[Restenosis and its management after metallic stents implantation in benign tracheal and main bronchial stenosis].
OBJECTIVE
To observe the occurrence of restenosis after metallic stents implantation in benign tracheal and main bronchial stenosis, and to evaluate the therapeutic effects of balloon dilatation, cryotherapy and electrocautery.


METHODS
Thirty patients with benign tracheal stenosis and 35 patients with main bronchial stenosis caused by tuberculosis were treated with metallic stents implantation and a follow-up was carried out to observe the occurrence of restenosis. Combined balloon dilatation, cryotherapy and electrocautery were used to manage the restenosis. The lumen of stenotic segment, dyspnea index and pulmonary function were measured before management and after the patient's condition became stable.


RESULTS
Restenosis occurred in 6 of the 30 patients receiving tracheal stenting and in 8 of the 35 patients receiving bronchial stenting, the restenosis rates were 20% and 22.86%, respectively. In total, 30 Chinese-made stents and 36 Ultraflex stents were implanted, and the restenosis rate was 20% and 22.2%, respectively (P > 0.05). The restenosis rate was 4/9 in the upper segmental tracheal stents, and was 9.09% in the middle-lower segmental stents (chi(2) = 5.114, P < 0.05, but chi(c)(2) = 3.100, P > 0.05). The restenosis rate was 16.67% in the fibrotic stage of endobronchial tuberculosis (EBTB), and was 60% in the inflammatory reaction stage of EBTB (chi(2) = 4.564, P < 0.05, but chi(c)(2) = 2.437, P > 0.05). The effective rate was 4/6 in the tracheal stenting restenosis patients, and was 2/4 and 2/2 in the upper and middle-lower segment groups, respectively. The effective rate was 7/8 in the bronchial stenting restenosis patients. After management, the lumen diameter of stenotic segment in the tracheal stenting restenosis patients increased from (3.33 +/- 1.63) mm to (9.33 +/- 3.98) mm (P < 0.02), the dyspnea index decreased from (3.67 +/- 0.52) to (1.50 +/- 1.64) (P < 0.02), the vital capacity (VC) increased from (1.39 +/- 0.17) L to (2.43 +/- 0.70) L (P < 0.01), the forced expiratory volume in one second (FEV(1)) increased from (1.02 +/- 0.15) L to (2.00 +/- 0.72) L (P < 0.02). After management, the lumen diameter of stenosis segment in the bronchial stenting restenosis patients increased from (3.00 +/- 0.76) mm to (7.38 +/- 2.00) mm (P < 0.001), the dyspnea index decreased from (1.63 +/- 0.52) to (0.50 +/- 0.76) (P < 0.005), VC increased from (1.74 +/- 0.16) L to (2.74 +/- 0.41) L (P < 0.001), FEV(1) increased from (1.41 +/- 0.19) L to (2.36 +/- 0.37) L (P < 0.001).


CONCLUSIONS
Restenosis occurred in some patients with benign tracheal and tuberculous bronchial stenosis after metallic stent implantation. The restenosis rate was higher in the upper tracheal stenosis than that in the middle-lower tracheal stenosis. Caution should be taken when metallic stents are placed in this part of the trachea. The restenosis rate was higher in the inflammatory reaction stage of EBTB than in the fibrotic stage. Effort should be made to avoid placing metallic stents at this stage of the disease. Balloon dilatation, cryotherapy and eletrocautery are effective methods in managing restenosis after stent implantation.
Yao
Xiao-peng
XP
Department of Respiratory, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Li
Qiang
Q
Bai
Chong
C
Huang
Yi
Y
Dong
Yu-chao
YC
Liu
Zhong-ling
ZL
Wang
Qin
Q
D000328:Adult; D000368:Aged; D001982:Bronchial Diseases / Q000209:etiology / Q000628:therapy*; D002404:Catheterization; D003131:Combined Modality Therapy; D017679:Cryotherapy; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects; D014135:Tracheal Stenosis / Q000209:etiology / Q000628:therapy*; D014376:Tuberculosis / Q000150:complications