Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy

نویسندگان

  • Shahryar Hashemzadeh
  • Khosrow Hashemzadeh
  • Farzad Kakaei
  • Raheleh Aligholipour
  • Kamyar Ghabili
چکیده

BACKGROUND Postintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy. METHODS Over a 5-year period from June 2005 to July 2010, 50 patients aged 14-64 years with moderate (50%-70% of the lumen) to severe (>70%) postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27) and those without previous tracheostomy (group B, n = 23). RESULTS Resection and primary anastomosis was performed via either cervical incision (45 patients) or right thoracotomy (five patients). In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly greater in group A compared with group B (P < 0.05). Six months after surgery, the outcome was satisfactory to excellent in 47 (95.9%) patients. CONCLUSION This surgical approach leads to highly successful results in the treatment of moderate to severe postintubation tracheal stenosis. In addition, previous tracheostomy might prolong the duration of surgery and increase the need for postoperative interventions due to an increase in the length and number of resected tracheal segments. Therefore, in the event of emergency tracheostomy in postintubation tracheal stenosis, insertion of the tracheostomy tube close to the stenotic segment is recommended.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Tracheal T-Tube Stent for Laryngotracheal Stenosis: Ten Year Experience

Introduction: The purpose of this retrospective study was to evaluate the outcome following stenting over a period of 10 years in patients with chronic laryngotracheal stenosis.   Materials and Methods: Between 2000–2010, out of 111 patients with laryngotracheal trauma, 71 underwent tracheal        T-stenting for laryngotracheal stenosis in the Department of Otorhinolaryngology at the Governmen...

متن کامل

Postintubation Tracheal Stenosis: Case Report and Review of Current Management

Tracheal stenosis is an uncommon but serious complication of prolonged intubation and tracheostomy patients. Treatment is often provided by otorhinolaryngologists or interventional pulmonologists, but because symptoms may not appear for weeks or months after extubation, primary care physicians are frequently the first to encounter this complication. On presentation, tracheal stenosis may be mis...

متن کامل

Surgical treatment for patients with tracheal and subgllotic stenosis

  Abstract   Background: Iatrogenic airway injury after endotracheal intubation and tracheotomy   remains a serious clinical problem. In this study we reviewed post-intubation and traumatic tracheal stenosis in 47 patients with a special attention to the cause, hense surgical treatment of the stenosis was performed and the results compared with the literatures.   Methods: Since February 1995 th...

متن کامل

Study of postintubation airway stenosis (PIAS) following suicide attempts

Background: The incidence of suicide attempts has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and got postintubation airway stenosis, may help us to better understand and prevent this complication. Materials and methods: Among patients who referred to us for treatment of PIAS, those who were intubated for suicide attemp...

متن کامل

Tracheal stenosis complicated with tracheoesophageal fistula.

OBJECTIVE The aim of the present study was to evaluate the results of surgical treatment in patients with simultaneous occurrence of postintubation tracheal stenosis (TS) and tracheoesophageal fistula (TEF). METHODS In the group of 51 patients with postcannulation tracheal stenosis who underwent segmental resection, TEF was identified simultaneously in five (10%) of them. The mean age of the ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 5  شماره 

صفحات  -

تاریخ انتشار 2012