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 safe...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.展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagno...A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of druginduced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.展开更多
Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate ...Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy （NSCIT） when used for the treatment of BCAS of different causes and types.Methods：This study enrolled a cohort of patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other origins.The patients were assigned to three groups determined by their type of stenosis：Web-like stenosis,granulation stenosis,and complex stenosis,and all patients received NSCIT.The efficacy and complications of treatment in each group of patients were observed.The Chi-square test,one-factor analysis of variance （ANOVA）,and the paired t-test were used to analyze different parameters.Results：The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%.Among 41 patients with complex stenosis,36 cases （88%） experienced remission and 29 cases （71%） experienced durable remission.When five patients with airway collapse were eliminated from the analysis,the overall remission rate was 97%.The average treatment durations for patients with web-like stenosis,granulation stenosis,and complex stenosis were 101,21,and 110 days,respectively,and the average number of treatments was five,two,and five,respectively.Conclusions：NSCIT demonstrated good therapeutic efficacy and was associated with few complications.However,this approach was ineffective for treating patients with airway collapse or malacia.展开更多
Background：A limitation of bronchoscopic balloon dilatation （BBD） is that airflow must be completely blocked for as long as possible during the operation.However,the patient often cannot hold his or her breath for ...Background：A limitation of bronchoscopic balloon dilatation （BBD） is that airflow must be completely blocked for as long as possible during the operation.However,the patient often cannot hold his or her breath for a long period affecting the efficacy of the procedure.In this study,we used an extra-small-diameter tube to provide assisted ventilation to patients undergoing BBD and assessed the efficacy and safety of this technique.Methods：Bronchoscopic balloon dilatation was performed in 26 patients with benign tracheal stenosis using an extra-small-diameter tube.The tracheal diameter,dyspnea index,blood gas analysis results,and complications were evaluated before and after BBD.Statistical analyses were performed by SPSS version 16.0 for Windows （SPSS,Inc.,Chicago,IL,USA）.Results：Sixty-three BBD procedures were performed in 26 patients.Dyspnea immediately improved in all patients after BBD.The tracheal diameter significantly increased from 5.5 ± 1.5 mm to 13.0 ± 1.3 mm （P 〈 0.001）,and the dyspnea index significantly decreased from 3.4 ± 0.8 to 0.5 ± 0.6 （P 〈 0.001）.There was no significant change in the partial pressure of oxygen during the operation （before,102.5 ± 27.5 mmHg;during,96.9 ± 30.4 mmHg;and after,97.2 ± 21.5 mmHg;P =0.364）,but there was slight temporary retention of carbon dioxide during the operation （before,43.5 ± 4.2 mmHg;during,49.4 ± 6.8 mmHg;and after,40.1 ± 3.9 mmHg;P 〈 0.001）.Conclusion：Small-diameter tube-assisted BBD is an effective and safe method for the management of benign tracheal stenosis.展开更多
In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The tr...In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.展开更多
基金supported by the Clinical Medicine Development Project of the Administration Bureau of Beijing Hospital(No.XMLX201314)
文摘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.
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
基金Supported by the Science and Technology Project of State Grid Corporation of China,No.SGHB0000AJJS1400182
文摘A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of druginduced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.
文摘Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy （NSCIT） when used for the treatment of BCAS of different causes and types.Methods：This study enrolled a cohort of patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other origins.The patients were assigned to three groups determined by their type of stenosis：Web-like stenosis,granulation stenosis,and complex stenosis,and all patients received NSCIT.The efficacy and complications of treatment in each group of patients were observed.The Chi-square test,one-factor analysis of variance （ANOVA）,and the paired t-test were used to analyze different parameters.Results：The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%.Among 41 patients with complex stenosis,36 cases （88%） experienced remission and 29 cases （71%） experienced durable remission.When five patients with airway collapse were eliminated from the analysis,the overall remission rate was 97%.The average treatment durations for patients with web-like stenosis,granulation stenosis,and complex stenosis were 101,21,and 110 days,respectively,and the average number of treatments was five,two,and five,respectively.Conclusions：NSCIT demonstrated good therapeutic efficacy and was associated with few complications.However,this approach was ineffective for treating patients with airway collapse or malacia.
文摘Background：A limitation of bronchoscopic balloon dilatation （BBD） is that airflow must be completely blocked for as long as possible during the operation.However,the patient often cannot hold his or her breath for a long period affecting the efficacy of the procedure.In this study,we used an extra-small-diameter tube to provide assisted ventilation to patients undergoing BBD and assessed the efficacy and safety of this technique.Methods：Bronchoscopic balloon dilatation was performed in 26 patients with benign tracheal stenosis using an extra-small-diameter tube.The tracheal diameter,dyspnea index,blood gas analysis results,and complications were evaluated before and after BBD.Statistical analyses were performed by SPSS version 16.0 for Windows （SPSS,Inc.,Chicago,IL,USA）.Results：Sixty-three BBD procedures were performed in 26 patients.Dyspnea immediately improved in all patients after BBD.The tracheal diameter significantly increased from 5.5 ± 1.5 mm to 13.0 ± 1.3 mm （P 〈 0.001）,and the dyspnea index significantly decreased from 3.4 ± 0.8 to 0.5 ± 0.6 （P 〈 0.001）.There was no significant change in the partial pressure of oxygen during the operation （before,102.5 ± 27.5 mmHg;during,96.9 ± 30.4 mmHg;and after,97.2 ± 21.5 mmHg;P =0.364）,but there was slight temporary retention of carbon dioxide during the operation （before,43.5 ± 4.2 mmHg;during,49.4 ± 6.8 mmHg;and after,40.1 ± 3.9 mmHg;P 〈 0.001）.Conclusion：Small-diameter tube-assisted BBD is an effective and safe method for the management of benign tracheal stenosis.
基金Youth Development Fund Task Book of the First Hospital of Jilin University,No.JDYY13202210.
文摘In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.
