Baugnée P E, Marquette C H, Ramon P, Darras J, Wurtz A
Cliniques Universitaires de Montgodinne, Yvoir, Belgique.
Rev Mal Respir. 1995;12(6):585-92.
Over a period of 6 years, 58 patients aged between 55 +/- 16 years have been treated for post-intubation tracheal stenosis (STPI). These patients were characterised by their frequency of an underlying respiratory or cardiac failure, a duration of intubation which was sometimes short and a delay between the extubation and the detection of stenosis which was les than one month in about one half of the cases. Thirty of the 58 patients presented with respiratory distress on admission. All the stenoses were treated initially by mechanical dilatation using a rigid bronchoscope. Radial incisions using an Nd-Yag laser were performed when necessary to facilitate the dilatation. The great majority of stenoses which were not fitted up with a tracheal endoprosthesis (EPT) at the first attempt recurred, leading to repeated therapeutic bronchoscopies (221 sessions in all). Fitting an EPT (Dumon prosthesis) was necessary in 35 cases on 12 occasions at the first attempt with the first bronchoscopy, and 23 times following a recurrence. Amongst the recurring stenoses a stabilisation was obtained at the price of repeated dilatations (4.3 sessions on average in only nine patients). Seven patients finally had a surgical resection and anastamosis of the trachea, of whom four had a transitory instillation of an EPT for the stenosis. The removal of the EPT was later attempted in 11 patients. Four did not present with any symptomatic recurrence. The secondary migration of the EPT is in practice one of the main inconveniences of the silicon prosthesis (8 cases now experienced). Our approach, which used to favour the mechanical dilatation has lead to a relatively high number of failures and thus to repeated bronchoscopies. This has lead us to re-define our therapeutic approach. The current schema which we propose is in the course of being validated in which we use EPT and surgical repair of the trachea more often. Only short stenoses (less than 1 cm) with a diaphragm are treated by dilatation and laser. The others are fitted initially with an EPT. The final management is guided by the progress in the stenosis, the tolerance of the endoprosthesis and the operability of the patients.
在6年的时间里，对58例年龄在55±16岁之间的患者进行了插管后气管狭窄（STPI）的治疗。这些患者的特点是潜在呼吸或心力衰竭的发生率较高，插管时间有时较短，拔管与狭窄检测之间的延迟在约一半的病例中不到1个月。58例患者中有30例入院时出现呼吸窘迫。所有狭窄最初均采用硬支气管镜进行机械扩张治疗。必要时使用Nd-Yag激光进行放射状切开以促进扩张。绝大多数首次尝试时未安装气管内支架（EPT）的狭窄复发，导致反复进行治疗性支气管镜检查（共221次）。35例患者在首次支气管镜检查时12次需要安装EPT（杜蒙支架），复发后23次。在复发性狭窄中，通过反复扩张（仅9例患者平均4.3次）实现了稳定。7例患者最终接受了气管手术切除和吻合术，其中4例因狭窄临时植入了EPT。后来尝试取出11例患者的EPT。4例未出现任何症状复发。EPT的继发性移位实际上是硅树脂支架的主要不便之处之一（现已发生8例）。我们过去倾向于机械扩张的方法导致了相对较高的失败率，从而需要反复进行支气管镜检查。这促使我们重新定义治疗方法。我们目前提出的方案正在进行验证，其中我们更频繁地使用EPT和气管手术修复。只有短的（小于1厘米）有隔膜的狭窄通过扩张和激光治疗。其他的最初安装EPT。最终的治疗取决于狭窄的进展、内支架的耐受性和患者的可手术性。
