4th Mediterranean Congress of Thoracic Disease 26-29, November, 2004. Alejandria (Egypt)
The aims of interventional bronchoscopy are to restore the potency of the airways due to malignant and, less frequently, to benign disease.
Main purposes are the quality of life improvement after resolving the probleme of the tracheo-bronchial obstruction (dyspnea respiratory failure, obstruction pneumonia...).
Many options are available for the interventional bronchoscopy: Techniques with mechanism of action immediate:
- Thermocoagulation High Frequence,
- Argon-Laser,
- Radiofrequency,
- Mecanical debulking,
- Balloon dilatation,
-
Stenting. Techniques with mechanism of action delayed, that of course, not indicate in emergency: Cryotherapy, endo- bronchial Brachitherapy
, Photodinamic therapy.
The tracheo-bronchial intervention is given by an experienced operator and by correct indication.
In our Centre we work currently with Thermocoagulation H. F., Cryotherapy, Balloon dilatation to dilate the tracheo- bronchial lumen, before stentings.
Numerous expandable and mixed silicone metallic stents, for trachea and bronchi are available.
Of all the various stent, the silicone Dumon-stent is the one most widely used and represents the standard stent. Indeed, sufficient experience has been acquired only with the Dumon stent
easy to insert and remove with excellent tolerance, with not too many possible complications (migrations, granulomas, obstructions secretions...).
Malignant stenoses are the most common indication for the placement of tracheo-bronchial stents. It can improve airway potency relieving symptoms (dyspnea, pulmonary function...) and, as
a result, improving quality of life. In endoluminal tumours we work firstly with Thermocoagulation H.F. frequently associated to Cryotherapy , before stentig, during the same procedure.
Prolonged endotracheal intubation , or tracheostomy tube, may lead to altered tracheal blood flow, resulting in mucosal injury, and scarring, followed by tracheal stenosis.
The ideal
curative treatment is surgical resection of the stenosis with end-to-end tracheal anastomosis.
In patients presenting contraindications to the surgical resection we can attempt, then,
treatment by means of interventional endoscopy.
Endobronchial treatment with Nd-Yag-Laser and Thermocoagulation H.F., are considered the ideal techniques for improve airway potency before
stent placement, of course during the same procedure, with rigid Dumon-bronchoscope.
In conclusion, stent placement may prolong the life of patients with severe airway obstruction and / or to relieve symptoms with improving the quality of life.
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