Abstract
Background. Main issues of treatment of patients with cicatricial stenosis of trachea (CST) are to increase its efficacy and safety, as well as to determine indications and contraindications for circular resection and reconstructive interventions on the trachea in patients with extended lesions of trachea, with stenoses involving subvocal cords part of larynx and well as multifocal narrowing of the trachea which could improve treatment results and quality of life of patients, to gain recovery and reduce disability and mortality.Material and methods. One hundred two patients aged from 11 to 62 years with CST were surgically treated. Stenotic site length in patients varied from 0,3 to 7 cm. Most frequently (64,2%), CST length of more than 2 cm was observed. In critical and decompensated stenosis with diameter of CST up to 5 mm with the threat of asphyxiation by the first stage we used endoscopic laser-and electric destruction of constriction followed by restricted zone bouging. If long-term rehabilitation was necessary and in case of absence of the conditions to the implementation of circular tracheal resection, we used tracheal stents. Circular resection of the trachea was performed in 24 patients. In case of contraindications, 28 patients underwent reconstructive plastic surgery with dissection the stenosis, excision of scar tissue and formation of trachea lumen in T-tube. After removing T-tube plasty of anterior tracheal wall and of soft tissues of the neck defects was performed using local tissues and grafts with microsurgical techniques.Results. Long-term results of treatment evaluated and studied in a period of 6 months to 5 years in 89 (87.3%) patients. 13 patients continues to one of the stages of complex treatment. Еhe patients are under dynamic endoscopic control. Good results were achieved in the treatment of 71 patients (79.8%), satisfactory - in 12 (13.4%), unsatisfactory results in 6 (6.7%) patients.Conclusions. 1. Patients with CST should undergo multimodal approach depending on degree and localization of narrowing, length and levels of restriction, taking into account severity of associated pathologies using complex of endosurgical, resection and reconstructive treatments. 2. When an extended CST involvement in the process is more than 30–50% of the trachea up to 5-6 cm, it’s possibly to perform circular tracheal resection provided that mobilization of necessary levels is sufficient. 3. In case of multifocal CST in conjunction with subglottic stenosis of the larynx formation of the lumen, it is expedient to form a lumen in the T-tube.
Highlights
Cicatricial tracheal stenosis is a disease associated with the replacement of normal tracheal wall by a rough scar tissue which narrows the lumen of the respiratory tract
On admission of patients with suspected tracheal stenosis, a thorough medical history is collected with emphasis on data about surgical interventions or resuscitations with intubation or tracheostomy, in order to determine the stage of the stenosis
In patients with cicatricialtracheal stenosis a multimodal approach should be implemented depending on the degree, localization, extension and levels of the stenosis, with the consideration of the severity of comorbidities, using complex endosurgical, resection and reconstructive- plastic methods of treatment
Summary
Cicatricial tracheal stenosis is a disease associated with the replacement of normal tracheal wall by a rough scar tissue which narrows the lumen of the respiratory tract. Main issues of treatment of patients with cicatricial stenosis of trachea (CST) are to increase its efficacy and safety, as well as to determine indications and contraindications for circular resection and reconstructive interventions on the trachea in patients with extended lesions of trachea, with stenoses involving subvocal cords part of larynx and well as multifocal narrowing of the trachea which could improve treatment results and quality of life of patients, to gain recovery and reduce disability and mortality
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