Chest
Clinical InvestigationsBronchoscopic Cryotherapy for Airway Strictures Caused by Tumors
Section snippets
Material and Methods
The endoscopic treatment was carried out using a cryoprobe that employs the Joule-Thomson effect (cooling of a gas upon sudden expansion from a high to a low pressure region).
This cryoprobe, with interchangeable tips, measures 55 cm in length and 3 mm in outside diameter. The principal feature of the probe is to be nonrigid, thus enabling one to reach tumors obstructing the main bronchus of the upper lobe. The entire probe is insulated except for the distal 1 cm. The cryoprobe is introduced
Results
Palliation was the most favorable outcome that we expected to achieve (Table 1). For malignant tumors of the bronchial tree, our objective was obtained in 13 cases out of 21: disappearance or important regression of the tumor permitting renewed or improved ventilation of a lobe (Figure 2, Figure 3, Figure 4) or a lung and interruption of hemoptysis.
We also managed to ablate five small benign granulomas without complications. Nevertheless, we had five technical failures: in one case, the probe
Complications
Two patients had a mild fever the same evening, but this may occur after any bronchial endoscopy. During cryotherapy, all patients were monitored by an electrocardiogram. Three of them showed a change in rhythm during the examination, but not coinciding with the time of cooling. A tachycardia often appears during bronchial endoscopy but it is not necessary to make electrocardiographic monitoring mandatory for this examination. Nevertheless, ECG monitoring revealed the reason for the death of an
Discussion
Cryotherapy in the bronchial tree is capable of inducing coagulation necrosis of tissue and destruction of tumors. All patients in this series with tumoral lesions were at an advanced stage of their illness; the data of this study do not show that survival has been extended, but the quality of life has certainly been improved with new ventilation of a lung or lobes and the cessation of hemoptysis. Five patients are still alive six months after cryotherapy; seven died from brain metastasis.
The
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Manuscript received May 1, 1985; revision accepted January 10.