Objective To evaluate the application value of spiral CT virtual endoscopy and three dimensional imaging in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis. Methods Thirty-three cases of benign tracheobronchial stenosis from June 2004 to November 2008 were checked by spiral CT with airway tracheobronchial reconstruction. For the patients with indications, balloon dilatation was performed under fiberoptic bronchoscope. The three-dimensional reconstruction images were compared with the findings under bronchoscopy. And the preoperative and postoperative three-dimensional reconstruction images were compared for airway diameter. Results Three cases were found stenosis of middle lobe by CT virtual endoscopy and did not undergo balloon dilatation. The remaining 30 cases were confirmed by bronchoscopy findings similar to the images by tracheobronchial reconstruction with CT, with consistent rate of 100% . Immediate postoperative three-dimensional CTreconstruction of tracheal bronchus revealed that diameter of stenotic bronchus increased from ( 2. 7 ±1. 3) mm to ( 6. 9 ±1. 6) mmafter operation. Conclusion Multislice spiral CT virtual endoscopy is helpful in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis and postoperative follow-up.
Objective To explore the diagnosis and treatment of airway involvement in relapsing polychondritis. Methods The clinical data of two patients with relapsing polychondritis with airway involvement were reported and the relative literatures were reviewed. Results The two patients were both old males, with clinical manifestations of cough, dyspnea, and fever. They were misdiagnosed in a other hospital. The pulmonary function tests showed obstructive ventilatory impairemnt. On inspiratory CT, tracheal / tracheobronchial wall thickening and airway stenosis, with or without tracheal cartilage calcification were common findings. The tracheal cartilages thickeness and membranous wall were normal. On expiratory CT scans, functional abnormalities were identified such as tracheobronchomalacia. The patients were relieved by medication of corticosteroids or with immunodepressant. Conclusions The relapsing polychondritis with airway involvement is easy to be misdiagnosed. Chest CT examination is a valuable method for diagnosis of relapsing polychondritis. Corticosteroids and immunodepressant can improve the outcome.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
ObjectiveTo explore the rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis and to share the treatment experience. MethodsThe critical patients with malignant airway stenosis who needed urgent bronchoscopic interventional therapy from January, 2007 to January, 2022 in Beijing Tiantan Hospital Affiliated to Capital Medical University were selected. The demographic and clinical data of intra-and-post the operation were collected. The rescue value and safety of emergency bronchoscopic intervention in the critical patients with malignant airway stenosis were evaluated, and the rescue process was summarized. ResultsForty-three patients were enrolled in the study, including 26 males and 17 females, with an average age of (61.6±11.4) years, including 20 cases of primary lung cancer and 23 cases of other malignant tumors; The main type of stenosis was endogenous (26 cases, 61.90%), followed by external pressure (12 cases, 28.57%) and mixed (4 cases, 9.52%) type. The stenosis site was almost the central airway (41 cases, 95.35%), and the main anesthesia method was general anesthesia (37 cases, 86.05%); Emergency bronchoscopic interventional therapy included local resection in 27 cases (62.79%), stent implantation in 12 cases (27.91%), exploration in 2 cases (4.65%), tumor biopsy in 1 case (2.33%), and adjustment of stent position in 1 case (2.33%); The dyspnea score and the degree of airway stenosis decreased significantly after interventional therapy (P<0.01); intraoperative complications occured in 21 cases and bleeding (19 cases) was the commonest one, short term postoperative complications occurred in 3 cases, including respiratory depression, glottic edema and airway spasm, respectively. ConclusionsEmergency bronchoscopic interventional therapy can quickly and effectively alleviate the severe airway obstruction caused by malignant tumor, and win time for the follow-up comprehensive treatment of tumor, but it needs close team cooperation and standardized rescue process.
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.
Objective To evaluate the efficacy and safety of local triamcinolone combined with conventional interventional therapy in the treatment of benign airway stenosis. Methods PubMed, Cochrane Library, EMbase, Web of science, wanfang, VIP and China National Knowledge Infrastructure were searched by computer between the establishment of the database and August, 2019, and all literatures on the local treatment of benign airway stenosis using triamcinolone combined with conventional interventional therapy were searched. According to inclusion and exclusion criteria, 2 researchers screened the literatures and performed the data extraction and methodological quality evaluation. Meta-analysis was performed with Revman5.2 and Stata software. Results In total, nine randomized controlled trials were included in this meta-analysis, including 449 patients with airway stenosis. The total result showed that in the comparison of short-term efficacy, there were no statistically significant differences in breathability score (SMD=–0.16, 95%CI –0.45 - 0.13, P=0.27), airway diameter (SMD=0.14, 95%CI –0.13 - 0.41, P=0.30), and cross-sectional stenosis rate (SMD=–0.01, 95%CI –0.36 - 0.34, P=0.96) between the treatment group and the control group. In the comparison of long-term efficacy, the breathability score (SMD=–2.53, 95%CI –3.78 - –1.28, P<0.05), airway diameter (SMD=1.31, 95%CI 0.83 - 1.78, P<0.05), cross-sectional stenosis rate (SMD=2.58, 95%CI: 2.11~3.08, P<0.05), and FEV1(SMD=0.42, 95%CI 0.13 - 0.70, P=0.004) of patients in the treatment group were all better than those in the control group. But in terms of adverse reactions, the incidence of bleeding in the airway between two groups was similar (RR=2.00, 95%CI 0.88 - 4.52, P=0.10), other adverse reactions such as blood glucose and plasma cortisol levels were mild, which can be relieved symptomatically. Conclusion Current evidence suggests that topical triamcinolone combined with conventional interventional therapy for benign airway stenosis has a better long-term clinical efficacy with fewer adverse reactions and better overall patient tolerance, which has clinical application value
Objective To improve the knowledge on dynamic benign central airway stenosis through two typical cases. Methods The clinical features, imaging findings, and bronchial morphologic changes of two cases characterized by dynamic benign central airway stenosis were retrospectively analyzed. The etiologies for the two cases were tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC), respectively. Results Central airway stenosis and reversible airway obstruction were common clinical characteristics for the two cases. However, there were identifiable differences on imaging findings and bronchial morphologic changes between the two cases. Multidetector computed tomography showed sabre-sheath trachea and narrowed trachea in coronal position for TBM, while small sized trachea in exhalation phase and narrowed trachea in sagittal position for EDAC. Bronchoscopy displayed narrowed airway, swelling mucosa, and the absence of annular cartilage for TBM, while crescent airway with membranacea part protruding to lumen in inspiration phase, and the integrity of annular cartilage for EDAC. Conclusion Multidetector computed tomography and bronchoscopy examinations are valid methods to distinguish TBM and EDAC, which are both characterized by dynamic benign central airway stenosis.