| Background: Endobronchial teberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree. The patients of EBTB usually progress to bronchial cicatrical stenosis and malacia. Surgical treatment, with complex sleeve resection or pneumonectomy, has been the established treatment method for patients with airway strictures secondary to tuberculosis. However, operation itself brings with wide range damage in this group of patients, and respiratory failure is well-known complication. Endoluminal metallic stents implantation is an attractive alternative management strategy. But because of its possible complications, metallic stenting for EBTB is still controversial. In this study, we reviewed the results of the use of the metallic stents in 49 patients experiencing EBTB in Changhai hospital.Objective: To evaluate the effect, safety and indications of endoluminal stents implantation in the treatment of EBTB. Methods: Based on the experience of traditional surgical treatment for EBTB, We selected forty-nine cases of EBTB with marked tracheobronchial stenosis and/or malacia. The locations of stents implantation included: trachea in 8, left main bronchus in 35, right main bronchus in 3, right intermediate bronchus in 2, left lower lobar bronchus in 1; The types of EBTB included: ulcerous-caseous necrosis type in 6, granular proliferation type in 4, cicatrical stenotic type in 35, tracheobronchial malacia type in 15. In accordance with different location, range and property of lesion , 24 domestic made Ni-Ti memory alloy stents and 25 Ultraflex stents were implanted respectively under general or local anesthesia. Before stenting and 1 week, 6~9 months after stenting, the lumen of stenosis segment, Borg index and pulmonary function were measured to evaluate the improvement of ventilation function. Complicatons after stenting were assessed to evaluated the safety of metallic stents implantation.Results: 1. After stents implantation, the mean lumen in the stenosis segments of 49 EBTB patients significantly increased (2.71±1.71mm vs 9.51±2.28mm, P<0.05). The Borg index markedly decreased (2.71±0.79 vs 0.64±0.33, P<0.05). In 42 cases , FVC, FEV1 and PEF increased from 2.22±0.65L to 2.88±0.59L, 1.31±0.52L to 2.35±0.57L, 3.97±1.80L/sec to 5.26±1.39L/sec respectively (P<0.05). 2. In 39 cases whose stents implantation lasted more than 6 months, the mean lumen in the stenosis segment was 8.74±3.85mm, and the Borg index was 0.90±0.68. In 26 cases, FVC, FEV1 and PEF was 2.75±0.65L, 2.04±0.67L, and 4.92±1.67L/sec respectively. Compared the results of 7 days after stents implantation, the difference of mean lumen in the stenosis segments, Borg index, FVC, FEV1 and PEF were not significantly changed (P>0.05). 3. 5 cases (10.2%) occurred short-term complications including pneumothorax, hoarseness, pneumonia and stent migration. All complications were cured.4. The long-term complications included stent fracture and restenosis. There is a high restenosis rate in ulcerous-caseous necrosis type EBTB (66.67%, 4/6 cases) and granular proliferation type EBTB (50%, 2/4 cases). On the contrary, the restenosis rate is lower in cicatrical stenotic type (15.79%, 3/19 cases) and tracheobronchial malacia type EBTB (10%, 1/10). Combination of cryotherapy and balloon dilatation can effectively prevent the aggravation of restenosis. One patient occurred stent fracture, and cured by tracheal incision and stent reimplantation.Conclusions: 1. Endoluminal metallic stenting using flexible bronchoscopy can effectively relieve the airway obstruction and improve pulmonary function in patients of cicatrical stenotic type and tracheobronchial malacia type EBTB. 2.In 6~9 months following stents implantation, the results of the mean lumen in the stenosis segment, Borg index, FVC, FEV1 and PEF indicate that the long-term effect maintains at a satisfactory level.3. In 39 cases who underwent long-term follow-up (range, 6 to 80 months;mean, 27.89±17.05 months), 10 patients occurred restenosis after stents implantat... |
PDF Full Text Request