不可切除气管、支气管内肿瘤的纤维支气管镜CO(2)冷冻治疗

BACKGROUND AND OBJECTIVE: Patients with tracheobronchial tumor are too frail for curative surgical treatment, and the original sites are unsuitable for radical resection. They always suffered from dyspnea, hymoptosis, obstructive pneumonia, and fever. Airway obstruction has a strong bad impact on the quality of life, and is the main cause of respiratory failure and death. An effective method of palliative is very important. We choose fibro-bronchoscopic cryosurgery for destruction of endobronchial tumors and analyze the outcomes. METHODS: Clinical records of 126 cases who under went endobronchoscopic cryosurgery were reviewed retrospectively from August 2004 to February 2014. Techniques and survival outcomes were analyzed. The precise position and length of the cryosurgery was evaluated through three dimension chest computed tomography (CT) and reconstruction of trachea and bronchus. Local infiltration and general intravenous anesthesia are two options before surgical procedure. Endobronchial tumor was removed by combining two methods of "Cryo-Resecion" and "Cryo-Melt". Bronchoscopic examination was rechecked 2 weeks later to evaluate if it is necessary to redo the endobronchoscopic cryosurgery. RESULTS: The symptoms of cough, short of breath, and hemoptysis were alleviated to different extend. The rate of dramatically improved and partial improved were 65.1% and 77.0% respectively. The mortality is 0.79%. Postoperative Complications included 2 cases of airway bleeding, 4 cases of bronchial stenosis, 2 cases of trachea burning injury, 2 cases of tracheomalacia, and 3 cases of atrium fibrillation. The median survival is 14 months, 1-, 2-, 3-yr survival rates were 58.6%, 24.2%, and 12.2% respectively, based on Kaplan-Meier estimates. CONCLUSION: Endobronchial cryosurgery is an easy and effective minimally invasive choice for controlling and releasing the airway obstructive symptoms resulting from the trachea or bronchial tumors. Besides, the problem of difficult endotracheal intubation could be resolved after removing the tracheal tumor with the benefit of cryotreatment. Some patients could get the chance for further treatment or radical resection. Therefore, the patients' quality of life could be improved and the lifetime could be prolonged.