| Background and Objective:Benign tracheal stenosis is the narrowing of trachea caused by benign lesions,such as hyperplasia or scarring,from trachea itself or the structure adjacent to it.A lot of diseases can contribute to tracheal stenosis,including trachea tuberculosis,lung transplantation,sleeve resection of bronchus,long-term tracheal intubation or tracheostomy,pulmonary tuberculosis,chronic reaction to foreign bodies,sarcoidosis,trauma,Wegner's granuloma,and tracheal and bronchial amyloidosis and et al.In foreign countries,the most frequent causes are lung transplantation or long-term tracheal intubation or tracheostomy,while in China it is tuberculosis.As a common diease in pulmonary department,benign tracheal stenosis has a gradually increasing morbidity.Stricture of the trachea can severely impair the respiartory function,which secondarily leads to remote obstructive pneumonitis,causing symptoms of repeat coughing,chest tightness and dyspnea,being associated with poor quality of life of the patient and potentially fatal.In practice,in order to evaluate the degree of stenosis several kinds of methods are being used,eg. tomography,tracheography,computed tomography and trachea imaging,pulmonary function test,virtual bronchoscopy and fibrostic bronchoscopy and so on,but with all of these means the detail construction of the bracing structure of trachea cannot be shown.Although magnetic resonance imaging can provide images of tracheal cartilages and measuring data of trachea wall,but it not so widely available.Extracorporal ultrasonography is a kind of effective and non-invasive examining technology.It can clearly qualify the soft tissue and cartilages in and in front of the neck.In animals it is reliable to measure the larygo-cavity morphometrically and quantitaively using ultrasonography,and beside this it is still safe,radio-free,non invasive, repeatable in short time,portable permitting bedside examination and low-cost.There are reports concerning the use of extracorporal ultrasonogrphy in measuring the structure of trachea of normal persons and patients of laryngeal diseases,but no study on patients suffering from benign tracheal stenosis has been reported,and no study in China has ever used this technology to evaluate the tracheal stucture and outcome of these patients.In this study the trachea of patients of benign tracheal stenosis were examined with extracorporal high-frequency ultrasonography from the anterior neck,in comparison with CT scanning and bronchoscopy,and the data on trachea cartilages,scars,and the diameter of trachea cavity obtained were thoroughly analyzed.The value of extracorporal ultrasonography on evaluating benign tracheal stenosis was discussed,giving rise to a possible new way to evaluate this disease, to assess the prognosis,at the same time to help lessening the pain of patients associated with examination,to cut off the medical cost, and to save social medial resourses,and this technology can be broadenly extended,doing good to society and possessing ecnomical significance.Methods:16 patients who had been diagosed of benign stenosis of upper and middle trachea pathologically by the Bronchoscopy Center of GuangZhou institute of Respiratory Diseases(GIRD) of the first affiliated hospital of Guangzhou medical college from Jan. 2009 to Feb. 2011 were retrospectively analyzed. Assess the position,severity,length of the stenosis portion and the remote airway and lung parychema using spiral CT scan and 3-dimensional reconstruction; Assess the position,severity,length of the stenosis portion and the remote airway through broncoscopy; With extracorporal ultrasonography, from the anterior of neck, to assess the length of and distance between T1-T4 on the paratracheal longitudinal sections(2cm away from the middle line of trachea),and the thickness of T1-T4 on the horizontal sections perpendicular to the middle line of trachea, to measure the outter coronal diameter of trachea, to observe the shape of the cartilage rings,and the echo of cartilages, the attachments on the wall of cartilages, and irregular soft tissue such as granuloma and scars and so on. Analyze the data obtained and the clinical data as well. Discuss whether the three groups of results from those three kinds of examining methods are related to each other and how they are linked to the outcome of patients.Results:The average dimensions of 16 subjectives by CT,ultrasonography and bronchoscopy were separately 7.5±2.4mm, 7.8±2.7mm,and 7.3±2.6mm.The difference between the value gained from CT and ultrasonography,and diffenrence between the value from bronchoscopy and ultrasonography,and diffenrence between the value from CT and bronchoscopy have no statistical significance(P >0.05); the average maximal thickness by CT was 3.5±1.5mm ,and by ultrasonography was 3.1±1.6mm.These values are not different significantly(P >0.05); 6 of 16 subjectives are divided into the non-refractory group,while the other 10 are the refractory group,among the non-refractory group33.3%(2 of 6) of the subjectives had no cartilage ring lesions,33.3%(2 of 6) had 1,16.7%(1 of 6) had 2,and 16.7% (1 of 6)had 3;50%(3 of 6) of the subjectives had no place of cartilage ring deformation,33.3%(2 of 6) had 1,and 16.7%(1 of 6) had 2;83.3%(5 of 6) of the subjectives possessed normal thickness of cartilage ring and it was slightly thin for 16.7%(1 of 6); 83.3%(5 of 6) of the subjectives had normal echo of cartilage ring while it was abnormal(only one place) for 16.7%(1 of 6),for all of these 6 subjectives soft tissue have been detected,thickness of which was from 1.6 to 6.2mm; among the refractory group 10%(1 of 10) of the subjectives had 1 cartilage ring lesion,40%(4 of 10) had 3,and 50%(4 of 10) had 4;30%(3 of 10) of the subjectives had no place of cartilage ring deformation,10%(1 of 10) had 1,30%(3 of 10) had 3,and 30% (3 of 10) had 4;50%(5 of 10) of the subjectives possessed normal thickness of cartilage ring and abnormal for the other 50%, of which two were slightly thinner in thickness,one was slightly thicker,one was inhomogenous in thickness,and one was thicker here(3 places) while thinner otherwhere(1 place); 30%(3 of 10) of the subjectives had normal echo of cartilage ring while abnormal for the other 70%(7 of 10),of which five had inhomogenous echo,one had strengthened echo,and one had strengthened and weakenen echo at the same time,soft tissue have been detected in 9 of 10 subjectives,with thickness from 0.6 to 5.2mm. The number of cartilage ring lesions between two groups has statistical significance(P<0.05),the results of the deformation,thickness and echo of cartilage ring between two groups have no statistical significance(P >0.05),and the results of the soft tissue between two groups have no statistical significance(P >0.05).Conclusions:The results obtained from extracorporal ultrasonography are tightly related to the results from spiral CT scan and trachea reconstruction and the bronchoscopy,and that it can help assess the prognosis. Above these,it is still a safe,radio-free,non invasive, repeatable in short time,portable permitting bedside examination and low-cost test. We conclude that the extracorporal ultrasonography can be the basic choice of non-invasive tests to evaluate the bracing structure of the trachea for the patients of benign stenosis of upper and middle trachea. |
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