Stenosis Of Left Main Bronchus Research Articles

Temporary and permanent restoration of airway continuity with the tracheal T-tube

The advantages of the tracheal T-tube compared with a regular tracheostomy tube are a physiologic direction of air flow, preservation of laryngeal phonation, and superior patient acceptance. Between 1968 and 1991, 140 patients aged 7 months to 95 years underwent placement of T-, TY- (n = 7), or a modified extended T-tube (n = 4). Primary diagnosis was postintubation stenosis in 86 patients, burn injury in 13 patients, malignant airway tumors in 12 patients, and various disorders in 29 patients. Stenting with a silicone rubber tube was temporary in 31 patients and 14 underwent later operative reconstruction. Definitive permanent insertion was performed in 49 patients. A modified tube was used in 4 patients with left main bronchial stenosis with effective long-term palliation in 3. Postoperative airway obstruction prompted placement in 32 patients. Positioning of the T-tube above the vocal cords in 12 patients for subglottic stenosis was effective in 10. The T-tube was not tolerated in 28 patients (20%) because of obstruction of the upper limb or aspiration. Five of 10 patients under the age of 10 years had airway obstruction necessitating tube removal. Long-term intubation in 112 patients exceeded 1 year in 49 patients and 5 years in 12 patients. Only 5 patients required tube removal for obstructive problems more than 2 months after placement. The tracheal T-tube restores airway patency reliably with excellent long-term results and represents the preferred management of chronic airway obstruction not amenable to surgical reconstruction.

Self-expandable metallic stent in benign tracheobronchial stenosis.

Acquired tracheobronchial stenosis has resulted from vehicular accidents, prolonged tracheal intubation, sleeve resection, tuberculosis and sarcodosis. Various modalities of therapy for the relief of such stenosis included surgery, cryotherapy, laser photoresection, and sometimes balloon dilatation. Several recent reports have described the use of self-expandable metal stents for the dilatation of stenotic areas in the tracheobronchial tree. Three patients of benign acquired tracheobronchial stenosis were treated with self-expandable metal stents, who had shown little response to several times of balloon dilatations; One patient had a tracheal stenosis caused by intubation, one a right main bronchial stenosis developed after reconstructive surgery of traumatic bronchial rupture, and the other a left main bronchial stenosis caused by longstanding endobronchial tuberculosis. We found that the using stent in benign acquired tracheobronchial stenosis can be effectively performed with alleviation of clinical symptoms and lung function. And even in longstanding localized stenosis of main bronchus without distal bronchial destruction, lung perfusion also improved.

TREATMENTS OF TRACHEO-BRONCHIAL STENOSIS IN INFANCY AND EARLY CHILDHOOD

Technical problems treating tracheo-bronchial stenosis in infancy and early childhood were studied in nine patients aged 2 to 22 months during past 15 years. Of the 9 patients, 2 patients were diagnosed as having congenital tracheal stenosis; one, right intermediate bronchial stenosis after operation ASD and tracheomalacia; one, congenital bronchoesophageal fistula; and five, tracheal compression by a vascular anomaly.Of the 2 patients with congenital tracheal stenosis, one with segmental tracheal stenosis was treated with resection and anastomosis. Five years postoperatively, re-operation was performed because of a stricture at the anastomotic site. Another patient with extensive tracheal stenosis was twice treated with tracheoplasty using free costal cartilage graft, however, he died of respiratory failure 1 year and 6 months after the second operation. The patient with right intermediate bronchial stenosis was successfully extubated after right middle and lower lobectomy. Five patients with tracheal compression caused by vascular anomalies could be improved by the division of anomalous vessels. The stenosis of left main bronchus one month after excision of a short wide fistulous tract between the mid-point of the esophagus and left main bronchus was successfully enlarged by balloon catheter dilatation.Unresolved problems are still lying in the treatment and postoperative management of disease, where best selection of the treatment depending on the cause of stenosis is important. Further accumulation of such case reports will lead to establishment of therapeutic guideline.