Radial probe endobronchial ultrasound scanning assessing invasive depth of central lesions in tracheobronchial wall / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy, photodynamics treatment, radiofrequency ablation and stenting, etc. The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan. This study used radial probe endobronchial ultrasound (RP-EBUS) scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall, and the influence of RP-EBUS scanning in treatment plan making and guidance.</p><p><b>METHODS</b>This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy. We performed EBUS scanning after common bronchoscopy under local anesthesia. A radial ultrasonic probe (2.0 mm in diameter with 20-MHz frequency) with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope. The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control. The circular image of EBUS, which revealed the layered structure of the tracheobronchial wall, could be achieved.</p><p><b>RESULTS</b>Total of 125 patients were enrolled in the study. Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% (27/30), sensitivity and specificity were 88.89% (24/27) and 100% (3/3), respectively. In response to EBUS images, 40 approaches were altered or guided: lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration (TBNA) (n = 8); Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility (n = 13), stents size were changed (n = 14), operation was canceled (n = 3) and foreign body was removed (n = 2). No complication associated with the use of EBUS was observed.</p><p><b>CONCLUSION</b>RP-EBUS can be a useful tool in assessing the central lesion invasive depth to the tracheobronchial wall.</p>

Application of high-frequency electrocautery combined with high pressure balloon expansion in treatment of benign airway obstruction / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of high-frequency electrocautery combined with high-pressure balloon expansion in the treatment of benign airway obstruction.</p><p><b>METHODS</b>Twelve patients with complete airway obstruction received treatment with high-frequency electrocautery and high-pressure balloon expansion, and 6 months of follow-up was performed.</p><p><b>RESULTS</b>After the initial treatment, the rate of airway obstruction relief exceeded 50% in 8 patients, who showed lung recruitment and an increased dyspnea index, suggesting total effectiveness; one patient showed mild improvement with airway stenosis relief by less than 50% (the upper-left lobe remained obstructed). Stents were implanted eventually in 7 patients for airway maintenance. Two patients showed relief of the airway obstruction by over 50% after the initial treatment, but lung recruitment or dyspnea relief failed to be achieved, suggesting non-response to the treatment. The airway failed to be found in 1 case (who received 5 previous operations of ablation and dilatation), which was considered a non-response case.</p><p><b>CONCLUSION</b>High-frequency electrocautery combined with high pressure balloon expansion is clinically effective with few complications in some cases of benign complete airway stenosis. The possibility of airway stenosis and even obstruction should be considered in patients with tuberculosis during the treatment.</p>