[The application of combined interventional procedures for the management of intractable central airway stenosis].
OBJECTIVE
to evaluate the application of combined five interventional procedures in the management of intractable central airway stenosis.


METHODS
clinical manifestations and pulmonary functions of 138 patients with intractable central airway stenosis were evaluated. Five interventional procedures, including high-frequency electrotome, argon plasma coagulation (APC), cryotherapy, stent placement and high-pressure balloon dilatation, were used in this study. Among them, two or more procedures were combined to manage complicated airway stenosis according to stenosis causes, types, position, degree and duration, or functions of distal lung tissue and airway. Forty-two cases were treated with high-frequency electrotome and APC, 54 cases with high-frequency electrotome, cryotherapy and APC, 29 cases with high-frequency electrotome, cryotherapy, APC and stent placement, and 13 cases with cryotherapy, APC and high-pressure balloon dilatation. Airways opening, short-term therapeutic effects and improvement of pulmonary functions were evaluated when ideal curative effects were achieved in the first month after intervention.


RESULTS
the total short-term effective rate in the 138 patients was 100%. The airway diameter was increased from (2.6 ± 1.5) mm before operation to (6.2 ± 1.7) mm after operation (P < 0.05). Dyspnea score was decreased from (2.4 ± 0.8) before operation to (0.7 ± 0.6) after operation (P < 0.05). FEV(1) was increased from (1.8 ± 0.6) L before operation to (3.1 ± 0.7) L after operation (P < 0.05). Among 23 cases benign disease, including 4 benign tumor, 15 tuberculosis and 4 other granulomatosis, 5 cases with various degrees of restenosis needed further interventional therapy after 3 months of follow up and effective rate was 78.3% (18/23). After 6 months of follow-up, 3 cases with restenosis needed re-intervention, and the effective rate was 86.9% (20/23). All of the 23 cases did not experience stenosis after 12 months of follow-up. Patients with malignant tumor were not followed up for long term.


CONCLUSIONS
combination of five interventional procedures, including high-frequency electrotome, APC, cryotherapy, stent placement and high-pressure balloon dilatation, has fewer complications and favorable clinical effects in management of intractable central airway stenosis.
Jin
Fa-Guang
FG
Department of Respiratory Disease, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China. jinfg@fmmu.edu.cn
Fu
En-Qing
EQ
Xie
Yong-Hong
YH
Li
Wang-Ping
WP
Nan
Yan-Dong
YD
Liu
Wei
W
Sun
Rui-Lin
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000628:therapy; D057908:Argon Plasma Coagulation; D002404:Catheterization; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014135:Tracheal Stenosis / Q000628:therapy*; D055815:Young Adult