Erfolgreiche Behandlung einer benignen Trachealstenose durch einen Silikonstent (Polyflex-Stent) über 5 Jahre

Zusammenfassung:

Inoperable, funktionell wirksame Stenosen des Tracheobronchialsystems können durch bronchoskopische Stenteinlage kurz- und mittelfristig oft effektiv behandelt werden. Silikonstents weisen bei langer Liegezeit gelegentlich Probleme in Form von Migration und Sekretretention auf. Metallstents können zu Granulationsgewebsbildung oder sogar Wandperforation führen. Hinsichtlich der Langzeitbehandlung mit Atemwegsstents über mehrere Jahre gibt es wenig Erfahrungen und keine einheitlichen Empfehlungen. Wir berichten über eine 76-jährige Patientin, die wegen einer benignen subglottischen Trachealstenose auf dem Boden zweier Tracheotomien mittels bronchoskopischer Dilatation und Einlage eines Silikon-Stents (POLYFLEX-Stent) behandelt wurde. Während einer Nachbeobachtungsdauer bislang von fast 5 Jahren kam es zu keiner Rezidivstenose. Schwere Stentkomplikationen in Form von Stentmigration, Sekretblockade und Granulationsgewebsbildung traten nicht auf. Eine Neigung zur bronchialen Verschleimung bot unter regelmäßiger Inhalationstherapie mit isotoner NaCl-Lösung keine Probleme. 21 und 56 Monate nach Stenteinlage kam es zu geringen Hämoptysen, ohne dass bronchoskopisch eine Blutungsquelle nachweisbar war. Histologisch war nach 56 Monaten am distalen Stentende eine Plattenepithelmetaplasie nachweisbar. Mikrobiologisch zeigte sich eine zunehmende, klinisch jedoch inapparente Besiedelung des Bronchialsekretes mit potenziell pathogenen Keimen.

Successful Treatment of a Benign Tracheostenosis with a Silicone Stent (Polyflex-Stent) over 5 Years - Case Report:

Inoperable, functional relevant stenoses of the airways can be effectively treated short-termed and medium-termed by means of bronchoscopic stenting occasionally, silicone stents cause problems after long-term periods, such as migration and retention of bronchial secretions. Metallic stents can lead to obstructing granulomas or even bronchial wall perforation. As regards long-term treatment with airway stents over several years, there is little experience and no uniform recommendations are known. We report on a 76-year old female patient with a severe benign subglottic tracheostenosis after tracheostomy who was successfully treated by means of bronchoscopic dilatation and stenting with a silicone stent (POLYFLEX stent). POLYFLEX Stent is a self-expanding silicone stent with an encapsulated monofilament network made of polyester. The network is completely covered by a silicone layer with a smooth inner surface (protecting against incrustation) and a structured outer surface of the stent (protecting against migration). The ends of the monofilaments were provided with a special protection to avoid tissue granulation and to yield x-ray contrast. During a follow-up of almost 5 years the stent is well tolerated and there is no restenosis. Complications such as migration, obstructing secretions and obstructing granulomas did not occur. A slight bronchial hypersecretion presented no problem under regular inhalation therapy with isotonic NaCl solution. 21 and 56 months after stenting there were two episodes of minor haemoptysis. There was no demonstrable source of haemorrhage by bronchoscopy. After 56 months, biopsy at the distal opening of the stent showed a squamous cell metaplasia, but no granulation tissue. Microbiological analysis of bronchial secretions revealed an increasing, but clinically silent colonisation with potentially pathogenic microorganisms.

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1 Fa. Karl Storz GmbH, 78503 Tuttlingen

2 Willy Rüsch AG, 71394 Kernen

3 Bess GmbH, 14169 Berlin

4 Pari-Werk GmbH, 82317 Starnberg