Department of Thoracic Surgery, Combined Military Hospital, Multan, Pakistan.
Department of Thoracic Surgery, Combined Military Hospital, Quetta Cantonment, Pakistan.
J Coll Physicians Surg Pak. 2022 Mar;32(3):373-376. doi: 10.29271/jcpsp.2022.03.373.
To ascertain the outcome of primary resection anastomosis in patients of post-intubation tracheal stenosis (PITS) and the associated morbidity.
A case series.
Department of Thoracic Surgery, Combined Military Hospital, (CMH) Rawalpindi, Lahore and Multan from January 2010 to August 2018.
Patients with tracheal stenosis due to prolonged intubation with functional were included. Exclusion criteria were patients having stenosis due to malignant cause, trauma and glottic stenosis involving vocal cords. Clinical examination, computerised tomography (CT) of neck plus chest and fiberoptic bronchoscopy were done in all the patients, while virtual bronchoscopy were done in 35 cases. Sharp dissection, aided by loupes, was the preferred technique. Thyroid tissue and strap muscle were used as flap for high cricoid lesion. Guardian stitch was applied to all cases. Postoperative elective bronchoscopy was performed after a fortnight.
Among 43 patients, [26 (60.5%) men and 17 (39.5) women] 18 patients were intubated for days >10 ,18 for <10 and 7 for <3 days. Thirty-four (79.1%) patients were under 40 years of age, while 23 patients had tracheostomy incorporated in surgery. Bronchoscopy evaluation of distance from vocal cords showed involvement of the first ring in six patients, 1st ring normal in 1, 2 rings normal in 17, while 3 or more rings spared in 19 patients. Length of stenotic segment was <2 cm in 17, between 2-3 cm in 21, and between 3-5 cm in five patients. All patients were successfully extubated. Two patients had twin lesions. Seven patients required hyoid bone excision and release. There was one recurrent stenosis managed successfully with dilatation and granulation removal.
Post-intubation tracheal stenosis (PITS) is curable disease. Primary resection and anastomosis remain the gold standard with acceptable morbidity and mortality. Key Words: Tracheal stenosis, Intubation, Resection, Primary anastomosis.
确定气管插管后狭窄（PITS）患者行一期切除吻合术的治疗效果及其相关并发症。
病例系列研究。
拉瓦尔品第联合军事医院胸外科，拉合尔和木尔坦，2010 年 1 月至 2018 年 8 月。
纳入因长时间插管导致的气管狭窄且功能正常的患者。排除标准为因恶性肿瘤、创伤和累及声带的声门狭窄导致的狭窄的患者。所有患者均进行临床检查、颈胸部计算机断层扫描（CT）和纤维支气管镜检查，35 例患者进行虚拟支气管镜检查。采用显微镜辅助下锐性分离技术，高位环状软骨病变采用甲状腺组织和颈前带状肌作为皮瓣。所有患者均应用吻合口保护缝线。术后两周内行选择性支气管镜检查。
43 例患者中，[26 例（60.5%）男性和 17 例（39.5%）女性]18 例插管>10 天，18 例插管<10 天，7 例插管<3 天。34 例（79.1%）患者年龄<40 岁，23 例患者在手术中同时行气管切开术。纤维支气管镜评估声带距离显示，6 例患者第一环受累，1 例第一环正常，17 例患者第二环正常，19 例患者累及 3 个或更多环。狭窄段长度<2cm 者 17 例，2-3cm 者 21 例，3-5cm 者 5 例。所有患者均成功拔管。2 例患者存在双病灶。7 例患者需要行舌骨切除术和松解术。1 例复发性狭窄患者经扩张和肉芽组织切除成功治疗。
气管插管后狭窄（PITS）是一种可治愈的疾病。一期切除吻合术仍然是金标准，具有可接受的发病率和死亡率。关键词：气管狭窄、插管、切除、一期吻合术。
