Background and objective: Treatment of critical airway stenoses remains a formidable challenge to surgeons and anesthesiologists. Suffocate is a leading cause of death if the patients with airway diseases were not treated properly. The purpose of this study is to explore the feasibility, safety and efficiency using video-assisted rigid bronchoscopes (VARB) in the treatment of central airway stenoses.
Methods: From August 27, 2007 to September 30, 2010, 194 patients (140 men and 54 women, mean age 57.5±1.3 years) with airway stenoses (145 with malignant and 49 with benign stenoses) were retrospectively reviewed underwent VARB treatment in our hospital. All the procedures were carried out under general anesthesia with high frequency jet ventilation. After the VARB was placed in the main trachea through the mouth, electric bronchoscope was combined to examine the lesions. Various methods for controlling the airway have been established to solve this problem, such as the electric loop, cryoprobe or argon plasma coagulation (APC) and stents.
Results: T325 procedures were accomplished in all the 194 cases. Every patients received 1.6 procedures of VARB. VARB occupied 21.3% (325/1,525) in all bronchoscopic procedures. Among the patients, there were 76 cases with primary airway tumor and 69 with secondary malignant tumor, 49 with benign airway stenoses. Karnofsky performance status (KPS) and short breathless index were obviously improved after the first treatment of VARB. Improvement of bronchial stenoses was superior to that of tracheal stenoses. The effect of electasis treatment is better in obstruction of main bronchus than that of segment bronchus. 26 airway stents were removed and 13 stents were successfully placed under VARB.
Conclusions: VARB can be applied safely and effectively for the management of tracheobronchial stenoses. Quality of life was improved after the treatment of VARB.
背景与目的: 大气道狭窄是内、外科和麻醉科都较难处理的重大疾病, 如不及时处理易引起窒息。本文旨在探讨应用电视硬质气管镜消除气道狭窄的可行性、有效性和安全性。
方法: 回顾分析2007年8月27日-2010年9月30日收治的194例大气道狭窄病例（平均年龄（57.5±1.3）岁，其中男性140例，女性54例；恶性气道狭窄145例，良性气道狭窄49例）在全身麻醉支持下经口插入硬质镜，连接高频通气，结合电子支气管镜对声门部、气管内及支气管内狭窄采用电圈套器、冷冻、氩等离子体凝固（argon plasma coagulation, APC）等综合治疗措施进行治疗的情况。
结果: 194例患者共接受了325次硬质镜检查，平均每例患者接受1.6次操作，硬质镜检查占所有气管镜检查的21.3%（325/1, 525）。气道内肿瘤包括原发肿瘤76例，转移性肿瘤69例。良性狭窄最常见病因为瘢痕狭窄，其次为良性肿瘤、原发性肉芽组织增生、异物、气管软化和复发性多发性软骨炎。硬质镜首次治疗后气道狭窄程度均明显下降，其中支气管的下降程度要大于主气管。首次治疗后KPS明显升高，气促指数明显下降。硬质镜下取出气管支架26个，放置气管支架13个。硬质镜治疗比较安全，术中死亡1例。
结论: 硬质镜治疗大气道狭窄较快速、有效、安全，能提高患者生存质量。