Airway stent placement for airway stenosis

  Airway stenosis can be a major clinical problem that has long troubled doctors in pulmonary medicine, thoracic surgery and oncology radiotherapy, with common causes such as tumor, tuberculosis, trauma and scar stenosis. Due to the non-specific early clinical manifestations, it is difficult to detect abnormalities on ordinary chest X-ray or radiographs, which makes it easy to misdiagnose and miss the diagnosis, and it is often not diagnosed in time. For those who can operate, the clinical application is greatly restricted due to the high trauma, complications and technical requirements of traditional surgery.  In the past, tracheal intubation was mostly used, which easily led to lung infection and significantly decreased the quality of life of patients, and for left and right main bronchial obstruction, tracheal intubation could not solve the problem at all. According to the literature, some tumor patients such as esophageal cancer, lung cancer and mediastinal tumor, etc., in advanced stage, the tumor often invades trachea and bronchus, narrowing the airway and causing difficulty in breathing, and if not treated in time, respiratory failure and obstructive pneumonia will occur, and patients can die within weeks.  Therefore, how to solve the airway stenosis, relieve the breathing difficulty, improve the patient’s quality of life and fight for further treatment for tumor patients so as to effectively prolong the survival is an important clinical problem to be solved. The earliest airway stent was the silicone rubber T-tube invented by Montgonery in 1965, which was first used in 1968 for subglottic stenosis and upper tracheal obstruction cases.  In 1982, Westaby used an inverted Y-shaped silicone rubber tube for endotracheal tube in the bronchial cavity under direct rigid microscopy to treat two patients with tracheal and bronchial obstruction.  With the widespread development of endoscopic treatment and the continuous improvement of interventional materials and techniques, endotracheal treatment with argon knife, Nd:YAG laser, high-frequency endoscopic electrocautery, etc. with the aid of fiberoptic bronchoscope, and some scholars combined with balloon dilation or stent placement for the treatment of airway stenosis have emerged. In China, Wei Guozhen first reported the successful placement of four bronchial metal stents under bronchoscopy in 1995, and then the reports of stent placement under bronchoscopy or X-ray for related tracheal and bronchial stenosis gradually increased.  Although airway stenting has many problems and the incidence of complications is 10%-20%, it is still a safe, effective and simple new technique for the treatment of airway stenosis.  Indications: It is suitable for patients with various primary malignant tumors (such as esophageal cancer, central lung cancer and mediastinal lymphoma, etc.) and metastatic tumors invading or compressing the airway or the left and right main bronchi and benign severe narrowing of the airway caused by various reasons, resulting in severe restriction of breathing without surgical relief of airway stenosis.  Significance: Mechanical support to open the narrowed airway through airway stenting can rapidly relieve the patient’s symptoms of respiratory distress, thus improving the patient’s general condition and significantly improving the patient’s quality of survival, and for some tumor patients, after their general condition improves, radiotherapy or interventional therapy can be appropriately selected according to the characteristics of the primary tumor, thus effectively prolonging the patient’s survival.