ABSTRACT
Objective To investigate the risk factors of central airway stenosis after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed. According to the incidence of central airway stenosis following lung transplantation, all recipients were divided into the stenosis group (n=36) and control group (n=119). The incidence of central airway stenosis after lung transplantation was summarized. The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses. Results Among 155 lung transplant recipients, 36 cases (23.2%) developed central airway stenosis. The average incidence time was (53±13) d after lung transplantation. Univariate analysis demonstrated that bilateral lung transplantation, grade 3 primary graft dysfunction (PGD), airway fungal infection, long cold ischemia time, long mechanical ventilation time and long intensive care unit (ICU) stay were the risk factors for central airway stenosis after lung transplantation (all P < 0.05). Multivariate analysis showed that airway fungal infection, long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation (all P < 0.05). Conclusions Airway fungal infection after lung transplantation, long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation. Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation.
ABSTRACT
Lung transplantation is the only effective treatment of most end-stage lung diseases. Airway anastomotic complications are the main obstacles affecting the postoperative survival and quality of life of lung transplant recipients. Airway anastomotic stenosis is the most common airway anastomotic complication after lung transplantation. In recent years, improvements in the recipient selection, organ preservation, surgical techniques, postoperative intensive care management, immunosuppression, antifungal and endoscopic treatment have decreased the incidence of airway anastomotic stenosis and improved the surgical efficacy of lung transplantation and the survival of the recipients. In this article, the pathogenesis, risk factors, diagnosis and treatment of airway anastomotic stenosis after lung transplantation were reviewed, aiming to provide novel ideas for clinical research, diagnosis and treatment of airway anastomotic stenosis following lung transplantation.
ABSTRACT
Objective: To evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis. Methods: We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room, The First Affiliated Hospital of Bengbu Medical College. We analyzed the patients' general data, diagnosis results, clinical manifestations, imaging and interventional treatment. The severity, type and distribution of stenosis were evaluated. The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index (MRC DI) and Karnofsky Performance Score (KPS). Through regular follow-up, dynamic observation and evaluation of clinical efficacy, according to the occurrence of intraoperative and postoperative complications, safety assessment was carried out to evaluate the postoperative outcome. The clinical efficacy, safety evaluation and prognosis were observed. Results: The average age of 46 patients was (62.43±12.34) years old. 36 (78.26%) had tracheal stenosis, 6 (13.04%) had stenosis in the left main bronchus, 10 (21.74%) in the right main bronchus, and 2 (4.35%) in the right middle bronchus. Among them, 33 patients (71.74%) had malignant central airway stenosis and 13 (28.26%) had benign lesions. Forty-six patients underwent 58 interventional therapies, including stent placement, cryotherapy and balloon dilatation. Endoscopic estimation of the degree of tracheal stenosis was (85.42±7.81)% before the first intervention and (24.17±5.79)% after operation. The degree of stenosis in the right main bronchus was improved from (81.00±17.13)% to (20.50±6.43)%. The degree of left main bronchus stenosis (24.17±9.14)% was significantly improved compared with preoperative (77.50±16.66)%. The difference was statistically significant (t=42.73, t=22.43, t=19.02, P<0.001). The degree of dyspnea was relieved in all the patients. Postoperative MRC DI was 0.98±0.62, significantly lower than the preoperative one 3.42±0.57(t=19.65, P<0.001). KPS was 34.01±13.14 and 83.91±8.96 before and after interventional therapy, and KPS increased significantly after operation (t=21.28, P<0.001). The main complications were local hemorrhage, hypoxemia in 4 cases (8.70%, 4/46), transient ventricular premature rupture in 1 case (2.17%, 1/46), and tooth loss in 2 cases(4.35%, 2/46). Most patients had sore throat of varying degrees after operation. The 1-year survival rate of patients with malignant central airway stenosis was 13.79% (4/29), and 4 patients with malignant tumor were followed up; 13 patients with benign airway stenosis had good quality of life. Conclusion: For central airway stenosis, especially complex central airway stenosis, rigid bronchoscopy combined with electronic bronchoscopy shows immediate improvement of dyspnea and causes rare severe complications; thus it is safe and effective. It can improve the patients' quality of life.