Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, School of Medicine, Genoa, Italy.
Acta Otorhinolaryngol Ital. 2022 Apr;42(2):99-105. doi: 10.14639/0392-100X-N1952.
The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation.
A case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021.
Among 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors' classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic.
With the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.
COVID-19 大流行不仅对全球医疗体系造成了大量肺病患者的影响，还带来了长期后遗症的问题，这对其构成了巨大挑战。在这方面，喉气管狭窄（LTS）是侵袭性通气的最常见并发症之一。
收集了 2020 年 6 月至 2021 年 9 月期间因 COVID-19 后 LTS 而行气管切除术和吻合术（TRA）的患者的病例系列。
在纳入的 14 名患者中，50%有糖尿病，64.3%肥胖。在重症监护病房期间，经口气管插管（OTI）的平均时间为 15.2 天，10 名患者（71.4%）进行了气管切开术，其中 7 名患者平均维持 31 天。根据欧洲喉科学会分类，13 名患者（92.9%）为 IIIa 级 LTS，1 名患者为 IIIa+级。根据作者的分类，所有患者均行 A 型 TRA。未报告重大围手术期并发症，末次随访时所有患者均无症状。
对于 COVID-19 后 LTS 患者，TRA 具有良好的适应证，是一种有效的治疗方法。需要缩短 OTI 时间并谨慎进行气管切开术，以降低气道损伤的发生率。
