Chest
Volume 97, Issue 2, February 1990, Pages 328-332
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A Dedicated Tracheobronchial Stent

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A dedicated tracheobronchial stent to be used in the treatment of external compression of the main airway is described. This stent is made of molded silicone. Its outside surface bears regularly placed studs to prevent displacement. First results are encouraging. So far, 118 prostheses have been placed in 66 patients. Tolerance was excellent and complications were rare. Migration occurred 12 times: in seven cases an early prototype that was poorly designed had been used. Obstruction was noted in two cases without major problems. Mean follow-up at the time of this writing is three months, with the longest follow-up 19 months.

(Chest 1990; 97:328-32)

Section snippets

METHODS AND MATERIALS

Between March 1987 and March 1989, 66 patients (45 men and 21 women) were intubated. The ages of these patients varied from 8 to 83 years (mean age: 54 years). Of these 66 patients, 21 had squamous cell carcinoma; two, oat cell carcinoma; seven, adenocarcinoma; three, adenoid cystic carcinoma; one, carcinoid tumor; one, Hodgkin's tumor; one, lymphoma; one, leiomyosarcoma; and one, mediastinal tumor. The remaining cases included two of amyloidosis, 23 of tracheal stenosis, and three of bronchial

CASE 1

In June 1987, a 19-year-old woman underwent emergency laser resection for an adenoid cystic carcinoma involving the lower third of the trachea and both main stem bronchi. In the following two months, she required four more laser treatments because of repeated restenosis of the left bronchi causing acute respiratory insufficiency. Under these conditions radiotherapy could not be undertaken. On September 10, 1987, we decided to insert a stent in the left main stem bronchus. With the stent in

RESULTS

Intubation was successful in all cases in this series. A total of 118 prostheses were inserted in the 66 patients, more than one prosthesis having been used in some patients either successively (17 cases: two to seven prostheses) or simultaneously (11 cases: two to three prostheses). The prosthesis was placed in the trachea in 59 cases, in the left main stem bronchus in 34, in the right main stem bronchus in 16, in the right lower lobe bronchus in five, in the left lower lobe bronchus in one

DISCUSSION

The foremost cause of death in lung cancer patients who have exhausted all therapeutic options is, of course, suffocation. It is thus quite certain that the lives of these patients could be extended significantly if patency could be maintained. Endoluminal obstruction can be removed using the YAG laser through an endoscope, but if extrinsic compression is involved, YAG resection, when feasible, only achieves temporary relief at best.

Theoretically a stent is a straightforward way to maintain an

ACKNOWLEDGMENTS

I am grateful to Andy Corsini for his help in preparing this manuscript.

REFERENCES (5)

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Manuscript received April 18; revision accepted June 23.

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