The application of laser therapy plus endobronchial stenting in treatment of complete airway obstruction
Guo, J.; Chen, Z.; Gao, X.; Wang, S.; Li, J.; Zhang, W.; Li, H.
Zhonghua Nei Ke Za Zhi 40(7): 435-438
2001
ISSN/ISBN: 0578-1426 PMID: 11798608 Document Number: 538174
To assess the efficacy of laser therapy plus endobronchial stenting in the treatment of complete airway obstruction. 17 cases with complete airway obstruction were treated with Nd: YAG laser and endobronchial stenting from April 1998 to November 2000. The patients' dyspnea, airway gauge, pulmonary function and complications were observed. The airways were all restructured following a single or multiple laser treatment; the airway gauge enlarged and the average diameter increased (5.82 +/- 1.01) mm. Immediate relief of dyspnea was achieved in sixteen patients and dyspnea index lessened one grade in 4 patients, 2 grades in 11 and 3 grades in one. Obvious improvement of forced expiratory volume in one second (FEV(1)) was noted in all patients;the improvement averaged (0.49 +/- 0.18) L. Endobronchial stents were placed for 14 patients after laser treatment. After stent placement, the airway was further opened and the average airway gauge increased (3.50 +/- 0.94) mm further in diameter. Patients' dyspnea and FEV(1) were further improved; dyspnea index lowered one grade in eight patients and 2 grades in two patients. FEV(1) improved further (0.41 +/- 0.20) L in average. Complications after laser therapy included hypoxemia in 15 patients, hemorrhage in 2 and postoperative dyspnea in 3. Follow-up duration ranged from 2-20 months. Complications after stenting included recurrent pneumonia in 4 patients, airway obstruction due to granuloma or tumour growth in 5 and stent migration in 1. Laser therapy and endobronchial stent placement were effective in the treatment of patients with totally occluded airway. Nd: YAG laser can be first chosen to restructure the occluded airway, then endobronchial stent must be used to further enlarge the airway and maintain the therapeutic effect.