Silicone stent insertion for treating tracheobronchomalacia in adults / 中国组织工程研究

BACKGROUND: Silicone tracheobronchial stent insertion can provide symptomatic relief through airway stabilization in patients with symptomatic tracheobronchomalacia. However, there are few studies on this method. OBJECTIVE: To evaluate the safety and efficacy of silicone stents in the treatment of tracheobronchomalacia. METHODS: Eight tracheobronchomalacia patients who underwent silicone stent implantation at Henan Provincial People’s Hospital between September 2015 and December 2018 were included in this study. According to the location and degree of airway softening, appropriate silicone stents were designed. Silicone stents were implanted in all eight patients, including hourglass stents in 2 cases, straight tube stents in 2 patients, Y-shaped stents in 3 patients, and T-shaped stents in 1 patient. All patients provided informed consent and this study was approved by the Medical Ethics Committee of Henan Provincial People's Hospital, China. Blood gas analysis was performed before and 30 days after surgery to measure blood oxygen level. Quality of life was assessed by card score. The position of stent, intraluminal endocrine, and granulation growth were dynamically monitored by bronchoscopy at 7, 30 and 60 days after surgery. RESULTS AND CONCLUSION: Silicone airway stents were placed successfully in seven patients. Dyspnea was relieved immediately. One patient had rupture of left main bronchial membrane during the procedure of insertion. The partial oxygen pressure and chi-square score of seven patients at 30 days after surgery were significantly higher than those before surgery (t=-8. 60, -20. 76, P < 0. 05). Tracheoscopy revealed that stent displacement occurred in 3 patients, difficulty in sputum expectoration and mild granulation tissue hyperplasia occurred in 3 patients, and improved after endoscopic treatment. The results suggest that silicone stent insertion in patients with tracheobronchomalacia can alleviate the symptoms of patients. Although the incidence of silicone stent displacement and sputum obstruction is high, silicone stent insertion is still an important treatment method.

Rigid bronchoscopy in the real world: Controversies and thinking / 第二军医大学学报

Rigid bronchoscopy (RB) is one of the oldest bronchoscopic techniques. Since the advent of flexible bronchoscopy (FB) in 1970s, usage frequency of RB procedures has rapidly decreased, which made many clinicians question its clinical value. However, the fact of prosperous“rigid hot”in China has appeared in the field of interventional pulmonology in recent years, which confused some pulmonologists-why does RB become hot in the field of interventional pulmonology domestically? what is the practical value of RB in the endoscopic procedures of modern respiratory diseases? how about the developing trend and application prospects of RB in future? This review summarized and discussed the existing debates as well as the latest progress on RB in clinical application, and put forward our views and opinions.

Incidence and etiology of stent associated respiratory tract infection caused by coated metal and silicone airway stents / 基础医学与临床

Objective To investigate the incidence and bacterial etiology of stent associated respiratory tract infec-tion (SARTI) caused by two types of airway stents.Methods Silicone and coated metal airway stent were placed into patients with central airway stenosis caused by varied pathologies. The incidence of stent related respiratory tract infection,bacteria etiology of SARTI and improved dyspnea score were compared between two groups receiving different airway stent.Results 1)Totally 171 patients received airway stents, and among them, 39 patients (22.81%) developed SARTI.2)The incidence of SARTI in metal stent group and silicone stent group was 29.21% (26/89) vs.15.85% (13/82),P<0.05;3)Bacterial spectrum of SARTI was different in metal and silicone stent groups:staphylococcus aureus was 38.46% vs. 69.23%,respectively;candida albicans was 23.08% vs. 0%,re-spectively;Singular proteus was 7.26% vs.0%,respectively;4)The narrowed lumen was improved from 74.27%± 7.13% to 17.64%±6.22%in the metal stent group,while the data was improved from 74.94%±9.18% to 12.68%± 8.32% in the silicone stent group (P<0.01). Accordingly, the dyspnea symptomscore was improvedfrom 2.85 ± 0.89 to 0.85±0.68 in metal stent group,and from 2.88±0.91 to 0±0.61 in the silicone stent group (P<0.05). Conclusions Compared with metal airway stents,silicone stents have a lower incidence of SARTI,which mightbe due to the projections in the silicon stent surface and wider expanded in the bronchial stenosis.

Clinical application of Dumon Y-shaped airway stent for complex airway diseases / 中国内镜杂志

Objective To investigate the feasibility and primary therapeutic effect of Dumon Y-shaped airway stent for complex airway disease (stenosis or fistula). Methods Seven patients with complex airway disease underwent placement of Dumon Y-shaped airway stent via rigid bronchoscope, and selected stent depend on carefully measuring the diameter and length of the stenosis or fistula. We retrospectively analyzed the therapeutic efficacy of the patients placed Dumon Y-shaped airway stent. Results All the Dumon Y-shaped airway stent placed successfully. The diameter of the narrowest tracheal stenosis under the carina was improved significantly from (8.03 ± 5.45) mm to (13.08 ± 3.41) mm after the operation. Medical Research Council dyspnea grade improved significantly from Ⅲ~Ⅳ to Ⅰ~Ⅱ and the oxygen saturation improved significantly from (93.86 ± 1.07) % to (98.14 ± 1.07) %. There is no treatment-related complication and death in the seven patients. Conclusion As a new choice, the technique of Dumon Y-shaped airway stent is feasible and safety for the complex airway disease (stenosis or fistula), and worthy of widely promoting.

Prognostic Factors for Endotracheal Silicone Stenting in the Management of Inoperable Post-Intubation Tracheal Stenosis

PURPOSE: Stenting has been developed to deal with airway stenosis and is applicable in patients with post-intubation tracheal stenosis (PITS) in whom surgery would not be indicated. The purpose of this study was to investigate the prognostic factors in inoperable patients in whom a silicone stent was inserted due to PITS. MATERIALS AND METHODS: We retrospectively evaluated 55 PITS patients undergoing silicone stenting between January 2001 and December 2009. RESULTS: Silicone stent was inserted to narrowed trachea after the combination of pre-dilatation including laser cauterization, mechanical bougienation and ballooning. Following airway stabilization, the stent could be removed successfully in 40% (22/55) of the patients after median 12 months of stenting. However, in 60% (33/55) of patients, the stent could not be removed successfully and surgical management was needed after initial stabilization. Multivariate analysis revealed that the stent could be successfully removed more frequently in those who do not have cardiovascular disease [odds ratio (OR)=12.195; p=0.036] and the intervention was performed within 6 months after intubation (OR=13.029; p=0.031). CONCLUSION: Among those patients undergoing silicone stenting due to PITS, the stent could be successfully removed when patients do not have cardiovascular disease and stented within 6 months after intubation.

Airway fire injury during rigid bronchoscopy in a patient with a silicon stent: A case report / 대한마취과학회지

Therapeutic bronchoscopy is widely employed as an effective first-line treatment for patients with central airway obstructions. Airway fires during rigid bronchoscopy are rare, but can have potentially devastating consequences. Pulmonologist and anesthesiologist undertaking this type of procedure should be aware of this serious problem and be familiar with measures to avoid this possibly fatal complication. We report the case of a 24-year-old patient with a silicone stent who experienced an electrocautery-induced airway fire during rigid bronchoscopy.

Transcanalicular diode laser-assisted dacryocystorhinostomy.

Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy. Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective). Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months. Conclusions: The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.

Minimal Stitch Canalicular Repair of Canalicular Lacerations

PURPOSE: To examine the results of minimal stitch on the restoration of tissue after canalicular laceration. METHODS: We have operated using sutures of tissues around canalicular laceration by inserting bicanalicular silicone stents and minimal horizontal mattress sutures with 8-0 Vicryl in cases of canalicular laceration instead of the existing method for the past 6 years. The ages of patients ranged from 2 to 76 years (average age 39.8+/-17.4 years), with most patients in their thirties (12 patients, 40%), 30 cases underwent canalicular repair with minimal stitch and bicanalicular silicone stent insertion within 24 hours after trauma. The silicone stent was removed 3 months after the operation if the patient did not complain of epiphroa while the canalicular remained open. RESULTS: Twenty-five eyes (83.3%) showed symptom improvement and good passage in lacrimal syringing test in 4~12 months (average: 6.8+/-2.2 months) of follow-up study. Complications included one case each of fistula formation, stent prolapse, and wound infection, and two cases of canalicular stenosis. CONCLUSIONS: We recommend this method because of its satisfying success ratio.

Monocanalicular Silicone Stent Insertion in Children with Nasolacrimal Duct Obstruction

PURPOSE: To determine the efficacy of Mini Monoka silicone stent insertion in treating nasolacrimal duct obstruction in children. METHODS: In 67 eyes of 61 children with nasolacrimal duct obstruction, the Mini Monoka silicone stent was inserted after probing under general anesthesia. The duration of epiphora or discharge, the age at the time of surgery, and probing history were recorded. The surgical results and postoperative complications were analyzed for the cases herein of Mini Monoka silicone stent insertion. RESULTS: The technical success rate of Mini Monoka silicone stent insertion was 91% in children with nasolacrimal duct obstruction, and the success rate for children without probing history was much higher than for those with probing history (81.5 : 97.5%, p=0.035). Postoperatively, the symptoms were resolved in 54 of 61 eyes (88.5%). The duration of preoperative symptoms was shorter in the successful group than in the failed group (15.9+/-7.1 : 21.9+/-8.8 months, p=0.044). Mini Monoka silicone tube was easily removed at 5.6 months after insertion in the clinic. Dacryocystitis was found to be a complication in two eyes yet was resolved without recurrence. Of the seven eyes with spontaneous extrusion of the stent, symptoms subsided in five eyes. CONCLUSIONS: Mini Monoka silicone stent insertion is an effective and relatively easy method, with a low risk of complication, to treatment children with nasolacrimal duct obstruction.

Monocanalicular Silicone Stent Insertion in Children with Nasolacrimal Duct Obstruction

PURPOSE: To determine the efficacy of Mini Monoka silicone stent insertion in treating nasolacrimal duct obstruction in children. METHODS: In 67 eyes of 61 children with nasolacrimal duct obstruction, the Mini Monoka silicone stent was inserted after probing under general anesthesia. The duration of epiphora or discharge, the age at the time of surgery, and probing history were recorded. The surgical results and postoperative complications were analyzed for the cases herein of Mini Monoka silicone stent insertion. RESULTS: The technical success rate of Mini Monoka silicone stent insertion was 91% in children with nasolacrimal duct obstruction, and the success rate for children without probing history was much higher than for those with probing history (81.5 : 97.5%, p=0.035). Postoperatively, the symptoms were resolved in 54 of 61 eyes (88.5%). The duration of preoperative symptoms was shorter in the successful group than in the failed group (15.9+/-7.1 : 21.9+/-8.8 months, p=0.044). Mini Monoka silicone tube was easily removed at 5.6 months after insertion in the clinic. Dacryocystitis was found to be a complication in two eyes yet was resolved without recurrence. Of the seven eyes with spontaneous extrusion of the stent, symptoms subsided in five eyes. CONCLUSIONS: Mini Monoka silicone stent insertion is an effective and relatively easy method, with a low risk of complication, to treatment children with nasolacrimal duct obstruction.

Outcome of Mini Monoka Silicone Monocanalicular Lacrimal Stents in Canalicular Laceration

PURPOSE: To determine clinical outcomes of mini Monoka silicone monocanalicular lacrimal stent (from now, mini Monoka stent) in canalicular injury. METHODS: From June 1996 to December 2001, mini Monoka stent was used in 70 eyes(77 canaliculi) of superior, inferior and bicanalicular injury. Mini Monoka stent was shortened about 20 mm with round tip and intubated. Punctal fixation suture was not done. RESULTS: The mean follow-up period was 7.9+/-1.0 months (4-12 months). The outcome of our repair was judged by the existence of epiphora, dye disappearance test, probing and irrigation. In 57 eyes (81.4%), there was no epiphora. In 11 eyes (15.7%), epiphora was developed only after certain stimuli. In 2 eyes (2.9%), there was epiphora at all times. Postoperative complications were premature stent loss 6 eyes (8.6%), conjunctival injection 3 eyes (3.9%). CONCLUSIONS: The intubation of mini Monoka stent for the lacerated canaliculus is the simply operative procedure in the outpatient department. The shortening of mini Monoka stent made this procedure easier. Despite no punctal fixation suture, the occurrence rate of the premature stent loss was not higher than that for published reports of mini Monoka stent.

The Effects of Placement of Bicanalicular Silicon Tube and Silicone Stent on Granuloma Formation in Endoscopic Intranasal Dacryocystorhinostomy

The placements of silicone tube and silicone stent are helpful in maintaining the patency of lacrimal passage in endoscopic intranasal dacryocystorhinostomy(DCR). Hwoever, they can cause obstruction of internal ostium due to complications, such as inflammation and granuloma formation. The authors evaluated the rates of granuloma formation in 33 cases who had undergone endoscopic DCR with placement of silicone tube and silicone stent and the optimal removal timing to increase patency rates. Granuloma formation was noted in 19 of 33 cases; 12 of the 19 cases developed granuloma formation between 7 and 12 week after operation. Therefore, we concluded that the rates of granuloma formation were higher in placement of both silicone tube and silicone stent than those of silicone tube alone, and the optimal time for their removal seemed to be between 4 and 6 weeks postoperatively.