[Clinical applications of rigid bronchoscopy in central airway obstructions]

Rigid bronchoscopy has expanded for therapeutic purposes lately. It has a large diameter working channel, the ability to maintain proper ventilation during operation, and the capacity to deal with massive bleeding and other complications. Our purpose was to describe the effectiveness and safety of rigid bronchoscopy in central airway stenosis.

We retrospectively analyzed all patients who had received rigid bronchoscopy for central airway obstruction in our respiratory department of this teaching hospital between December of 2008 and December of 2014. The advantages and limitations of the operations were analyzed through observing the changes of the degree of stenosis, pulmonary function, and Karnofsky performance status scale. Complications were also recorded.

Totally 209 rigid bronchoscopic procedures were performed in 132 patients with central airway stenosis (86 men; median age, 59 years; range, 9 to 85 years), of them 68% was malignancy. The rigid bronchoscopy provided immediate relief of central airway obstruction. Tracheal obstruction was (63.3 ± 22.4)% before and (17.8 ± 16.0)% after the procedures; obstruction in the left main bronchus was (71.1 ± 23.9)% before and (27.0 ± 24.0)% after the procedures; and the right main bronchus was (73.0 ± 26.2)% before and (34.9 ± 29.8)% after the procedures, (t=21.85, 12.27, 11.17 separately, P<0.01). Spirometry revealed that FEV1 improved significantly from (1.6 ± 0.8) L before to (2.0 ± 0.8) L after the procedures. Besides, many sophisticated procedures, such as stent implantation, corrupted metal stent removing and lithotripsy were performed under rigid bronchoscopy. There were no fatal complications.

Rigid bronchoscopy provides immediate relief of central airway obstruction and maintains proper ventilation during sophisticated intraluminal operations. It provides better visualization for advanced procedures and is an optimal selection for securing the airway in severe central airway obstruction even with respiratory failure.