Objective To investigate the efficacy and safety of balloon dilatation-guided placement difficult Y-style silicone stent in the treatment of malignant complex tracheal stenosis.Methods This was an observational study.A retrospective study was conducted on 6 patients diagnosed with severe tracheal stenosis who failed to undergo conventional silicone stent implantation in the Respiratory Intervention Diagnosis and Treatment Center of Jining No.1 People's Hospital from August 2021 to March 2022.There were 4 males and 2 females,aged(62±7)years.There were 3 cases of unilateral bronchial stenosis with protrusion widening,and 3 cases of bilateral main bronchial stenosis with protrusion widening.Four patients had pulmonary malignancies and two patients had esophageal cancer invading the airway.In the process of Y-style silicone stent implantation for malignant complex airway stenosis,6 patients with difficult stent implantation were treated with balloon dilatation-guided technique.The indicators of successful Y-style silicone stent placement and intraoperative and postoperative complications were observed.Results The Y-style silicone stents were successfully placed in all 6 patients,and there were no intraoperative or postoperative complications.There were no operation-related deaths.After operation,the patients'tracheal stenosis was relieved,the dyspnea was significantly relieved,and the grade of dyspnea was improved from grade Ⅲ-Ⅳ to grade 0-Ⅱ.Conclusion Balloon dilatation-guided placement difficult Y-style silicone stent in the treatment of malignant complex tracheal stenosis is effective and safe.