With the increasing popularity of bronchoscopy in clinical applications, the following local therapies are available as treatment options for patients who cannot undergo surgery or radiotherapy: various bronchoscopy-mediated laser, high-frequency electric knife, radiofrequency ablation, argon plasma coagulation (APC), microwave, photodynamic therapy, cryopreservation, airway stenting, balloon dilation, submucosal or intra-tumoral drug injection, etc. The implementation of endobronchial interventions must be based on strict indications, clear treatment objectives, objective assessment of whether a proposed treatment technique can achieve the desired goals, and implementation of the treatment in hospitals where it is available.
For intraluminal polyp-like tumors, direct laparoscopic resection or carbon dioxide laparotomy can be performed, while APC can be performed on the root of the tumor.
For the infiltrating type, photodynamic therapy can be performed after resection of the intraluminal tumor, and radioactive particle therapy can be considered if external irradiation is contraindicated.
For patients with central airway stenosis who are inoperable or refuse surgery, endoscopic endoluminal interventions can be considered. These include thermal ablation (high-frequency electric knife, radiofrequency ablation, APC, microwave, laser, etc.), photodynamic therapy, cryotherapy, airway stenting, submucosal or intra-tumoral drug injection, and other techniques.
4. For airway stenosis and airway fistula that cannot be relieved by conventional treatment, endoprosthesis should be the main treatment method, and endoprosthesis can be divided into two types: metal stent and non-metal stent; according to the presence or absence of perithelium, metal stent can be divided into perithelial stent and non-perithelial stent (bare stent). Non-metallic stents can be divided into silicone stents, plastic stents, etc.
If the distal lung function of the lesion is lost, or if the lesion also obstructs the small airways, endoscopic interventions should be carefully chosen.
The choice of individualized bronchoscopic endoluminal interventions is important and should be discussed in the MDT, taking into account the performance of the equipment and personnel of the proposed technique. The ideal treatment modality is a combination of multiple modalities, such as thermocoagulation or cryotomy to remove large intraluminal lesions and freeze-thaw to remove basal lesions.