Abstract
BACKGROUND: Airway fistula represents a complex clinical condition where the optimal bronchoscopic management remains controversial. This study aims to evaluate clinical characteristics, bronchoscopic treatment efficacy, and prognostic factors. METHODS: This retrospective study analysed 45 patients with fistulas who underwent a total of 56 bronchoscopic intervention sessions over the past seven years. The fistulas were categorized and analysed based on their size, clinical features and treatment efficacy, with prognostic factors for healing being evaluated. In parallel, a bioinformatic analysis was initiated with 2075 genes sourced from GeneCards. Following filtration, the top 20 hub genes were identified and subsequently subjected to pathway enrichment analysis to elucidate the underlying mechanisms. RESULTS: Compared to the non-remission group, the remission group exhibited significantly smaller fistula diameters, higher lymphocyte counts, and lower high-sensitivity C-reactive protein (hsCRP) levels. Prognostic analysis revealed that fistula size and hsCRP level were independent predictors. Small fistulas (≤5 mm) cases solely underwent blocking agent intervention had a significantly higher remission rate. While the others (>5 mm) were mostly managed with stents, endobronchial valves, and cardiac occluders. Bioinformatic analysis of public data identified significant enrichment in the PI3K-AKT signaling pathway and cytokine-cytokine receptor interaction pathway, pinpointing six core genes, including CXCL8, IL1B, IL6, TNF, TGFB1, and IL13. CONCLUSIONS: Prioritize bronchoscopic treatment with inflammation control for small fistulas; recommend combined therapies for large fistulas.The PI3K-AKT and cytokine pathways may be involved in healing and represent potential targets for future drug development.