Granulation tissue formation is a common complication after implantation of metallic stents in patients with central airway obstruction. A combination of balloon dilatation and cryotherapy is a treatment option. Herein, we report the case of a 53-year-old female patient who underwent tracheal metallic stent implantation due to lung adenocarcinoma with treatment-related tracheo-esophageal fistula. One year after the procedure, acute respiratory failure developed due to extensive granulation formation with central airway obstruction at both ends of the stent. We performed bronchoscopic cryotherapy with cryogen applied to 4 granulation sites followed by the use of an endotracheal tube cuff as a balloon dilator. The airway obstruction was relieved by this procedure and the patient was extubated immediately thereafter. The presented case provides evidence that the combination of cryotherapy and endotracheal tube cuff as a balloon dilator is feasible and safe for the management of granulation tissue-induced central airway obstruction and respiratory failure.
患有中央氣道阻塞的患者在植入金屬支架後,肉芽組織形成是常見的併發症之一。球囊擴張與冷凍療法的組合是一個治療選擇。我們報告一名53歲的女性患者,由於肺腺癌治療後產生了氣管-食道瘻管,而植入了氣管金屬支架。一年後,由於廣泛的肉芽組織形成,支架兩端出現中央氣道阻塞,造成了急性呼吸衰竭。我們進行支氣管鏡冷凍治療,將冷凍劑應用於病灶的四個部位,再使用氣管內管氣囊作為球囊擴張器,緩解氣道阻塞,並在術後立即拔管。本案例提供了在加護病房裡使用內視鏡冷凍治療加上氣管內管氣囊作為擴張器的範例,證實該治療對於控制肉芽組織引起的中央氣道阻塞以及呼吸衰竭是安全且可行的。
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