| Background and Objective Around the world, compared with the rest of the body’s tissues and organs of primary malignant tumors, the morbidity and mortality of patients with lung cancer are the highest. In recent decades, with the comprehensive treatment methods such as surgery, radiation and chemotherapy and targeted therapy progress, which improved survival of patients with lung cancer, overall, the survival rate has not been significantly improved. Advanced tumors patients with multiple systemic metastasis and progressive consumption and other cachexia, are usually the direct cause of death in patients with lung cancer. In addition, there are also some patients died of tumor local progression. About 20% ~ 20% of advanced cancer patients will appear central airway stenosis(central airway obstruction(CAO) [2-3], esophageal cancer,mediastinal tumors and thyroid cancer locally advanced, kidney cancer and other malignant diseases of lung metastasis can also cause central airway stenosis,leading to intractable cough,dyspnea,obstructive pneumonia, or even life-threatening.The treatment of malignant central airway stenosis,which respiratory physicians often encounter in clinical medical activities.Meanwhile, malignant central airway stenosis, a critical respiratory disease,whose treatment is difficult. In recent years,with the development of a wide range of interventional pulmonology newtechnologies and rapid application in clinical work, makes the central airway stenosis treatment present diversified situation. At the same time,it has become one of the key techniques for the department of respiratory medicine in the treatment of lung disease.In this study, 48 ceses with central airway stenosis caused by malignant tumors,were selected for airway stent implantation treament guided by fiber bronchoscope. The dyspnea symptom,Shortness of breath rating, Kamofsky score(KPS score),blood-gas analysis,lung function were evaluated and compared before and after treatment,and complications were analyzed. At the same time,analyzing its clinical value and safety in the treatment of central airway stenosis caused by malignant tumors.MaterialsFrom February 2012 to October 2014, In the Second Affiliated Hospital of Zhengzhou University, diagnosis and treatment of Respiratory Medicine bronchoscope chamber,48 ceses with central airway stenosis caused by malignant tumors,were selected for airway metal stents implantation treament guided by fiber bronchoscope. The dyspnea symptom,Shortness of breath rating, Kamofsky score(KPS score),blood-gas analysis,lung function were evaluated and compared before and after treatment,and complications were analyzed. Intraoperative,postoperative recent and long-term complications were analyzed in order to evaluate its clinical efficacy and safety.ResultsA total of 54 airway metal stents were implanted in 48 airway stenosis patients,one-time successful 45cases(45/48,93.75%). Patients with airway obstruction symptoms significantly reduce after airway metal stents implantation treament,dyspneic symptoms were ameliorated instantly. The recent effective rate was 100%. All the patients after treatment, compared with before treatment, PaO2 before treatment(51.8±8.0 mm Hg) and PaCO2(64.7 ±12.6 mmHg), SaO2 83.5 ± 8.8(%),Shortness of breath rating 3.9± 0.2, Kamofsky score(60.25±6.10 KPS score), VC(L) 1.77± 0.54, FEV1(L) 1.44±0.47, PEF(L) 2.91±1.33, PaO2 after treatment(72.4±11.3 mmHg) and PaCO2(43.2±6.4 mmHg), SaO2 94.7± 3.9(%),Shortness of breath rating 2.1±0.5, Kamofsky score(79.56 ± 8.90 KPS score), VC(L) 2.83±0.30, FEV1(L) 1.85±0.54, 3.83 ±1.57 PEF(L),and the differences are statistically significant(P<0.05). The recent effective rate was 100%. In this study,the average survival time of the patients is 3~5 months. The intraoperative,postoperative recent and long-termserious complications related to airway metal stents were not found in all cases.ConclusionsFiber bronchoscope guidance airway metal stents implantation in the management of patients with lost operation time’ advanced tumors merger central airway stenosis,is a kind of effective palliative intervention methods. It is safe and effective. airway metal stents implantation can quickly rescue patients from the airway stenosis,alleviate difficulty breathing, and create opportunitys for follow-up the comprehensive treatment. The intraoperative,postoperative recent and long-term serious complications related to airway metal stents were little and mild in all cases.Postoperative adjuvant radiotherapy, chemotherapy and molecular targeted therapy,can prolong the survival time of patients with adanced cancer merger central airway stenosis. It is worth popularizing application in clinic. |
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