Anastomosis, Surgical ; adverse effects ; Brachiocephalic Trunk ; pathology ; Hemorrhage ; etiology ; therapy ; Humans ; Larynx ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Trachea ; surgery ; Tracheal Stenosis ; etiology ; surgery ; Tracheotomy ; adverse effects

OBJECTIVETo investigate etiology and airway management in children with tracheobronchomalacia.

METHODBronchoscopic examinations were performed in 671 children. The cases with tracheomalacia and bronchomalacia were analyzed in etiopathogenesis and summarized their therapy simultaneously.

RESULTBronchoscopic examination indicated tracheomalacia and bronchomalacia in 148 cases, tracheomalacia in 77 cases and bronchomalacia in 71 cases. Among the cases with tracheomalacia, compression by vascular rings was found in 46 cases, incorporated congenital esophageal atresia with tracheoesophageal fistula was found in 5 cases, tracheomalacia was associated with tracheostoma and mechanical ventilation in 6 cases, with congenital airway malformation in 11 cases and isolated tracheomalacia was found in 4 cases. Among the cases with bronchomalacia, incorporated congenital cardiovascular malformation was found in 64 cases, congenital airway malformation in 6 cases and isolated bronchomalacia in 1 case. Ten children with anomalous innominate artery underwent aortopexy, twelve children with dextro-aorta arch with concomitant aberrant left subclavian artery and double aorta underwent arches vascular ring lysis, six children with pulmonary sling underwent plasty. Severe malacia segments were resected directly in four children during operation. Mechanical ventilation was performed in 38 children. Tracheostoma was performed in 4 children to treat tracheomalacia and bronchomalacia, it could relieve symptom to a certain extent. In 2 children metal stents were inserted into the bronchus for the treatment of bronchomalacia, one was successful and the other needed re-insertion of stent again, these two patients underwent balloon-dilatation in distal part of stent afterwards.

CONCLUSIONThe congenital cardiovascular malformation was the main reason to develop tracheobronchomalacia in children. The symptom of majority of the cases with cardiovascular malformation would be improved within 6 months after surgical intervention. In severe cases, treatments included mechanical ventilation and tracheostoma. Stenting could be applied in refractory cases, but it had certain limitations.

Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; complications ; therapy ; Humans ; Infant ; Male ; Stents ; Trachea ; pathology ; Tracheal Stenosis ; etiology ; therapy ; Tracheobronchomalacia ; diagnosis ; etiology ; therapy

Bronchi ; abnormalities ; pathology ; Bronchial Diseases ; complications ; congenital ; diagnosis ; pathology ; Bronchoscopy ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Infant ; Male ; Pneumonia ; etiology ; physiopathology ; Respiratory System Abnormalities ; complications ; diagnosis ; pathology ; Trachea ; abnormalities ; pathology ; Tracheal Stenosis ; etiology ; pathology

PURPOSE: Tracheal restenosis due to excessive granulation tissue around a silicone stent requires repeated bronchoscopic interventions in patients with post-tuberculosis tracheal stenosis (PTTS). The current study was conducted to identify the risk factors for granulation tissue formation after silicone stenting in PTTS patients. MATERIALS AND METHODS: A retrospective study was conducted between January 1998 and December 2010. Forty-two PTTS patients with silicone stenting were selected. Clinical and radiological variables were retrospectively collected and analyzed. RESULTS: Tracheal restenosis due to granulation tissue formation were found in 20 patients (47.6%), and repeated bronchoscopic interventions were conducted. In multivariate analysis, tracheal wall thickness, measured on axial computed tomography scan, was independently associated with granulation tissue formation after silicone stenting. Furthermore, the degree of tracheal wall thickness was well correlated with the degree of granulation tissue formation. CONCLUSION: Tracheal wall thickening was associated with granulation tissue formation around silicone stents in patients with post-tuberculosis tracheal stenosis.
Adult ; Bronchoscopy/methods ; Female ; Granulation Tissue/*pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Silicones ; Stents/*adverse effects ; Tomography, X-Ray Computed ; Trachea/*pathology ; Tracheal Stenosis/etiology/*pathology ; Tuberculosis/*complications

Benign cicatricial airway stenosis (BCAS) is a potentially life-threatening disease. Recurrence occurs frequently after endoscopic treatment. Paclitaxel is known to prevent restenosis, but its clinical efficacy and safety is undetermined. Therefore, in this study, we investigated the efficacy and associated complications of paclitaxel as adjuvant treatment for BCAS of different etiologies. The study cohort included 28 patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other etiologies. All patients were treated at the Department of Respiratory Diseases, Beijing Tian Tan Hospital, Capital Medical University, China, between January 2010 and August 2014. After primary treatment by balloon dilation, cryotherapy, and/or high-frequency needle-knife treatment, paclitaxel was applied to the airway mucosa at the site of stenosis using a newly developed local instillation catheter. The primary outcome measures were the therapeutic efficacy of paclitaxel as adjuvant treatment, and the incidence of complications was observed as well. According to our criteria for evaluating the clinical effects on BCAS, 24 of the 28 cases achieved durable remission, three cases had remission, and one case showed no remission. Thus, the durable remission rate was 85.7%, and the combined effective rate was 96.4%. No differences in outcomes were observed among the different BCAS etiologies (P=0.144), and few complications were observed. Our results indicated that paclitaxel as an adjuvant treatment has greater efficacy than previously reported BCAS treatment methods.
Adolescent ; Adult ; Aged ; Bronchi ; pathology ; Chemotherapy, Adjuvant ; adverse effects ; Cicatrix ; complications ; drug therapy ; surgery ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; adverse effects ; therapeutic use ; Postoperative Complications ; Respiratory Insufficiency ; drug therapy ; etiology ; surgery ; Tracheal Stenosis ; drug therapy ; etiology ; surgery ; Tracheotomy ; adverse effects