Etiology Of 316 Patients With Moderate And Severe Malignant Central Airway Obstruction And Evaluation Of The Efficacy And Safety Of Airway Metal Stent Implantation

ObjectiveUsing the method of retrospective analysis,the pathogenesis of malignant central airway obstruction in China was preliminarily understood,and the efficacy and safety of airway metal stenting therapy in clinical treatment of malignant central airway obstruction were evaluated.Methods1.Obejective: To investigate the treatment of moderate and severe malignant central airway obstruction combined with airway metal stent implantation therapy for endoscopic interventional therapy for endoscopy from January 2001 to December 2015 in the Changhai Hospital.To collect their clinical,imaging,pathology and respiratory endoscopic diagnosis and treatment of information for research.2.Implementation process:(1)severity of airway obstruction: according to bronchoscopic estimation combined with CT image measurement to determine the extent of airway disease,degree of obstruction,according to the obstruction site of the percentage of the percentage of cross-sectional area reduced: 0: no stenosis,1: ? 25%,2 Level: 26% ~ 50%,Level 3: 51% ~ 75%,Level 4: 76% ~ 90%,Level 5: ?91%.Among them,3 for moderate stenosis,4,5 for severe stenosis;(2)cause of the cause identified: based on clinical data of patients with bronchoscopic pathological biopsy results to determine the cause of airway obstruction;(3)stent selection and placement Methods: The use of domestic nickel-titanium alloy metal stent,imported Ultraflex stent,in the local anesthesia,local anesthesia + intravenous or general anesthesia,the use of guide wire guide,bronchoscopy under the direct placement of airway metal stent method;(4)Evaluation of the curative effect: Analysis of changes before and after treatment in patients with dyspnea index,stenosis diameter,FEV1 index,to evaluate the efficacy of metallic stent therapy;the complications of restenosis at 1 months and 6 months after stent implantation were reviewed to evaluate the efficacy of the stent;(5)safety evaluation: The lesion was observed in hemorrhage,edema,glottal stent displacement and other complications,to evaluate the safety of stenting;occurrence of granulation hyperplasia,secretions,displacement,bleeding,stent fracture and other complications were after stent implantation,to evaluate the safety of the stent after implantation.3.Statistical analysis: The data were processed by SAS 9.3 software.The Wilcoxon sign was used for the rank data.If the t-test was used for the homogeneity test or the variance homogeneity test,the Wilcoxon sign was used.The test level(?)was 0.05,P <0.05 was statistically significant.Results1?Etiology composition: 316 cases of malignant central airway obstruction patients include: lung cancer in 179 cases(56.7%),esophageal cancer in 104 cases(32.9%),thyroid cancer in 21 cases 6.7%),3 cases(0.9%)of laryngeal carcinoma,2 cases of lymphoma(0.6%),1 case of nasopharyngeal carcinoma(0.3%)and 6 cases(1.9%)of other organ tumors.2?Airway obstruction site and degree: There were 179 cases of tracheal stenosis(46 cases in the middle segment,41 cases in the middle segment,33 cases in the middle segment,30 cases in the middle and lower segments,26 cases in the lower segment and 3 cases in the trachea);30 cases of simple left main stenosis;Cases;simple right middle bronchial stenosis in 7 cases.Multi-site narrow(2 or more parts)76 cases.Moderate obstruction in 146 cases(46.2%),severe obstruction in 170 cases(53.8%).3?Metal stent placement therapy: All patients treated with different levels of dyspnea were reduced in grade,9 in descending grade 1,305 in grade 2 and 2 in grade 3(S = 25034,P <0.0001).The diameter of the stenosis of the obstructed site increased from 3.51 ± 1.92 mm before treatment to 8.79 ± 2.05mm(S = 30189,P <0.0001)after treatment.The FEV1 increased from 1.95 ± 0.64 L to 2.37 ± 0.60L(t = 10.381,P <0.0001)in 68 patients with pulmonary function.Follow-up results showed a statistically significant difference in the incidence of restenosis at 6 months after stent implantation and the incidence of restenosis at 1 month postoperatively(P = 0.0008).4?Metal stent placement therapy safety: There were 58 cases(58 / 316,18.3%),glottic edema(5 / 316,1.6%)and 2 cases(2 / 316,0.6%)in the postoperative and postoperative short-term complications.,No bleeding and death and cardiac arrest and other serious adverse events.Stent implantation follow-up occurred after the complications are: tumor to the cavity growth,secretions retention,granulation proliferation,displacement,bleeding and stent fracture.Conclusion1?Lung cancer,esophageal cancer is the most common cause of malignant central airway obstruction.The airway should be examined in patients with lung cancer and esophageal cancer in order to detect and treat central airway obstruction as early as possible.2?Airway metal stent placement therapy can quickly relieve the degree of moderate and severe malignant central airway obstruction,the treatment is effective.But the maintenance of postoperative efficacy needs to be further combined with the etiology of the tumor and stent cavity maintenance.3?On the basis of the assessment of the disease,familiar with the treatment of complications,airway metal stent placement therapy is a relatively safe treatment.But the incidence of bleeding in surgery is high,need to pay attention.Stent placement with time after the occurrence of a variety of complications should be followed regularly.