Brascia Debora, De Palma Angela, Cantatore Mirko Girolamo, Pizzuto Ondina, Signore Francesca, Sampietro Doroty, Valentini Mariangela, Genualdo Marcella, Marulli Giuseppe
Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy.
Front Surg. 2023 Mar 31;10:1150254. doi: 10.3389/fsurg.2023.1150254. eCollection 2023.
An increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation/tracheostomy (PI/T) upper airways lesions. The purpose of this study is to report our early experience in endoscopic and/or surgical management of PI/T upper airways injuries of patients surviving COVID-19 critical illness.
We prospectively collected data from patients referred to our Thoracic Surgery Unit from March 2020 to February 2022. All patients with suspected or documented PI/T tracheal injuries were evaluated with neck and chest computed tomography and bronchoscopy.
Thirteen patients (8 males, 5 females) were included; of these, 10 (76.9%) patients presented with tracheal/laryngotracheal stenosis, 2 (15.4%) with tracheoesophageal fistula (TEF) and 1 (7.7%) with concomitant TEF and stenosis. Age ranged from 37 to 76 years. Three patients with TEF underwent surgical repair by double layer suture of oesophageal defect associated with tracheal resection/anastomosis (1 case) or direct membranous tracheal wall suture (2 cases) and protective tracheostomy with T-tube insertion. One patient underwent redo-surgery after primary failure of oesophageal repair. Among 10 patients with stenosis, two (20.0%) underwent primary laryngotracheal resection/anastomosis, two (20.0%) had undergone multiple endoscopic interventions before referral to our Centre and, at arrival, one underwent emergency tracheostomy and T-tube positioning and one a removal of a previously positioned endotracheal nitinol stent for stenosis/granulation followed by initial laser dilatation and, finally, tracheal resection/anastomosis. Six (60.0%) patients were initially treated with rigid bronchoscopy procedures (laser and/or dilatation). Post-treatment relapse was experienced in 5 (50.0%) cases, requiring repeated rigid bronchoscopy procedures in 1 (10.0%) for definitive resolution of the stenosis and surgery (tracheal resection/anastomosis) in 4 (40.0%).
Endoscopic and surgical treatment is curative in the majority of patients and should always be considered in PI/T upper airways lesions after COVID-19 illness.
由于新型冠状病毒肺炎（COVID-19）感染，越来越多的患者接受了长时间的有创机械通气，导致大量插管/气管切开术后（PI/T）上气道损伤。本研究的目的是报告我们对COVID-19危重症幸存者PI/T上气道损伤进行内镜和/或手术治疗的早期经验。
我们前瞻性收集了2020年3月至2022年2月转诊至我们胸外科的患者的数据。所有疑似或确诊为PI/T气管损伤的患者均接受了颈部和胸部计算机断层扫描及支气管镜检查。
纳入13例患者（8例男性，5例女性）；其中，10例（76.9%）患者出现气管/喉气管狭窄，2例（15.4%）出现气管食管瘘（TEF），1例（7.7%）同时出现TEF和狭窄。年龄范围为37至76岁。3例TEF患者接受了手术修复，包括食管缺损双层缝合联合气管切除/吻合术（1例）或直接气管膜壁缝合（2例）以及插入T形管的保护性气管切开术。1例患者在食管修复初次失败后接受了再次手术。在10例狭窄患者中，2例（20.0%）接受了初次喉气管切除/吻合术，2例（20.0%）在转诊至我们中心之前接受了多次内镜干预，入院时，1例接受了紧急气管切开术和T形管置入，1例因狭窄/肉芽组织取出先前置入的气管镍钛合金支架，随后进行了初次激光扩张，最后进行了气管切除/吻合术。6例（60.0%）患者最初接受了硬质支气管镜检查（激光和/或扩张）。5例（50.0%）患者出现治疗后复发，其中1例（10.0%）需要重复硬质支气管镜检查以最终解决狭窄问题，4例（40.0%）需要进行手术（气管切除/吻合术）。
内镜和手术治疗对大多数患者具有治愈性，COVID-19疾病后PI/T上气道损伤患者应始终考虑采用内镜和手术治疗。
