PURPOSE: Benign complex tracheobronchial stenosis (BCTS) is a tracheobronchial stenosis that longer than 1 cm or has more than one site of stenotic area. The etiology of the stenosis is not from malignant neoplasm. BCTS causes challenge in diagnosis and management because of nonspecific presentation and usually precluded surgical treatment. The study aims to report experience in management of BCTS in Siriraj hospital.
METHODS: Retrospective analysis of data from medical records of BCTS patients who had been treated at Division of respiratory disease and tuberculosis, Siriraj hospital between January 2006 and January 2011 was done. Their age, duration of symptom, duration of follow up and number of intervention bronchoscopic procedures were reported as mean and range. The causes of the lesion, sites of the lesions and type of stent with complications were reported.
RESULTS: Forty - six BCTS cases were treated at Division of respiratory disease and tuberculosis, Siriraj hospital during the study period. The mean age was 38.4 year-old(15-73). All except 2 was female. Most common etiology of stenosis was tuberculosis (69%). The lesion was at trachea in 56%, right main bronchus 39% and left main bronchus 50%. Tracheobroncho malacia was found in 45% of patients. Multiple lesions were found in 43% of patients. 23 airway stents were inserted in 21 patients. 6 of them were metallic. Most common complication was granulation tissue formation at the end of the stent. During the mean follow up period of 83 weeks (10-260), average number of intervention procedure was 4.9 per patient (1-36).
CONCLUSIONS: BCTS usually caused by tuberculosis and presented in young female. The length and multiple lesions precluded them from definitive surgical resection. Current techniques in intervention bronchoscopy are not suitable for this condition by the high number of procedure per patient. High dose rate brachytherapy or cryospray may be the potential treatments.
CLINICAL IMPLICATIONS: Intervention bronchoscopic technique can be used in BCTS with moderate success.The development of new technique is needed.
DISCLOSURE: The following authors have nothing to disclose: Jamsak Tscheikuna, Supparerk Disayabutr
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