Silicone Stents in the Management of Inoperable Tracheobronchial Stenoses – Methods (2)

Silicone Stents in the Management of Inoperable Tracheobronchial Stenoses - Methods (2)Stenoses showing residual obstruction of the airway lumen of >50 percent after laser resection and mechanical dilatation or airways with collapsing walls caused by destruction of the cartilaginous support were kept patent with stents. In all patients we used silicone stents (Endoxane) (Fig 1) that were inserted according to the technique described by Dumon.
Assessment of Immediate Efficacy and Tolerance of Stents
The ventilation of the lung distal to the stent was checked clinically at the end of the operation before the patient left the operating room. Twenty-four hours after the procedure, a chest radiograph was taken to locate the position of the stent (Fig 2) and to assess lung volumes. A repeated fiberoptic bronchoscopy was performed under local anesthesia to reassess the exact stent position, to check its patency, and to carry out a debridement of fibrin and necrotic tumor tissues (Fig 3). The improvement in the patients condition was assessed by comparing the pretreatment and posttreatment scores of the following variables: dyspnea (New York Heart Association), Karnofskv performance scale, and the World Health Organization activity index. Pretreatment and posttreatment lung function tests with assessment of the entire flow/volume loop were recorded in the patients who underwent elective procedures with a preoperative dyspnea of <3. In the patients with dyspnea 4 and in those undergoing an emergency procedure because of life-threatening tracheobronchial obstruction, only posttreatment measurements were obtained.

Figure-1

Figure 1. Silicone stent (Endoxane): diameter, 14 mm; length, 50 mm.

Figure-2

Figure 2. Chest radiograph showing perfectly deployed stent (14×50 mm) bridging lower trachea and left main bronchus in a patient with squamous cell carcinoma of the right upper lobe having caused atelectasis of the right lung and severe obstruction of lower trachea and left main bronchus.

Figure-3

Figure 3. Proximal tracheal stent 24 h after insertion: Ijft, Proximal end showing patent stent with large fibrin clot that was removed by forceps. Right, Distal end of stent after debridement w ith view of normal distal trachea and carina.