The Cause Analysis And The Assessment Of The Efficacy And Safety Of Endoscopic Treatment In Malignant Central Airway Obstruction Disease

ObjectiveTo analyze the clinical data and the endoscopic treatment of500cases withmalignant central airway obstructions；Analyze the causes of malignant centralairway obstruction and assess the efficacy and safety of endoscopic treatment guidedby bronchoscope.Materials and MethodsThe clinical data of500cases with malignant central airway obstruction fromAugust1999to March2011in respiratory endoscopy center of Changhai Hospitalwere reviewed and the causes of the500cases were analyzed. The efficacy wasassessed by the changes of the patients’ Borg’s Dyspnea Scale, the pulmonaryfunction（FEV1）and the airway diameter；The safety was assessed by analyzingcomplications occurred perioperation.Results1、General features:500cases with malignant central airway obstruction fromAugust1999to March2011in respiratory endoscopy center of Changhai Hospital. Ofthe500patients,361cases were male and139cases were female; The age wasbetween7and86，and the average age was (57士13).2、Etiology: The causes were as follows: lung cancer (54.80%,274/500),esophageal cancer (21.20%,106/500), adenoid cystic carcinoma (11.00%,55/500)，thyroid cancer (2.80%,14/500), laryngeal cancer (1.40%,7/500), Carcinoid tumour(1.20%,6/500), mucoepidermoid carcinoma(1.00%,5/500), renal carcinoma(1.00%,5/500), mediastinal malignant tumors(1.00%,5/500), colorectal cancer(0.80%,4/500),malignant thymoma(0.60%,3/500), lymphoma(0.60%,3/500), liver cancer(0.40%,2/500), breast cancer(0.40%,2/500), epithelial-myoepithelial carcinoma(0.40%,2/500), malignant melanoma(0.20%,1/500), gastric carcinoma(0.20%,1/500),malignant schwannoma(0.20%,1/500), nasal eosinophilic tumor(0.20%,1/500),embryonic tumor(0.20%,1/500), liposarcoma(0.20%,1/500), sarcocarcima(0.20%,1/500).3、The position of central airway obstruction: trachea248csaes, trachea-leftprincipal bronchus-right principal bronchus20cases, trachea-left principal bronchus27cases, trachea-right principal bronchus20cases, trachea-right middle bronchus4 cases, trachea-left principal bronchus-right middle bronchus1case, trachea-rightprincipal bronchus-right middle bronchus1case, left principal bronchus85cases,right principal bronchus49cases, right middle bronchus26cases, left principalbronchus-right principal bronchus9cases, right principal bronchus-right middlebronchus8cases，left principal bronchus-right principal bronchus-right middlebronchus1case，left principal bronchus-right middle bronchus1case.4、The major endoscopic treatment methods included high frequency electriccauterization，stent implantation，brachytherapy，argon plasma coagulation (APC) andlaser therapy.210patients were treated with no less than two kinds of endoscopictreatments and290cases were treated with a single endoscopic treatment. Stentimplantation (270/500), high frequency electric cauterization (362/500) were usedmost in the500patients.5、The the Borg’s Dyspnea Scale improved from （4.07±1.42）to（1.89±0.96）（t=51.144, P <0.01）；The average airway diameter increased from (4.37±3.11) mmpre-operation to (10.50±2.83) mm post-operation (t=56.678, P <0.01) and the averagevolume of FEV1in164patients increased from (2.10±0.29)L to (2.40±0.31)Lsignificantly (t=30.933，P<0．01).6、There were no serious complications occurred perioperation except hyoxemia(265/500)、bleeding（102/500）and arrhythmia (100/500); Complications with metalstent were restenosis（86/270），migration（20/270）and stent fracture（4/270）。Therewere no fatal complications.Conclusion1、The the major causes of malignant central airway obstruction are lung cancerand esophageal cancer.2、The symptom induced by airway obstruction can be alleviated by endoscopictreatments, which provides the choice to malignant tumor for further treatment. Metalstent implantation can rapidly expand the airway, improve ventilation, and it is themost useful method to deal with serious airway obstruction; The high frequencyelectricity treatment have the characteristic of high efficiency and good costperformance, and it is the most commonly used treatment; Brachytherapy has theadvantages in controlling the disease than other therapies3、The endoscopic treatments can be widely clinically, with the advantage ofsecurity and less trauma. 4、The endoscopic treatments can only partially solve the problem of airwayobstruction, and fundamentally it still need to cooperate with effective local andsystemic treatment.