[Argon plasma coagulation combined with covered stent placement for management of tracheobronchial stenoses/occlusions as well as esophagorespiratory fistulas].
OBJECTIVE
It is a complex problem and difficult treatment for tracheobronchial stenoses/occlusions involving in carina. The aim of this study is to investigate the feasibility and efficiency of argon plasma coagulation (APC) and bifurcated covered Z-type stents (CZTS) placement for the treatment of tracheobronchus stenoses and esophagorespiratory fistula (ERF).


METHODS
Thirty-two cases with airway disorders were retrospectively reviewed for the treatment of APC and CZTS placement. Under the bronchoscopic guidance, APC was first given in patients with airway stenoses, then CZTS was placed under the fluoroscopic and flexible bronchoscopic guidance either with airway stenoses or ERF.


RESULTS
APC was first given in 19 patients with airway stenoses. Airway structures were significantly improved after APC procedure (57.4%-72.1% before APC vs 12.8%-25.8% after APC). Thirty-two CZTS were technically successfully placed in 30 out of 32 cases involving in carinal bifurcation. After APC and stent placement, short breath index was significantly reduced and karnofsky physical score (KPS) increased obviously. The endobronchial defects were successfully palliated with bifurcated CZTS placed under fluoroscopy and flexible bronchoscopy in 12 out of 13 patients with ERFs. There is no bleeding introprocedure. Mucous retention was very common in all types of the stents less than 2 weeks after stenting, which required debridement by bronchoscopy and could be prevented by normal saline solution nebulizations. Granuloma developed at the ends of stents after 1 month of stenting which all of them were treated successfully with APC and CO2 cryosurgery.


CONCLUSIONS
Utilization of APC and retrieval bifurcated CZTS placement is a simple and safe protocol for the management of airway complex stenoses involving the tracheal carina and ERF.
Wang
Hongwu
H
Minimal Invasive Tumor Therapy Center, Meitan General Hospital, Beijing 100028, China. wanghongwu2008@yahoo.cn
Luo
Lingfei
L
Zhou
Yunzhi
Y
Ma
Hongming
H
Li
Jing
J
Zou
Heng
H
Li
Dongmei
D
Zhang
Nan
N
D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D004937:Esophageal Fistula / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016156:Respiratory Tract Fistula / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000601:surgery / Q000628:therapy*