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Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites ( OR 1.548; 95% CI: 1.038-2.307, P= 0.032) , dyspnea index ( OR 2.140; 95% CI: 1.604-2.855, P< 0.001) , and interventional method ( OR 0.458; 95% CI: 0.267-0.787, P= 0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites ( OR 1.508; 95% CI: 1.273-1.787, P< 0.001) , stenosis grade ( OR 1.581; 95% CI: 1.029-2.067, P= 0.001) , anesthesia method ( OR 1.581; 95% CI: 1.029-2.067, P< 0.001) , and local drug usage ( OR 1.304; 95% CI: 1.135-1.497, P< 0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.

Objective: This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. Methods: A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. Results: The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B ( P< 0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance ( P> 0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain ( P< 0.05). However, there were no significant differences in the degree of cough and pain between group A and group B ( P> 0.05). Most patients in group C had no uncomfortable sensation during the operation ( P< 0.05), and the willingness to re-examination was significantly higher than that in group A and group B ( P< 0.05). Conclusion: Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.

Objective: To expolre the indications, safety, advantages and disadvantages of performing artificial pneumothorax prior to medical thoracoscopy. Methods: Data of 152 patients undergoing medical thoracoscopy for pleural diseases in the Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2007 to September 2014 were studied through retrospective analysis. According to the performance of artificial pneumothorax prior to medical thoracoscopy, the pleural space adhesions and the pleural effusions, patients were grouped into artificial pneumothorax group (107 cases) and non-artificial pneumothorax group (45 cases), adhesion group (102 cases) and non-adhesion group (50 cases), and few or no pleural effusion group (94 cases) and massive pleural effusion group (58 cases), respectively. The incidence of complications such as subcutaneous emphysema, pleural reaction, infection, aeroembolism and pulmonary injury/hemorrhage in different groups were compared, and the vital signs of patients were observed. Results were compared using the Chi square test. Results: After thoracoscopic examination, the definite diagnosis rates of artificial pneumothorax group and non- artificial pneumothorax group were 83.2% (89/107) and 93.3% (42/45) respectively, which showed no significant difference (χ(2)=2.744, P= 0.098). Three cases of subcutaneous emphysema occurred in the artificial pneumothorax group, while all these 3 cases belonged to adhesion group, and one of them belonged to few or no pleural effusion group, and 2 of them belonged to massive pleural effusion group. No subcutaneous emphysema cases were observed in the non-adhesion group. In the non-artificial pneumothorax group, one case of lung trauma caused by trocar was observed, which belonged to adhesion group and few or no pleural effusion group; no lung puncture wound cases were observed in massive pleural effusion group and non-adhesion group. Other complications related to artificial pneumothorax and thoracoscopy, such as pleural reaction, infection, air embolism and pulmonary injury/hemorrhage, were not observed. No significant changes were found between the vital signs of patients before and after artificial pneumothorax. Conclusion: For pleural effusion or pleural disease patients with pleural space adhesion, the performance of artificial pneumothorax prior to operation was recommended. Artificial pneumothorax was not recommended for patients without pleural space adhesions.

Objective: To study the effect of self-expanding bare metal stents on the trachea of dogs, and therefore to provide useful information for choice of airway stents by interventional physicians. Methods: In this experiment, 8 beagles were randomly divided into 4 groups. Four self-expanding metal stents of different diameters (16, 18, 20 and 22 mm, respectively) were placed in the trachea of these beagles for 3 months and their impacts on normal trachea were observed. Results: In the 16 mm stent group (stent-to-airway diameter ratio 103%), good epithelialization was observed and the tracheal structure had no significant damage. In the 18 mm stent group (stent-to-airway diameter ratio 116%), slight granulation tissues were observed, but the cartilage and outer membrane were normal. In the 20 mm stent group (stent-to-airway diameter ratio 129%), severe granulation tissues were observed. Cartilage was damaged but outer membrane was normal. In the 22 mm stent group (stent-to-airway diameter ratio 142%), no obvious granulation tissues were found. Cartilage was normal, but outer membrane was ruptured. Conclusion: In a certain range, tracheal granulation tissues increased as the stent diameter increased. However, if the stent diameter continued to increase, a decreasing trend of tracheal granulation was observed, but severe tracheal injury by stent expansion force would occur.

Objective: To explore the techniques and related complication management of airway metal stents removal with rigid bronchoscope under general anesthesia., Methods: We reviewed 20 patients who had received rigid bronchoscopic stents removal under general anesthesia from Jan. 2008 to Jan. 2015. The clinical data were analyzed retrospectively. The indications for stents removal and potential difficulties encountered, the relationship between techniques and related complications of stents removal were discussed and analyzed, and our experiences were summarized., Results: The indications for airway metal stents removal included stent migration, fracture, and granulation related in-stent restenosis. Nineteen airway metal stents were removed from 20 patients, which included 9 covered metal stents, 6 without fragmentation and 3 with fragmentation. The average duration of stenting before removal was (7.4±6.9)months (5 days-24 months). Of the 11 uncovered metal stents, which had stayed in the airway for (10.2±7.0) months (20 days-24 months), 10 were removed successfully and 1 failed. Three of them were removed intact and 7 fragmented. Complications were as follows: airway bleeding requiring management (n=11), airway collapse (n=6), re-obstruction requiring temporary stent placement (n=5), postoperative tracheal intubation (n=1), mucosal tear with tracheoesophageal fistula (n=1), airway firing (n=1), airway obstruction, and death as a result of attempted stent removal (n=1)., Conclusions: Airway metal stent removal is a high-risk operation. Indications for stents removal should be evaluated thoroughly and all the advantages and disadvantages should be evaluated. Once stent removal is decided, the type of the metal stent, the position of the stent implanted, the duration of stenting, and the extent of the stent embedded in granulation tissue should be carefully considered to assess the difficulty of the procedure. Dissection of the stent from the airway wall before extracting it can reduce complications such as airway bleeding, mucosal tear and airway obstruction. At the same time, a standby stent is needed to deal with possible airway collapse after stent removal. Removal of metal airway stents should only be performed by a proficient and experienced interventional pulmonology team to ensure successful operation and to improve patient safety.

Objective: To observe the inhibitory effect and potential mechanism of mitomycin C and paclitaxel on the proliferation of Human Pulmonary Fibroblast in vitro. So as to providing an experimental reference for the design of drug eluting airway stents., Methods: Cell viability was measured by MTT assay after different concentrations of mitomycin C or paclitaxel varying from 10(-1)1 mol/L to 10(-4) mol/L had been applied to the fibroblasts for 24, 48 or 72 h, respectively. Cell apoptosis was assessed by flow cytometry using dual staining with annexin V-FITC and propidium iodide 48 h after administering mitomycin C or paclitaxel at a concentration of 5×10(-6), 10(-5), 5×10(-5), 10(-4), 2×10(-4) mol/L, respectively. And the morphological character of cell apoptosis was observed by Hoechst 33342 fluorescent staining., Results: The results of MTT revealed that cell proliferation were inhibited by mitomycin C and paclitaxel at all concentrations and exposure times. Among them, the inhibitory effect of mitomycin C were weak when the concentrations were between 10(-1)1 mol/L to 10(-8) mol/L. And within this context, the inhibitory ratio didn't correspond to the elevation of the concentration or the prolongation of the exposure times.However, when the concentration were between 10(-7) mol/L to 10(-4) mol/L, the inhibitory ratio rise progressively as the elevation of the concentration at all exposure times. The inhibitory ratio were 53.52%, 60.23%, 89.81% and 96.47% respectively when cells were treated by 10(-7), 10(-6), 10(-5) mol/L and 10(-4) mol/L mitomycin C for 72 h. An apparent "threshold dose effect" was observed in the paclitaxel treated groups.It's worth noting that the inhibitory ratio was only 48.22% when the cells had already been treated by 10(-5) mol/L paclitaxel for 72 h.However, when the concentration had reached 10(-4) mol/L, the inhibitory ratio sharply climbed to 93.38% even the cells had only been treated for 24 h. And the inhibitory ratio continued to rise as time prolonged. The results of cell apoptosis were consistent with MTT.When a significant inhibitory effect were detected by MTT, remarkable cell apoptosis could be observed by flow cytometry, and typical apoptotic cell could be identified by Hoechst 33342 fluorescent staining., Conclusions: A certain concentration of mitomycin C or paclitaxel can inhibit Human Pulmonary Fibroblast proliferation in vitro. Both of these two drugs have potential value for the preparation of drug eluting airway stents. In order to ensure the inhibitory effect, the eluting concentration of mitomycin C and paclitaxel should not be less than 10(-7) mol/L and 10(-5) mol/L. But the eluting concentration of these two drugs should not exceed 10(-4) mol/L when both of the inhibitory ratio of these two drugs were higher than 95%.On this basis, elevating the drug concentration has little significance for improving the inhibitory effect, but increase the risk of systemic toxicity. Inducing cell apoptosis is one of the potential mechanisms of mitomycin C and paclitaxel in inhibiting cell proliferation.

Objective: To establish a feasible method to culture primary fibroblasts isolated from human airway granulation tissues, and therefore to provide experimental data for the investigation of the pathogenesis of benign airway stenosis., Methods: The granulation tissues were collected from 6 patients during routine bronchoscopy at our department of Beijing Tiantan Hospital from April to June 2011. Primary fibroblasts were obtained by culturing the explanted tissues. Cell growth was observed under inverted microscope., Results: All of these 6 primary cultures were successful. Fibroblast-like cells were observed to migrate from the tissue pieces 3 d after inoculation. After 9-11 d of culture, cells reached to 90% confluence and could be sub-cultured. After passage, the cells were still in a typical elongated spindle-shape and grew well. The cells could be sub-cultured further when they formed a monolayer., Conclusion: Explant culture is a reliable method for culturing primary fibroblasts from human airway granulation tissues.

Objective: To assess the efficacy and safety of topical application of mitomycin-C in the management of benign cicatricial airway stenosis (BCAS), and to discuss the feasibility of catheter drip to achieve the topical application of mitomycin-C., Methods: Twenty patients with BCAS were divided into control group and experimental group (topical application of mitomycin-C). Patients in control group were treated only with interventional bronchoscopy which including balloon dilation, argon plasma coagulation/electrotomy, cryotherapy, stent placement and so on, while patients in experimental group were treated with interventional bronchoscopy adjuncted with topical application of mitomycin-C (0.4 mg/ml). According to the length of airway lesion, the dosage was 1 ml/cm. Topical application of mitomycin-C was achieved by catheter drip. Photographs were taken at the place above the proximal end of airway stenosis and a software called Digimizer was used to measure the cross sectional area of stenosed airway. A 3-month follow-up was done to observe the safety and curative effect of topical application mitomycin-C in airway., Results: Ten patients (3 male and 7 female) ranging in age from 20 to 71 years [mean (36 ± 17) years] enrolled in control group and 10 patients (5 male and 5 female) ranging in age from 20 to 74 years [mean (42 ± 18) years] enrolled in experimental group. The average airway cross-sectional areas before and after treatment of 2 groups were (22 ± 13) mm(2), (23 ± 11) mm(2) (control group) and (20 ± 8) mm(2), (34 ± 12) mm(2) (experimental group), respectively. The average increased airway cross-sectional areas of experimental group and control group before and after treatment were (15 ± 13) mm(2) and (1 ± 10) mm(2) respectively, which had statistical differences. The average times of treatment during 3 months were (2.8 ± 1.5) in control group vs (1.8 ± 0.9) in experimental group which had statistical differences. The 3-month effective rate was 90% of experimental group vs 40% of control group, and the symptom improvement rate was 80% of experimental group vs 30% of control group. There were significant differences in outcomes between two groups. No drug-related complications occurred in experimental group during the follow-up period., Conclusions: Mitomycin-C is an effective adjuvant treatment method in the management of BCAS. Topical application of mitomycin-C in airway is safety. Catheter drip to achieve the topical application of mitomycin-C in airway is a convenient, economical and effective method.

Objective: To observe the effects of a domestically made jet ventilator in dogs during interventional procedures by rigid bronchoscopy under general anesthesia., Methods: Ten healthy mongrel dogs were inserted with a rigid bronchoscope under general anesthesia, and the dogs underwent 3 different ventilation conditions randomly: spontaneous breathing alone (group A), and normal frequency jet ventilation with spontaneous breathing (group B), normal frequency jet ventilation without spontaneous breathing (group C). When the interventional procedure lasted 30 min, 60 min, 90 min, 120 min, blood gas analysis was performed. Arterial blood gas analysis under different driving pressures (0.20 mPa, 0.25 mPa, 0.30 mPa) was compared when dogs underwent normal frequency jet ventilation without spontaneous breathing. Oxygen concentrations at the proximal end and the distal end of the rigid bronchoscope were measured out-of-body, when high pressure oxygen (FiO(2) 100%) was used to drive the normal frequency jet ventilation., Results: After the operation, PaCO(2) increased all the groups. In group C, PaCO(2) increased and pH decreased remarkably as compared with group A and group B (P < 0.01). In group C, PaO(2) decreased after the operation: compared with group A and group B, the difference being significant (P < 0.05). The ventilation effects of the jet ventilator was closely related with its driving pressure, and higher driving pressure improved the dog's oxygenation and the discharge of carbon dioxide. Under high pressure oxygen (FiO(2) 100%), oxygen concentration in the distal end of the rigid bronchoscope was lower than 50% whether (the driving pressures and I:E) was adjusted or not (P > 0.05). The oxygen concentration at the distal end of the rigid bronchoscope was increased a little (but below 50%) when jet needle tip inserted superficially or deeply into the adapter, but the oxygen was lower than 40% at most situation when it was in the midrange (3 - 6 centimeters in the adapter)., Conclusions: This domestically made jet ventilator could not provide enough effective ventilation during interventional procedures with rigid bronchoscopy under general anesthesia because hypoxemia and hypercapnia occurred when the operation time was prolonged. The PaO(2) and PaCO(2) of the dogs were better when spontaneous breathing was maintained during the procedure. The ventilation effects of the jet ventilator was closely related with its driving pressure. The oxygen concentration at the distal end of the rigid bronchoscope was lower than 40% in most situation when it was in the midrange (3 - 6 centimeters in the adapter) under high pressure oxygen (FiO(2) 100%). There was no significant change in the oxygen concentration with adjustment of the driving pressure or the I:E ratio of the jet ventilator.

Objective: To explore and evaluate the technique of performing interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia., Methods: From July 2009 to January 2010, 29 patients received interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia. Airway pressure and tidal volume before and after bronchoscope insertion, arterial blood gas analysis during interventional bronchoscopy, complications and operation time were recorded. The factors influencing ventilation effects were evaluated., Results: All the patients' condition were kept stable during interventional bronchoscopy and no severe complications occurred. Tidal volume was reduced by 27.1%, while peak airway pressure, plateau pressure and mean airway pressure were increased by 63.1%, 43.7% and 32.4% following insertion of the bronchoscope respectively. Patients using tracheal intubation had their peak pressure increased by 79.3%, which was higher than that of patients using larynx mask (55.3%)., Conclusions: Interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia was safe and reliable. Although peak airway pressure increased following insertion of bronchoscope, the mean airway pressure was maintained in a low level. When performing interventional bronchoscopy during mechanical ventilation, the inside diameter of larynx mask and tracheal intubation should be as large as possible to minimize airway pressure and auto-PEEP.

Objective: To evaluate the efficacy of different interventional bronchoscopic techniques for the management of benign cicatricial hyperplasia airway stenosis, and to study the factors associated with the treatment effects., Methods: From December 2004 to December 2009, 36 patients with cicatricial airway stenosis were admitted to our department. An investigation was made to analyze the effects by different interventional bronchoscopic treatments. The most suitable treatment modality for cicatricial airway stenosis was explored and described., Results: For the 36 patients, the disease was cured in 9, improved in 10, not improved in 12, and failure in 5. The cure rate, effective rate and ineffective rate were 25%, 53% and 47%, respectively. Further analysis showed that the effective rate was 8% and 82% respectively for the electrical coagulation therapy and the balloon dilation combined with needle electrical knife and/or cryotherapy. Restenosis extension after operation occurred in 67% of the cases by electrical coagulation therapy, but only 12% of cases by the balloon dilation combined with needle electrical knife and/or cryotherapy., Conclusions: Our experience demonstrated that for the treatment of airway cicatricial stenosis, electrical coagulation might induce and worsen serious airway restenosis resulting in failure of treatment. On the other hand, balloon dilation combined with needle electrical knife and/or cryotherapy might be a relative safe and effective therapy for airway cicatricial stenosis.

Objective: it is more difficult and carries more risks to place airway stent under local anaesthesia for the patient with severe airway stenosis. The technique and method of domestically made recalled nitinol alloy stent implantation for severe airway stenosis was explored and evaluated., Methods: by using bronchoscopy via larynx mask, trachea intubation, or rigid bronchoscope under general anaesthesia and mechanical ventilation, stents are placed in the airway of patients with severe airway stenosis for which had been difficult to performed under local anaesthesia., Results: according to the various tracheobronchial lesions of patients, 42 stents were successfully placed in 40 patients, via larynx mask 23 cases, trachea intubation 11 cases, and rigid bronchoscope 6 cases under general anaesthesia and mechanical ventilation. No complications happened. The recalled nitinol alloy stents were placed in trachea 27 cases (membrane covered stent 9 cases), left primary bronchus 8 cases, right primary bronchus to medial segment 2 cases, trachea to left primary bronchus (wedge shaped stent) 5 cases respectively. The airway pressure decreased to normal level and other ventilator parameters also recovered after stents were placed. In most patients, the dyspnea index was improved immediately and the scores decreased from grades IV-V to grades 0-II, with higher scores indicating worse dyspnea., Conclusion: for patients with severe airway stenosis, it is safer, effective and more comfortable to place the stent via larynx mask, trachea intubation, or rigid bronchoscope under general anaesthesia and mechanical ventilation compared to local anaesthesia and is worth spread and popularization in the future.

Objective: To observe the influence of paclitaxel on the proliferation of human pulmonary fibroblast (HPF), and therefore to explore the possible effect on granulation tissue formation in-stent restenosis after airway stent., Methods: The HPFS were divided into 3 groups: 24 h group, 48 h group and 72 h group, and there were 3 different dosage groups in each time group. MTT assay was used for detecting cell proliferation., Results: The inhibition ratio of 4.5 microg/ml group, 13.5 microg/ml group and 45 microg/ml group were 43.7%, 58.8% and 68.1% after 24 hours; 75.5%, 77.7%, 91.9% after 48 hours; 95.1%, 97.1%, 97.0% after 72 hours., Conclusions: Paclitaxel inhibited the proliferation of HPF, and the inhibition ratio has partly relation with time and dosage.