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

机译：插管后气管狭窄的外科治疗：伊朗先前气管切开术效果的经验

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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.
机译：背景：气管插管后气管狭窄仍然是气管手术最常见的适应症。如果在拔管后疾病迅速进展，应选择外科手术方法，例如初次切除和吻合或各种气管成形术。我们报告了中，重度插管后气管狭窄手术治疗的经验。我们还比较了有无气管切开术的患者在插管后气管狭窄的术中变量。方法：在2005年6月至2010年7月的5年中，有50名年龄在14-64岁的患者患有中度（50％-70％的管腔） ）至重度（> 70％）的患者在插管后气管狭窄进行了切除和原发性吻合。对患者进行随访以评估手术结果。为了研究既往气管切开术对治疗的影响，比较了先前有气管切开术的患者（A组，n = 27）和没有进行过气管切开术的患者（B组，n = 23）的手术变量。宫颈切口（45例）或右胸切开术（5例）。在两名患有声门下狭窄的患者中，对气管病变和环状软骨的前部进行了完全切除，并使用蒙哥马利T型管将剩余的气管与甲状腺软骨吻合。气管无瘘瘘管患者只有1例围手术期死亡。与B组相比，A组的切除节段的长度，切除的环的数量以及随后的手术时间明显更长（P <0.05）。手术六个月后，47例（95.9％）患者的结果令人满意，达到了极好。结论：该手术方法在中度至重度插管后气管狭窄的治疗中取得了非常成功的结果。另外，由于切除的气管段的长度和数量的增加，以前的气管切开术可能会延长手术时间并增加术后干预的需要。因此，在插管后气管狭窄紧急气管切开术的情况下，建议将气管切开术插管靠近狭窄段。

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