Topolnitskiy E B, Shefer N A, Podgornov V F
Siberian State Medical University, Tomsk, Russia.
Tomsk Regional Clinical Hospital, Tomsk, Russia.
Khirurgiia (Mosk). 2022(3):36-43. doi: 10.17116/hirurgia202203136.
To describe 10-year experience of treating the cicatricial tracheal stenosis (CTS) in a regional multi-field hospital.
There were 120 CTS patients aged 13-75 years. In 8 (6.7%) patients, CTS was combined with tracheoesophageal fistula (TPF). Post-intubation stenosis was diagnosed in 16 (13.3%) cases, post-tracheostomy - in 102 (85%) ones, post-traumatic - in 2 (1.7%) patients. CTS length ranged from 1.2 to 8 cm. Fifty (41.7%) patients had cervical CTS, 40 (33.3%) patients - cervico-thoracic tracheal stenosis, 11 (9.2%) patients - tracheal stenosis at the thoracic level. Nineteen (15.8%) patients had multifocal stenoses. We used endoscopic techniques, circular tracheal resection (CTR) and laryngotracheal reconstruction.
Postoperative mortality rate was 0.83%. CTR was performed in 33 patients, laryngotracheal reconstruction - 77, endoscopic stenting - 6 patients. In 4 cases, local CTS was eliminated by bougienage and argon plasma exposure. CTS was successfully disconnected with TEF using CRT in 3 cases, laryngotracheoplasty and stenting - in 5 cases. The fenestrated tracheal defect was closed by a three-layer autologous flap in 59 patients. Of these, autologous flap was reinforced with porous nickel-titanium implants in 17 patients. Postoperative complications after CRT occurred in 6 (16.7%) patients (anastomotic leakage - 2, anastomositis - 1, restenosis - 2). No patients died. Postoperative complications after laryngotracheal reconstruction were observed in 18 (23.4%) patients including 5 ones with restenosis who underwent CTR with a favorable outcome.
CTS treatment requires a multidisciplinary approach. Each surgery has certain indications and place in treatment algorithm. CTR is highly effective, but may be accompanied by complications associated with tracheal anastomosis. Decrease of postoperative morbidity will improve immediate and long-term results of CTS treatment. The chosen treatment algorithm ensured good and satisfactory results in 98% of patients.
描述一家地区性多领域医院治疗瘢痕性气管狭窄（CTS）的10年经验。
120例CTS患者，年龄13 - 75岁。8例（6.7%）患者CTS合并气管食管瘘（TPF）。插管后狭窄诊断16例（13.3%），气管切开术后狭窄102例（85%），创伤后狭窄2例（1.7%）。CTS长度为1.2至8厘米。50例（41.7%）患者为颈部CTS，40例（33.3%）患者为颈胸段气管狭窄，11例（9.2%）患者为胸段气管狭窄。19例（15.8%）患者有多灶性狭窄。我们采用了内镜技术、环形气管切除术（CTR）和喉气管重建术。
术后死亡率为0.83%。33例患者进行了CTR，77例进行了喉气管重建，6例进行了内镜支架置入。4例患者通过探条扩张和氩等离子体暴露消除了局部CTS。3例患者通过CTR成功分离了CTS与TEF，5例患者通过喉气管成形术和支架置入成功分离。59例患者采用三层自体皮瓣封闭有孔气管缺损。其中17例患者的自体皮瓣用多孔镍钛植入物加强。CTR术后6例（16.7%）患者出现并发症（吻合口漏2例，吻合口炎1例，再狭窄2例）。无患者死亡。喉气管重建术后18例（23.4%）患者出现并发症，其中5例再狭窄患者接受CTR治疗，效果良好。
CTS治疗需要多学科方法。每种手术在治疗方案中都有特定的适应症和地位。CTR非常有效，但可能伴有气管吻合相关的并发症。降低术后发病率将改善CTS治疗的近期和远期效果。所选择的治疗方案在98%的患者中确保了良好且令人满意的结果。
