Topolnitskiy E B, Shefer N A, Kapitanova D V, Podgornov V F
Siberian State Medical University, Tomsk, Russia.
Tomsk Regional Clinical Hospital, Tomsk, Russia.
Khirurgiia (Mosk). 2022(4):5-10. doi: 10.17116/hirurgia20220415.
To analyze postoperative outcomes and perioperative management of patients with post-intensive care tracheal stenosis and previous COVID-19 pneumonia.
There were 8 patients with post-intensive care tracheal stenosis and previous COVID-19 pneumonia aged 34-61 years between January 2021 and April 2021. Lung damage CT-3 was observed in 2 (25%) patients, CT-4 - in 5 (62.5%) patients. In one case, COVID-19 pneumonia with lung damage CT-2 joined to acute cerebrovascular accident. Post-tracheostomy stenosis was detected in 7 (87.5%) cases, post-intubation stenosis - in 1 patient. Duration of invasive mechanical ventilation ranged from 5 to 130 days. In 75% of cases, tracheal stenosis was localized in the larynx and cervical trachea. Two patients admitted with tracheostomy. In one case, an extended tracheal stenosis was combined with atresia of infraglottic part of the larynx. One patient had tracheal stenosis combined with tracheoesophageal fistula (TEF). Length of tracheal stenosis was 15-45 mm. Tracheomalacia was observed in 4 (50%) patients. All patients had severe concomitant diseases.
To restore airway patency, we used circular tracheal resection with anastomosis, laryngotracheoplasty and endoscopic methods. Tracheal resection combined with TEF required circular tracheal resection with disconnection of fistula. Adequate breathing through the natural airways was restored in all patients. There was no postoperative mortality. Three patients with baseline tracheal stenosis had favorable postoperative outcomes after circular tracheal resection. Four patients are at the final stage of treatment after laryngotracheoplasty and tracheal stenting.
Patients after invasive mechanical ventilation for COVID-19 pneumonia are at high risk of cicatricial tracheal stenosis and require follow-up. Circular tracheal resection ensures early rehabilitation and favorable functional results. Laryngotracheoplasty is preferred if circular tracheal resection is impossible. This procedure ensures adequate debridement of tracheobronchial tree and respiratory support. Endoscopic measures are an alternative for open surgery, especially for intrathoracic tracheal stenosis and intractable tracheobronchitis.
分析重症监护后气管狭窄且曾患新型冠状病毒肺炎患者的术后结局及围手术期管理。
2021年1月至2021年4月期间，有8例年龄在34至61岁之间的重症监护后气管狭窄且曾患新型冠状病毒肺炎的患者。2例（25%）患者观察到肺部损伤CT-3级，5例（62.5%）患者为CT-4级。1例患者的新型冠状病毒肺炎合并肺部损伤CT-2级，同时并发急性脑血管意外。7例（87.5%）患者检测到气管切开术后狭窄，1例患者为插管后狭窄。有创机械通气时间为5至130天。75%的病例中，气管狭窄位于喉部和颈段气管。2例患者因气管切开入院。1例患者存在广泛性气管狭窄合并声门下部分闭锁。1例患者的气管狭窄合并气管食管瘘（TEF）。气管狭窄长度为15至45毫米。4例（50%）患者观察到气管软化。所有患者均患有严重的合并症。
为恢复气道通畅，我们采用了环形气管切除吻合术、喉气管成形术和内镜方法。气管切除合并TEF需要进行环形气管切除并离断瘘管。所有患者均恢复了通过自然气道的充分呼吸。无术后死亡病例。3例基线气管狭窄患者在进行环形气管切除术后获得了良好的术后结局。4例患者在接受喉气管成形术和气管支架置入术后处于治疗的最后阶段。
新型冠状病毒肺炎有创机械通气后的患者发生瘢痕性气管狭窄的风险较高，需要进行随访。环形气管切除可确保早期康复并获得良好的功能结果。如果无法进行环形气管切除，喉气管成形术是首选。该手术可确保对气管支气管树进行充分清创和呼吸支持。内镜措施是开放手术的替代方法，特别是对于胸段气管狭窄和难治性气管支气管炎。
