Esakov Yu S, Pechetov A A, Khlan T N, Solodinina E N, Slepenkova K V, Bessonova S A, Lukich K V, Davydenko P I
Vishnevsky National Medical Research Center for Surgery of Healthcare Ministry of Russia, Moscow, Russia.
Khirurgiia (Mosk). 2019(2):19-25. doi: 10.17116/hirurgia201902119.
To present single-center experience and results of surgical treatment of acquired tracheal stenosis.
There were 99 patients with acquired tracheal stenosis for the period from January 2008 to December 2017. Median age was 39 (28; 55) years (range 19-79 years), male/female ratio - 64/35. There were 59 patients with tracheostomy-related stenosis, 31 - post-intubation injury, 6 - posttraumatic stenosis, malignant and idiopathic stenosis was observed in 2 and 1 patients, respectively. Single-stage circular tracheal resection or staged surgical approach were preferred depending on localization and severity of stenosis, respiratory function at admission, severity of concomitant diseases and possibility of prolonged head adduction, presence of tracheostomy and cervical tissues inflammation, functional state of laryngeal structures.
Single-stage circular tracheal resection was applied in 44 (44.4 %) out of 99 cases. In 55 (55.6%) patients staged approach was preferred: Montgomery T-tube placement followed by tracheoplasty after 6-12 months - 27 patients; tracheoplasty on prefabricated endotracheal stent - 8 patients; staged endotracheal treatment (including Dumon prosthesis deployment) - 12 patients. In 11 cases circular resection was done as a final stage of treatment. There was no in-hospital mortality after circular tracheal resection. Morbidity included anastomotic dehiscence - 2 (3.6%), recurrent stenosis in 6 months after surgery - 1 (1.8%), granulation tissue growth followed by stenosis - 4 (7.3%), wound infection - 3 (5.5%) cases), postoperative pneumonia - 2 (3.6%) patients, respectively.
Tracheal resection is preferred for tracheal stenosis management. Alternative techniques are life-saving procedures, but could potentially extent the length of stenosis and delay recovery of the patient.
介绍单中心关于获得性气管狭窄手术治疗的经验及结果。
2008年1月至2017年12月期间，共有99例获得性气管狭窄患者。中位年龄为39（28；55）岁（范围19 - 79岁），男女比例为64/35。其中59例为气管切开相关狭窄，31例为插管后损伤，6例为创伤后狭窄，恶性狭窄和特发性狭窄分别见于2例和1例。根据狭窄的部位和严重程度、入院时的呼吸功能、伴随疾病的严重程度、长时间头部内收的可能性、是否存在气管切开及颈部组织炎症、喉结构的功能状态，优先选择一期环形气管切除或分期手术方法。
99例患者中，44例（44.4%）采用一期环形气管切除。55例（55.6%）患者优先选择分期手术方法：蒙哥马利T形管置入，6 - 12个月后行气管成形术 - 27例；预制气管内支架上的气管成形术 - 8例；分期气管内治疗（包括放置杜蒙假体） - 12例。11例环形切除作为治疗的最后阶段。环形气管切除术后无院内死亡。并发症包括吻合口裂开 - 2例（3.6%），术后6个月复发狭窄 - 1例（1.8%），肉芽组织生长伴狭窄 - 4例（7.3%），伤口感染 - 3例（5.5%），术后肺炎 - 2例（3.6%）。
气管切除是治疗气管狭窄的首选方法。替代技术是挽救生命的手术，但可能会延长狭窄长度并延迟患者康复。
