Evaluation Of The Efficacy Of Tracheal Stents In Malignant Central Airway Obstruction

Objective:To investigate the therapeutic effect,complications and risk factors of airway stent implantation for malignant Central Airway Obstruction(m CAO),which can provide guidance for airway stenting in clinical practice.Methods:This retrospective study was conducted to analyze the patients who received airway stent implantation for m CAO in the Pulmonary and Critical Care Medicine of Zhangzhou Municipal Hospital Affiliated to Fujian Medical University between January 1,2018 and May 1,2020.The general demographic characteristics,clinical and laboratory data,preoperative evaluation and postoperative scores of the included patients were collected.The differences between the KPS score,Brog score and SF-6D score before stenting and 1 week after surgery were compared,the postoperative complications were analyzed,and the possible risk factors affecting the success rate of airway stenting were discussed.Results:A total of 75 patients with central airway obstruction caused by malignant tumors were included in this study,which are including 36 cases of lung cancer(21 cases of lung squamous cell carcinoma,9 cases of lung adenocarcinoma,4 cases of other types of lung cancer,and 2 cases of lung squamous cell carcinoma and lung adenocarcinoma)and 39 cases of extrapulmonary tumor.79 airway stents were placed.The main results of the study showed that the success rate of operation reached 93.3%,among which 1patients died within 1 week after operation,which were non-operative related deaths.The clinical success rate was 97.3%.The secondary results of the study showed that the postoperative physical fitness of the patients was better than that before surgery,the postoperative quality of life was improved,postoperative dyspnea was improved.According to the analysis results of paired T-test:Preoperative KPS score(58.8±20.5)and 1 week postoperative(70.5±21.6),preoperative SF-6D score(0.534±0.115)and 1 week postoperative(0.608±0.124),preoperative Brog score of patients with central airway obstruction(6.64±2.04)and 1 week postoperative(3.16±2.22)were showed significant differences(P < 0.001).Early postoperative complications(within 48 hours after operation)occurred in 12 cases(16%),including respiratory distress in 2 cases(2.7%)and hemorrhage in 10 cases(13.3%).Late complications(≥48hours after operation)were more common,with an incidence of 53.3%(40cases),including: airway secretions increased in 23 cases(30.7%),granulation tissue growth at the edge of the stent in 23 cases(30.7%),stent migration in 8cases(10.7%),and lower respiratory tract infection in 3 cases(4%)。Risk factors that may affect the success rate of stent implantation were included in Logistic regression analysis,and the results showed that gender,,smoking history,tumor stage,previous treatment history,Degree of airway obstruction and surgical urgency were not associated with the success rate except age(P=0.011).Conclusion: Airway stent implantation is an effective palliative treatment for malignant central airway obstruction.The short-term efficacy evaluation has shown that the clinical symptoms of patients are relieved and the quality of life is improved after operation.