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首页> 外文期刊>Journal of Thoracic Disease >Long-term outcomes of tracheobronchial stenosis due to tuberculosis (TSTB) in symptomatic patients: airway intervention vs . conservative management
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Long-term outcomes of tracheobronchial stenosis due to tuberculosis (TSTB) in symptomatic patients: airway intervention vs . conservative management

机译：在症状患者中由于结核病（TSTB）引起的气管支气管狭窄的长期结果：气道干预vs。保守管理

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Background: Patients with tracheobronchial stenosis due to tuberculosis (TSTB) have a variable clinical course and response to treatment including airway intervention. There are no clear guidelines on the best approach to manage such patients. This study examines long-term outcomes of patients with TSTB and factors associated with recurrent symptoms or need for repeat airway intervention following initial bronchoscopic intervention. Methods: This is a retrospective analysis of patients with TSTB over an 18-year period. Symptoms, radiological, bronchoscopic findings, airway interventions and complications were obtained. Multivariate logistic regression analysis was performed to identify factors predictive of recurrence of symptoms or need for repeat airway intervention. Results: A total of 131 patients with mean age 50±18 years and median follow-up 5 (interquartile range, 2–10) years were included. Nineteen (29.7%) patients underwent balloon dilatation alone, 22 (34.4%) had additional resection or stenting, and 19 (29.7%) underwent all 3 procedures. Among patients conservatively managed, a larger proportion (55.6%) of patients with no recurrence of symptoms had active TB. Patients who developed recurrent symptoms had longer symptom duration (12 vs. 3 months, P=0.025), and more had recurrent lower respiratory tract infections (50% vs. 5.6%, P=0.003), lung collapse (90.0% vs. 41.7%, P=0.011) or linear fibrosis (70.0% vs. 30.6%, P=0.033) compared to those without recurrent symptoms. Bronchomalacia (OR =17.18; 95% CI, 3.43–86.18) and prior bronchoscopic airway resection (OR =4.97; 95% CI, 1.20–20.60) were strongly associated with the recurrence of symptoms or need for repeat airway intervention on multivariate logistic regression analysis. Conclusions: Bronchomalacia and prior bronchoscopic airway resection are associated with the recurrence of symptoms despite airway intervention. Patients who are diagnosed with TSTB early in the course of active TB may be conservatively managed.
机译：背景：由于结核病（TSTB）引起的气管静脉曲张狭窄的患者具有可变的临床课程和对包括气道干预的治疗的反应。没有明确的管理这些患者的最佳方法。本研究审查了TSTB患者的长期结果和与复发症状相关的因素，或者在初始支气管镜介入后再需要重复气道干预。方法：这是对18年内TSTB患者的回顾性分析。获得症状，放射性，支气管镜调查结果，气道干预和并发症。进行多元逻辑回归分析，以确定预测症状复发的因素，或者需要重复气道干预。结果：共有131例平均年龄50±18岁，包括中位随访5（四分位数，2-10）岁。十九（29.7％）单独接受球囊扩张的患者，22例（34.4％）额外切除或支架，19（29.7％）接受了所有3个程序。在保守管理的患者中，症状无复发的患者的较大比例（55.6％）具有活跃的TB。发育复发症状的患者具有更长的症状持续时间（12与3个月，P = 0.025），并且经常发生的较低呼吸道感染（50％与5.6％，P = 0.003），肺塌陷（90.0％与41.7与没有复发症状的人相比，％，P = 0.011）或线性纤维化（70.0％与30.6％，P = 0.033）。支气管癌（或= 17.18; 95％CI，3.43-86.18）和先前的支气管镜呼吸道切除（或= 4.97; 95％CI，1.20-20.60）与症状复发或需要对多变量逻辑回归的重复呼吸介入的需求强烈相关分析。结论：支气管癌和先前的支气管镜呼吸道切除仍与呼吸道干预症状的复发相关。可以保守诊断在活跃的TB过程中诊断为TSTB的患者可以保守管理。

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