ABSTRACT
El tratamiento endoscópico establecido de las estenosis traqueobronquiales tipo web-like es el láser. La aparición en el mercado de un nuevo modo de corte con un menor efecto coagulante se ha postulado como una alternativa al láser debido a un menor daño en los tejidos afectados. Objetivos: Estudiar las consecuencias clínicas, funcionales y los efectos secundarios de esta técnica y posteriormente compararla con un grupo similar de pacientes tratados con láser ND-YAG. Pacientes y método: Entre marzo del 2005 y julio del 2007 se incluyeron 22 pacientes que fueron sometidos a 34 procedimientos de broncoscopia intervencionista mediante el sistema de radiofrecuencia VIO-300-D, usando un modo el programa Endo-cut I en combinación con el electrodo de cuchilla reutilizable. Resultados: El 100% de los pacientes tratados presentaron mejorías de los síntomas, del diámetro de la luz traqueobronquial y de la función pulmonar que fueron estadísticamente significativas. El tiempo libre de síntomas fue de 157±93 días, y menos del 50% de los pacientes necesitaron una segunda intervención. Retrospectivamente, se compararon estos pacientes con un grupo similar de 22 pacientes tratados con el láser Nd-YAG. El análisis de seguimiento mostró que solo el 18% (4/22) de los pacientes tratados con esta nueva técnica presentaron fibrina, en comparación con el 41% (9/22) de los tratados con láser (p<0,001). Conclusión: El uso de esta técnica es eficaz en el tratamiento de las estenosis benignas traqueobronquiales tipo web-like ya que todos los pacientes mostraron mejoría clínica y funcional, requiriendo menos del 50% una segunda intervención. En comparación con el láser, una ventaja de esta técnica es la menor producción de fibrina, probablemente debido a su menor efecto anticoagulante(AU)
The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. Objectives: To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. Patients and methods: Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. Results: All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157±93 days. There was an overall decrease observed in mean obstruction (P<.001). Improvements in FVC (P=.01), Raw (P=.0016) and RV/TLC (P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy (P<.001). Conclusion: The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anticoagulation effect(AU)
Subject(s)
Humans , Tracheal Stenosis/surgery , Bronchoscopy/methods , Electrosurgery/methods , Prospective Studies , /methods , Laser Therapy/methods , FibrinABSTRACT
UNLABELLED: The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. OBJECTIVES: To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. PATIENTS AND METHODS: Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. RESULTS: All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157 ± 93 days. There was an overall decrease observed in mean obstruction (P<.001). Improvements in FVC (P=.01), Raw (P=.0016) and RV/TLC (P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy (P<.001). CONCLUSION: The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anti-coagulation effect.
