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The Value of Extracorporeal Ultrasonography on Evaluating the Trachea Structure and Prognosis in the Patients with Benign Tracheal Stenosis

Author: ZhouZuo
Tutor: LiShiYue
School: Guangzhou Medical College
Course: Department of Respiratory Medicine
Keywords: High-frequency ultrasound in vitro Benign tracheal stenosis Tracheal cartilage Prognosis
CLC: R445.1
Type: Master's thesis
Year: 2011
Downloads: 16
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Abstract

Background and Purpose: benign tracheal stenosis refers to the tracheal itself or non-malignant lesions of the trachea outside oppression caused tracheal stenosis, the most common benign proliferative scar stenosis. The etiology constitute the complex, including the trachea tuberculosis, lung transplantation, bronchial sleeve resection, long-term intubation or tracheostomy, tuberculosis, foreign body reaction, sarcoidosis, trauma, Wegener's granulomatosis, tracheobronchial amyloidosis. Foreign benign tracheal stenosis in the etiology constitute mainly mainly lung transplant after long-term intubation or stoma narrow, our places trachea tuberculosis in the first place. Benign tracheal stenosis is a common problem, the incidence of respiratory diseases is increasing year by year, can severely affect the respiratory function stenosis in the trachea, causing stenosis distal obstructive pneumonia, caused by repeated coughing, chest tightness, difficulty breathing, and affect the patient's quality of life even lead to death. Scar tissue resection, balloon dilation, airway stenting is a common method for the treatment of tracheal stenosis, short-term these methods can achieve significant results, forward with the proliferation of local tissue repair and scar formation can lead to restenosis, repeated treatment and poor efficacy, this is a worldwide problem plagued the treatment of benign tracheal stenosis. According to the characteristics of patients with lesions individualized treatment options and assess their prognosis, at home and abroad were not put forward a better means of checking and evaluation methods. Tomography auxiliary examination methods commonly used in tracheal stenosis, tracheal contrast the CT scan trachea imaging and pulmonary function, virtual bronchoscopy, bronchoscopic examination, these checks means are unable to determine the trachea support structure exists lesions. Although NMR trachea imaging can provide tracheal cartilage imaging to provide a the airway support structure measurement parameters, but patients with high check a long time, to avoid difficulty breathing artifacts. Vitro high frequency ultrasound is an effective, non-invasive means, the neck superficial soft tissue and anterior tracheal cartilage structure show good form of quantitative measurements prove the larynx is reliably measured by ultrasound in experimental animals, and a safe, non-radiation, non-invasive, can be detected several times within a short period of time, do bedside check, low-cost advantage. Foreign application of external ultrasound detect normal human trachea and the laryngeal lesion patients reported, but no application of external ultrasound detect benign tracheal stenosis tracheal system reports currently no application of external ultrasound benign tracheal stenosis tracheal structure and the reports of the prognosis. In this study, benign tracheal stenosis patients with carotid the preceding paragraph trachea line in vitro high frequency ultrasound the trachea imaging contrast CT scan, bronchoscopy, analyze their value measurements of tracheal cartilage, scar soft tissue and tracheal lumen diameter of from clinical evaluation of high-frequency ultrasound in vitro benign tracheal stenosis value, the result will explore new methods of benign tracheal stenosis check and prognosis, to alleviate the suffering of patients, reduce medical costs, save social medical resources, with a wide range of applications, will produce significant social and economic benefits. Subjects and methods: 1. Objects selected: January 2009 to February 2011, 16 cases admitted to a hospital in Guangzhou Institute of Respiratory Diseases, bronchoscopy Center bronchoscopic and pathological examination confirmed benign on the middle of the tracheal stenosis Guangzhou Medical; including laser / electrosurgical / argon plasma coagulation (APC), frozen, balloon-expandable metal stent interventional techniques in two or more (including two kinds), after more than two times interventional treatment, January again stenosis into the a refractory benign upper middle tracheal stenosis group, or included in the non-refractory benign on the middle of the tracheal stenosis group; 2. research methods: (1) the use of the the spiral CT trachea measurements reconstruction of understanding of the airways to narrow the location, extent, length, and The narrow distal airway lesions and lung parenchyma; (2) of airway stenosis site, extent, length, and narrow distal airway lesions bronchoscopy understand; (3) the use of an external high frequency ultrasonic measuring anterior trachea beside midline longitudinal section (trachea midline 2cm) 1 trachea cartilage ring - 4th tracheal ring (T1-T4) is the width and spacing of the thickness and of the cross-section of the vertical trachea midline plane T1-T4 tracheal outer coronal diameter observed the cartilage ring morphology cartilage echo, cartilage ring wall attached thickening, irregular abnormal soft tissue, such as granulation, scar; (4) analysis of more than three kinds of check measurement data and clinical data, explore vitro high frequency ultrasound on benign middle of tracheal stenosis tracheal structure to determine the results of the tracheal measurements of spiral CT reconstruction, bronchoscopy check to determine results, and prognosis. 1, the minimum transverse diameter of the narrow segment tracheal lumen: 16 patients underwent CT, ultrasound, bronchoscopy measurements were 7.5 ± 2.4mm, 7.8 ± 2.7mm, 7.3 ± 2.6mm, CT and ultrasound measurements comparing P gt ; 0.05, bronchoscopy with ultrasound measurement results contrast P gt; 0.05, CT and bronchoscopy measurement results contrast P gt; 0.05; 2, the wall of the airway soft tissue maximum thickness: in vitro high-frequency ultrasound can clear the display gas wall soft tissue; row CT, ultrasound The measurement results were 3.5 ± 1.5mm, 3.1 ± 1.6mm, results comparing P gt; 0.05; cartilage number of rings lesions,: non-refractory group, no cartilage ring lesions 2 cases (33.3%) the cartilage ring lesions as a 2 cases accounted for 33.3% the cartilage ring 2 1 cases accounted for 16.7%, the cartilage ring lesions and 3 cases (16.7%); refractory group ring of cartilage lesions 1 1 cases accounted for 10% of the lesions, cartilage ring lesions and three of four cases accounted for 40%, cartilage the ring lesions and four of five cases (50%); groups cartilage ring lesion number contrast P lt; 0.05; cartilage ring morphology: In vitro high frequency ultrasound can clearly show the cartilage ring shape; non-refractory group, no cartilage ring deformation of three cases accounted for 50% of the cartilage ring deformation one of two cases accounted for 33.3%, the cartilage ring deformation 2 cases (16.7%); refractory no cartilage ring deformation group accounted for 30%, 3 cases a cartilage ring deformation cases accounted for 10%, the cartilage ring deformation for three of three cases accounted for 30%, the cartilage ring deformation 4 cases of 30 %; groups cartilage ring deformation results contrast P gt; 0.05; 5, the thickness of the cartilage ring: In vitro high frequency ultrasound can clearly show the thickness of the cartilage ring; cartilage ring becomes non-refractory group of normal thickness cartilage ring 5 cases (83.3%), thin patients (16.7%); refractory group, the thickness of the cartilage ring normal five cases accounted for 50% of the five cases, the abnormal thickness of the cartilage ring accounted for 50%, including two cases of a cartilage ring thinning, 1 case of a a cartilage ring thickness uneven thickening of the cartilage ring, were different cartilage ring different lesions (a thinning and thickening of 3); groups thickness of the cartilage ring results contrast P gt; 0.05; 6, cartilage ring echo: in vitro high-frequency ultrasound can clearly display the cartilage ring echo; echo normal cartilage ring non-refractory group 5 cases (83.3%), abnormal cartilage ring echo one cases accounted for 16.7% (and a cartilage echo abnormalities ); refractory group of normal cartilage ring echo echo cases accounted for 30%, echo abnormal cartilage ring 7 cases accounted for 70 percent, including five cases of uneven echo, increased cases of the two diseases exist at the same time one cases ; groups cartilage ring echo results contrast P gt; 0.05;, two sets of soft tissue of the airway wall thickness: non-refractory group, all 6 patients were detected echoes of the soft tissue thickness of 1.6-6.2mm range; refractory group detected in 9 patients to the echo of the soft tissue, the thickness ranging from 0.6-5.2mm, and 1 patient did not detect the echoes of the soft tissue; the maximum thickness of the soft tissue results contrast P GT; 0.05. Conclusion: In vitro high frequency ultrasound benign on the middle of tracheal stenosis tracheal diameter check results with spiral CT the tracheal measurements reconstruction, bronchoscopy results on the the tracheal support structure observed by high-frequency ultrasound in vitro, can understand the tracheal rings lesions and soft tissue situation, especially cartilage ring lesion number of therapeutic effect and prognosis, abnormal cartilage morphology the abnormal cartilage thickness cartilage echo abnormal wall thickness of the soft tissue abnormalities Prognostic value needs further observation. The security check, non-invasive, convenient, repeatable inspection, the cost can be as benign on the middle tracheal stenosis basic checks.

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