Лечение рубцовых стенозов трахеи после ларингэктомии

Abstract

The aim of the research. To evaluate the results of treatment of patients with cicatricial tracheal stenosis after laryngectomy. Material and methods. A total of 15 patients with cicatricial tracheal stenosis (CTS) and persistent tracheostomy after laryngectomy for laryngeal cancer were treated. The treatment employed an algorithm including bougienage, cryodestruction and stenting, as well as complex bronchodilator therapy aimed at restoring bronchial patency. Cryotherapy of CTS was performed through a tracheostomy with a developed cryoapplicator made of titanium nickelide. Results. The duration of cannula-bearing period after tracheal stenosis was from six months to three years. The length of cicatricial changes ranged from 10 to 55 mm. Tracheal stenosis was detected in the area of the end tracheostomy in 10 patients, at the level of the thoracic trachea in 4 patients, subtotal tracheal injury after laryngectomy in 1 patient. Subcompensated tracheal stenosis was detected in 10 patients, decompensated – in 5, of which 2 patients had this condition combined with tracheomalacia. In case of decompensated stenosis, emergency bougienage of the trachea was performed. Recanalisation and maintenance of the tracheal lumen was carried out according to the proposed treatment regimen. No fatal outcomes were registered during the hospitalisation period. All patients managed to restore adequate breathing and tracheal lumen. Within 6-8 months, 12 patients were decannulated, the rest continued cannula-bearing and free breathing was supported by stenting. The failure of their decannulation was associated with the presence of tracheomalacia and subtotal tracheal stenosis. Conclusion. Surgical correction of CTS in patients after laryngectomy requires an alternative therapeutic approach and differs from those prescribed in the classical version of stenosis. The proposed CTS treatment after extirpation of the larynx is an effective method for restoring the patency of the airways, allowing 80% of patients to restore free breathing without a tracheostomy cannula. The use of the adapted cryoapplicator made of titanium nickelide expands the possibilities of cryosurgery, and the developed method of CTS treatment may be recommended for wide practical application.