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气管插管后气管狭窄手术治疗的长期疗效:气管切除与重建的回顾性分析

Long-term outcomes of surgical management in post-intubation tracheal stenosis: a retrospective analysis of tracheal resection and reconstruction.

作者信息

Ulusan Ahmet, Tunca Ibrahim Emre, Elma Bekir, Sanli Maruf, Isik Ahmet Feridun

机构信息

Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey.

出版信息

Updates Surg. 2025 Apr;77(2):533-540. doi: 10.1007/s13304-024-02040-w. Epub 2024 Nov 23.

Abstract

Post-intubation tracheal stenosis (PITS) is a serious complication of prolonged intubation, often requiring surgical intervention. This study aims to present the long-term outcomes of patients with PITS who underwent tracheal resection and reconstruction, as well as to discuss the efficacy of these surgical methods in comparison to stenting. This retrospective study included patients treated for PITS at our center between October 2005 and October 2022. Patients were divided into two groups: those who underwent tracheal resection and reconstruction (n = 29) and those treated with stenting (n = 47). The clinical characteristics, surgical techniques, complications, and long-term outcomes were recorded and analyzed. The mean age of the patients was 41.3 years, with 40.0% aged between 40 and 60 years. The mean intubation duration was 16.8 days. In the resection group, 22 of 29 patients (75.8%) showed no recurrence or complications during long-term follow-up. The overall success rate for surgical treatment was 93.1%, with a mortality rate of 6.8%. In the stenting group, successful stent removal was achieved in 9 of 47 cases, with a mean stent removal time of 26 months. Granulation tissue formation and restenosis were more frequently observed in stented patients compared to those who underwent surgery. Tracheal resection and end-to-end anastomosis remain the gold standard treatment for PITS, with a lower recurrence rate and fewer long-term complications compared to stenting. However, stenting may be a viable option for patients who are not suitable candidates for surgery. Careful preoperative evaluation and long-term follow-up are essential to optimize patient outcomes.

摘要

气管插管后气管狭窄(PITS)是长期插管的严重并发症,常需手术干预。本研究旨在呈现接受气管切除重建的PITS患者的长期预后,并与支架置入术比较,探讨这些手术方法的疗效。这项回顾性研究纳入了2005年10月至2022年10月在本中心接受PITS治疗的患者。患者分为两组:接受气管切除重建的患者(n = 29)和接受支架置入术治疗的患者(n = 47)。记录并分析临床特征、手术技术、并发症及长期预后。患者的平均年龄为41.3岁,40.0%的患者年龄在40至60岁之间。平均插管时长为16.8天。在切除组中,29例患者中有22例(75.8%)在长期随访中未出现复发或并发症。手术治疗的总体成功率为93.1%,死亡率为6.8%。在支架置入组中,47例患者中有9例成功取出支架,平均支架取出时间为26个月。与接受手术的患者相比,支架置入患者更常观察到肉芽组织形成和再狭窄。气管切除端端吻合术仍是PITS的金标准治疗方法,与支架置入术相比,复发率更低,长期并发症更少。然而,对于不适合手术的患者,支架置入术可能是一种可行的选择。仔细的术前评估和长期随访对于优化患者预后至关重要。

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