背景:良性气管狭窄相对罕见,但由于其剧烈症状包括呼吸困难和吸气性喘鸣,仍然是一种严重的慢性疾病,以及随之而来的对生活质量的负面影响。传统上,通过切除狭窄的气管段的手术方法一直是首选的治疗方法。然而,内镜技术已经出现,可能提供一种安全且侵入性较小的替代方法。
目的:回顾性研究的目的是评估单中心良性气管狭窄内镜治疗的手术相关安全性和结果。
方法:该研究包括2013年至2022年在我院接受硬质气管镜下良性气管狭窄内镜治疗的所有患者,通过电乳头切开针和扩张(内窥镜气管成形术)进行放射状切口,然后进行曲安奈德作为局部粘膜下注射,另外,从2020年开始,布地奈德吸入。
结果:在总共38项干预措施中,共有22例患者接受了治疗,每个都导致症状的立即改善。无介入围手术期并发症或死亡率。在38项干预措施中,11没有接受曲安奈德给药,平均21.1(±18.0)个月后复发率为54.5%,而27人局部服用曲安奈德,有37%的复发率。自2020年以来,我们还对新入院患者和复发患者(n=8)进行了干预后布地奈德吸入治疗,以预防复发。到目前为止,其中只有一人(12.5%)经历过复发。
结论:我们的研究结果表明,内镜下气管成形术提供了一种安全、成功、良性气管狭窄患者的微创手术替代开放手术。我们建议将曲安奈德局部用于粘膜作为一种额外的治疗方法,以降低复发的风险。然而,鉴于不受控制的研究设计和低样本量,安全性和有效性无法最终证明。尽管如此,我们的研究结果为进一步调查提供了有希望的途径.需要进一步研究吸入糖皮质激素的额外益处。
BACKGROUND: Benign tracheal stenosis is relatively rare but remains a significant chronic disease due to its drastic symptoms including dyspnoea and inspiratory stridor, and consequent negative effect on quality of life. Traditionally, the surgical approach by resection of the stenotic tracheal segment has been the therapy of choice. However, endoscopic techniques have arisen and may offer a safe and less invasive alternative.
OBJECTIVE: The aim of the retrospective study was to evaluate procedure-related safety and outcome of endoscopic treatment of benign tracheal stenosis at a single centre.
METHODS: The study included all patients at our institution who between 2013 and 2022 had received endoscopic treatment of benign tracheal stenosis by rigid tracheoscopy, radial incision by electric papillotomy needle and dilation (endoscopic tracheoplasty) followed by triamcinolone acetonide as a local submucosal injection and additionally, from 2020, budesonide inhalation.
RESULTS: A total of 22 patients were treated in a total of 38 interventions, each resulting in immediate improvement of symptoms. There were no peri-interventional complications or mortality. Of the 38 interventions, 11 received no triamcinolone acetonide administration, resulting in a 54.5% recurrence rate after an average of 21.1 (±18.0) months, while 27 had local triamcinolone acetonide, with a 37% recurrence rate. Since 2020, we additionally initiated post-interventional budesonide inhalation as recurrence prophylaxis for newly admitted patients and patients with recurrences(n = 8), of whom only one (12.5%) has to date experienced a recurrence.
CONCLUSIONS: Our results indicate that endoscopic tracheoplasty offers a safe and successful, minimally invasive alternative to open surgery for patients with benign tracheal stenosis. We recommend local administration of triamcinolone into the mucosa as an additional treatment to decrease the risk of recurrence. However, given the uncontrolled study design and low sample size, safety and effectiveness cannot be conclusively demonstrated. Nonetheless, our findings suggest promising avenues for further investigation. Further studies on the additional benefit of inhaled corticosteroids are warranted.