Krishnan Aravind, Guenthart Brandon A, Choi Ashley, Trope Winston, Berry Gerald J, Pinezich Meghan R, Vunjak-Novakovic Gordana, Shaller Brian, Sung C Kwang, Liou Douglas Z, Damrose Edward J, Lui Natalie S
Department of Cardiothoracic Surgery, Stanford University, Stanford, CA.
Department of Pathology, Stanford University, Stanford, CA.
Ann Thorac Surg Short Rep. 2023 Jun 7;1(3):460-4. doi: 10.1016/j.atssr.2023.05.013.
Severe Coronavirus Disease 2019 (COVID-19) infection is associated with prolonged intubation and its complications. Tracheal stenosis is one such complication that may require specialized surgical management. We aimed to describe the surgical management of post-COVID-19 tracheal stenosis.
This case series describes consecutive patients with tracheal stenosis from intubation for severe COVID-19 infection at our single, tertiary academic medical center between January 1, 2021, and December 31, 2021. Patients were included if they underwent surgical management with tracheal resection and reconstruction, or bronchoscopic intervention. Operative through six-month, symptom-free survival and histopathological analysis of resected trachea were reviewed.
Eight patients are included in this case series. All patients are female, and most (87.5%) are obese. Five patients (62.5%) underwent tracheal resection and reconstruction (TRR), while three patients (38.5%) underwent non-resection-based management. Among patients who underwent TRR, six-month symptom free survival is 80%; one patient (20%) required tracheostomy after TRR due to recurrent symptoms. Two of the three (66.7%) of patients who underwent non-resection-based management experienced durable relief from symptoms of tracheal stenosis with tracheal balloon dilation, and the remaining patient required laser excision of tracheal tissue prior to experiencing symptomatic relief.
The incidence of tracheal stenosis may increase as patients recover from severe COVID-19 infection requiring intubation. Management of tracheal stenosis with TRR is safe and effective, with comparable rates of success to TRR for non-COVID-19 tracheal stenosis. Non-resection-based management is an option to manage tracheal stenosis in patients with less severe stenosis or in poor surgical candidates.
2019年冠状病毒病（COVID-19）重症感染与长时间插管及其并发症相关。气管狭窄就是其中一种可能需要特殊手术治疗的并发症。我们旨在描述COVID-19后气管狭窄的手术治疗方法。
本病例系列描述了2021年1月1日至2021年12月31日期间在我们单一的三级学术医疗中心因重症COVID-19感染插管而导致气管狭窄的连续患者。如果患者接受了气管切除重建手术治疗或支气管镜介入治疗，则纳入研究。回顾了手术至术后六个月无症状生存情况以及切除气管的组织病理学分析结果。
本病例系列纳入了8名患者。所有患者均为女性，且大多数（87.5%）为肥胖患者。5名患者（62.5%）接受了气管切除重建手术（TRR），而3名患者（38.5%）接受了非切除性治疗。在接受TRR的患者中，六个月无症状生存率为80%；1名患者（20%）在TRR后因症状复发需要气管造口术。在接受非切除性治疗的3名患者中，有2名（66.7%）通过气管球囊扩张术获得了气管狭窄症状的持久缓解，其余1名患者在症状缓解前需要激光切除气管组织。
随着从需要插管的重症COVID-19感染中康复的患者数量增加，气管狭窄的发生率可能会上升。TRR治疗气管狭窄安全有效，其成功率与非COVID-19气管狭窄的TRR相当。对于狭窄程度较轻或手术条件较差的患者，非切除性治疗是管理气管狭窄的一种选择。
