Risk factors analysis of central airway stenosis after lung transplantation / 器官移植

Objective To investigate the risk factors of central airway stenosis after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed. According to the incidence of central airway stenosis following lung transplantation, all recipients were divided into the stenosis group (n=36) and control group (n=119). The incidence of central airway stenosis after lung transplantation was summarized. The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses. Results Among 155 lung transplant recipients, 36 cases (23.2%) developed central airway stenosis. The average incidence time was (53±13) d after lung transplantation. Univariate analysis demonstrated that bilateral lung transplantation, grade 3 primary graft dysfunction (PGD), airway fungal infection, long cold ischemia time, long mechanical ventilation time and long intensive care unit (ICU) stay were the risk factors for central airway stenosis after lung transplantation (all P < 0.05). Multivariate analysis showed that airway fungal infection, long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation (all P < 0.05). Conclusions Airway fungal infection after lung transplantation, long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation. Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation.

Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation / 器官移植

Lung transplantation is the only effective treatment of most end-stage lung diseases. Airway anastomotic complications are the main obstacles affecting the postoperative survival and quality of life of lung transplant recipients. Airway anastomotic stenosis is the most common airway anastomotic complication after lung transplantation. In recent years, improvements in the recipient selection, organ preservation, surgical techniques, postoperative intensive care management, immunosuppression, antifungal and endoscopic treatment have decreased the incidence of airway anastomotic stenosis and improved the surgical efficacy of lung transplantation and the survival of the recipients. In this article, the pathogenesis, risk factors, diagnosis and treatment of airway anastomotic stenosis after lung transplantation were reviewed, aiming to provide novel ideas for clinical research, diagnosis and treatment of airway anastomotic stenosis following lung transplantation.

Central Airway Obstruction Tumour Debulking Using Rigid Bronchoscopy and Cryotherapy: A Case Report

@#Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was completely relieved post-procedure.

The value of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of severe central airway stenosis / 西安交通大学学报(医学版)

Objective: To evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis. Methods: We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room, The First Affiliated Hospital of Bengbu Medical College. We analyzed the patients' general data, diagnosis results, clinical manifestations, imaging and interventional treatment. The severity, type and distribution of stenosis were evaluated. The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index (MRC DI) and Karnofsky Performance Score (KPS). Through regular follow-up, dynamic observation and evaluation of clinical efficacy, according to the occurrence of intraoperative and postoperative complications, safety assessment was carried out to evaluate the postoperative outcome. The clinical efficacy, safety evaluation and prognosis were observed. Results: The average age of 46 patients was (62.43±12.34) years old. 36 (78.26%) had tracheal stenosis, 6 (13.04%) had stenosis in the left main bronchus, 10 (21.74%) in the right main bronchus, and 2 (4.35%) in the right middle bronchus. Among them, 33 patients (71.74%) had malignant central airway stenosis and 13 (28.26%) had benign lesions. Forty-six patients underwent 58 interventional therapies, including stent placement, cryotherapy and balloon dilatation. Endoscopic estimation of the degree of tracheal stenosis was (85.42±7.81)% before the first intervention and (24.17±5.79)% after operation. The degree of stenosis in the right main bronchus was improved from (81.00±17.13)% to (20.50±6.43)%. The degree of left main bronchus stenosis (24.17±9.14)% was significantly improved compared with preoperative (77.50±16.66)%. The difference was statistically significant (t=42.73, t=22.43, t=19.02, P<0.001). The degree of dyspnea was relieved in all the patients. Postoperative MRC DI was 0.98±0.62, significantly lower than the preoperative one 3.42±0.57(t=19.65, P<0.001). KPS was 34.01±13.14 and 83.91±8.96 before and after interventional therapy, and KPS increased significantly after operation (t=21.28, P<0.001). The main complications were local hemorrhage, hypoxemia in 4 cases (8.70%, 4/46), transient ventricular premature rupture in 1 case (2.17%, 1/46), and tooth loss in 2 cases(4.35%, 2/46). Most patients had sore throat of varying degrees after operation. The 1-year survival rate of patients with malignant central airway stenosis was 13.79% (4/29), and 4 patients with malignant tumor were followed up; 13 patients with benign airway stenosis had good quality of life. Conclusion: For central airway stenosis, especially complex central airway stenosis, rigid bronchoscopy combined with electronic bronchoscopy shows immediate improvement of dyspnea and causes rare severe complications; thus it is safe and effective. It can improve the patients' quality of life.

Application of airway stenting in modern pediatric interventional respiratory diseases / 中国实用儿科杂志

With the popularization and development of lung CT scanning and technology of bronchoscopy in pediatrics,central airway obstruction has been diagnosed more and more.Central airway obstruction can affect airway ventilation and secretion discharge,such children are often hospitalized for repeated pneumonia,and sometimes need mechanical ventilation but may be difficult weaning from it. Malnutrition,hypoxic brain injury and backward growth and development are often associated. In the past,central airway obstruction has been mainly treated by surgery. However,with the development of minimally invasive technology of bronchoscopy in children,airway stent implantation has become an effective and alternative treatment recently. This article reviews the types of pediatric central airway obstruction,indications and contraindication of airway stent implantation,types and selection of stent,and the procedures of stent implantation.

Correlation Study on Clinical Pathological Features and TCM Syndromes in Central Air Way Non-small Cell Lung Cancer / 中国中医药信息杂志

Absctact: Objective To discuss the correlation between the TCM syndromes and the clinical pathological features of central air way non-small cell lung cancer.MethodsTCM syndromes were determined through inquiry and physical examination for 109 cases of lung cancer patients. Remaining specimens after excision and routine pathological examination were under HE staining for pathological diagnosis and study. The correlation between the TCM syndromes and the clinical pathological features was analyzed.ResultsThe histological types of central airway non-small cell lung cancer comprised squamous cell carcinoma (69/109, 63.3%), salivary type carcinoma (27/109, 24.8%), adenocarcinoma (10/109, 9.2%) and other rare carcinomas (adenosquamous, 2/109, 1.8%; sarcomatoid carcinoma, 1/109, 0.9%). The clinical and pathological features showed that the elderly, male, smoking patients most commonly suffered from squamous cell carcinoma, while the young, female, non-smoking patients suffered from salivary type carcinoma most frequently. The distribution characteristics showed that the qi-yin deficiency syndrome was most common in squamous cell carcinoma and salivary type carcinoma, accounting for 41.4% (29/70) and 40.7% (11/27) respectively; qi-deficiency and phlegm-dampness syndrome was most common in adenocarcinoma, accounting for 50.0% (6/12). TCM syndrome types were closely related to sex, to smoking history, and to Karnofsky score respectively, with statistical significance (P<0.05,P<0.01). The qi-yin deficiency syndrome was common in male, smoking patients, while the qi-deficiency and phlegm-dampness syndrome and yin-deficiency and heat-toxin syndrome were common in female and non-smokers. The qin-yin deficiency syndrome was common in patients of Karnofsky score≥60, and qi-deficiency and phlegm-dampness syndrome was most frequently found in <60 scores group.Conclusion The histological types of central air way non-small cell lung cancer are related to age, gender and smoking history of patients. Patients with different ages, genders and smoking histories distribute differently in TCM syndrome.

Evaluation of conventional TBNA needle aspiration smear and embedding in the diagnosis of central airway peripheral lesions / 中国内镜杂志

Objective To evaluate the yield of conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of patients with central airway peripheral lesions. Methods This was a retrospective study, 77 patients with central airway peripheral lesions were enrolled from January 2011 to March 2017. Specimens were smeared and/or embedded. Results The positive diagnostic value for malignant lesions were 92.86% (52/56), and 42.86%(9/21) for benign lesions. The average value was 79.22% (61/77). Conclusions C-TBNA had high positive rate of diagnosis and less complications for cent ral airway peripheral lesions.

Two Cases of Central Airway Obstruction Treated with an Insulation-Tipped Diathermic Knife-2 / 대한내과학회지

Central airway obstruction can result from various benign and malignant conditions, and often requires prompt palliation. The efficacies of a variety of bronchoscopic techniques for the treatment of central airway obstruction such as electrocautery, laser, brachytherapy, argon plasma coagulation and cryotherapy have been established. An insulation-tipped diathermic knife-2 (IT knife-2) was initially introduced for gastrointestinal endoscopic submucosal dissection and has been used globally as a safe and effective instrument. However, its use has not been reported for the treatment of endotracheal or endobronchial lesions. Here, we report the case of central airway obstruction in a 65-year-old male due to malignancy and a 52-year-old-female with post-radiation bronchial stenosis that were treated successfully with the IT-knife-2 via flexible bronchoscopy.

Initial experience of endobronchial silicon stents from a tertiary care centre in north India.

Background. Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Methods. Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Results. Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign postintubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Conclusions. Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction / 결핵및호흡기질환

BACKGROUND: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. METHODS: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately -89degrees C, and the icing time was 5~20 seconds. RESULTS: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications-one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. CONCLUSION: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Patología traquaal diagnosticada por fibrobroncoscopia: experiencia en 111 casos

Objetivo: Determinar la etiología benigna o maligna de las lesiones traqueales diagnosticadas por fibrobroncoscopia y el tratamiento establecido. Material y métodos: Estudio de observación clínica, retrospectivo y prospectivo, en pacientes con fibrobroncoscopia diagnóstica (octubre 2001 a septiembre 2003). Se registraron diagnóstico histopatológico benigno o maligno de las lesiones y el tratamiento. Se aplicaron las pruebas de varianza ANOVA y de comparación de proporciones con límites de confianza de la distribución binominal (Bernoulli). Resultados: De 867 fibrobroncoscopias, 153 (17.6%) fueron de vía aérea central realizadas en 111 pacientes, 62 (55.8%) hombres y 49 (44.1%) mujeres, edad promedio 52 años, desviación estándar 20.15, rango 3-82 años. Tenían patología benigna 66/111 (59.4%): las más frecuentes fueron estenosis posintubación 41/66 y granuloma inespecífico 9/66; otras causas incluyen compresión extrínseca, traqueomalacia, tuberculosis, fístula traqueoesofágica, escleroma, bridas, adenoma papilar. En 45/111 (40.5%) la patología fue maligna: primaria en 34/45 siendo más frecuente el adenocarcinoma 18/45; otros tumores fueron: cáncer epidermoide pulmonar, cáncer epidermoide laríngeo, carcinoma de células pequeñas; y metástasis: 4/45 como cáncer de próstata, cervicouterino, colangiocarcinoma y sarcoma fibromixoide retroperitoneal. Correspondieron a extensión local o infiltración tumoral 7/45 casos. Por ANOVA no se encontraron diferencias en cuanto al porcentaje de estenosis de diferente localización. Por comparación de proporciones no hubo diferencias significativas entre patología benigna y maligna; de cada 10 casos, 6 benignos y 4 malignos. De las lesiones malignas hubo diferencia significativa entre primarias y metastásicas e infiltrantes de tumores intratorácicos, 34/45 (75.5%), p<0.05. Después del tratamiento se obtuvo una mejoría inmediata de la sintomatología obstructiva. Conclusión: La fibrobroncoscopia permite determinar: localización, grado de obstrucción y tipo de lesión de laringe, tráquea y bronquios principales, benigna o maligna. Es útil para planear la terapéutica curativa o paliativa más conveniente para corregir la obstrucción. Predominó la estenosis posintubación traqueal 41/66 (62%) entre las lesiones benignas.

Objective: To determine the malignant and benign etiology of tracheal lesions by fiberoptic bronchoscopy (FOB) and the results of their treatment. Material and methods: Retrospective and prospective study of patients with diagnostic FOB, from October 2001 to September 2003. Histopathologic diagnosis and treatment of all lesions were recorded. ANOVA and proportions comparison with confidence limits for binomial distribution (Bernoulli) were applied. Results: Of 867 FOB, 153 (17.6%) were performed in the main airway in a total of 111 patients. Sixty-two (55.8%) were males and 49 (44.1%) females, mean age of 52 years; SD 20.15, range 3-82 years. Of these, 66/111 (59.4%) had benign lesions, the most frequent were post-intubation stenosis (41/66) and non-specific granuloma (9/66), other lesions such as extrinsic compression, tracheomalacia, tuberculosis, tracheoesophageal fistula, scleroma, strips and papillary adenoma were found. In 45/111 (40.5%) the lesion was malignant; of these, 34/45 were primarythe most common being adenocarcinoma (18/45); other tumors were epidermoid pulmonary, epidermoid laryngeal and small cell carcinoma, and metastases, and 4/45 were prostate cancer, uterine cervix carcinoma, cholangiocarcinoma and retroperitoneal fibromixoid sarcoma. 7/45 had local infiltration or invasion from intrathoracic tumors. ANOVA did not demonstrate differences between the percentages of stenosis of different localization. There was statistical difference between primary and metastatic malignancies p <0.05. Immediate relief of respiratory difficulty was registered following treatment. Conclusion: Site, degree of obstruction and type of tracheal lesions can be evaluated by FOB to establish the most convenient treatment for the obstruction, whether curative or palliative. Among benign lesions post-endotracheal intubation structure was the most common.