Furthermore, the severity classification of airway obstruction decreased from preoperative (4±0.82) to postoperative (1.36±0.49) levels (t=18.794; P<0.001). Among the patients, only one experienced moderate bleeding necessitating prolonged mechanical balloon compression and intracavitary lesion removal, while the other patients had minor and negligible bleeding.
TAE combined with endoscopic debulking can effectively control intraoperative bleeding and respiratory distress and achieve successful local resolution of endotracheal hypervascular tumors.
肿瘤侵犯导致的气道阻塞或并发呼吸窘迫及咯血在临床管理中构成重大挑战，通常需要迅速有效的干预以缓解症状并改善患者预后。本研究旨在评估选择性经导管动脉栓塞术（TAE）作为一种预备措施在支气管镜减瘤术前减轻气道阻塞的有效性和安全性，以此应对这一临床挑战。
分析了2018年1月至2022年8月在郑州大学第一附属医院接受治疗的因肿瘤侵犯导致气道阻塞或并发呼吸窘迫及咯血的患者数据。在评估计算机断层扫描（CT）结果和支气管镜检查结果后，进行选择性TAE作为支气管镜减瘤术前减轻气道阻塞的预备措施，并评估出血相关并发症的发生情况、卡诺夫斯基功能状态（KPS）评分、呼吸困难指数及气道阻塞程度。
所有22例患者在支气管镜肿瘤减瘤术前均接受了选择性TAE。总体有效率为100%，KPS评分从术前的（60.45±14.63）显著提高至术后的（74.55±9.63）水平（t=-6.891；P<0.001）。同样，呼吸困难评分从术前的（2.91±0.81）大幅降至术后的（1.73±0.63）水平（t=6.973；P<0.001）。气道阻塞从术前的（79.14%±14.56%）大幅降至术后的（21.27%±7.19%）水平（t=26.857；P<0.001）。此外，气道阻塞严重程度分级从术前的（4±0.82）降至术后的（1.36±0.49）水平（t=18.794；P<0.001）。患者中，仅1例出现中度出血，需要延长机械球囊压迫及腔内病变清除时间，其他患者出血轻微且可忽略不计。
TAE联合内镜减瘤可有效控制术中出血和呼吸窘迫，并成功实现气管内高血运肿瘤的局部消退。
