Introduction: Different etiologies are responsible for a wide spectrum of tracheal injuries. Some of these, such as cicatricial laryngo-tracheal stenosis and tracheoesophageal fistula (T-E) not rarely represent a challenge in tracheal surgery. Aim of this study is to retrospectively review the pattern of post-intubation lesions, extension of surgery and long term results in 49 patients. Methods: From December 1987 to February 2007, 49 patients (23 males and 26 females), mean age 50 (range 15–78), were submit- ted to surgical treatment: cicatricial tracheal stenosis (Group A), T-E fistula (Group B), and tracheal tear (Group C). All patients were symptomatic. Results: No post-operative deaths. In Group A (n = 34) the stricture was considered moderate (residual lumen:30–50%) in 27 patients, and severe (<30%) in 7. Tracheal resection and reconstruc- tion (RR) was performed in 24 cases, laryngo-tracheal RR in 10. Two major complications were observed (partial dehiscence of the suture). In group B (n = 10): all patients underwent tracheal RR and direct closure of the T-E fistula. One patient died 10 days postop; 1 with minimal recurrence of the T-E fistula was treated by a temporary T- tube. In group C (n = 5): 3 patients (tear of the membranous wall) were submitted to immediate tracheal suture (right thoracotomy) protected with an intercostal-muscle flap. A trans-tracheal approach trough cervico-sternotomy was adopted in one case. One patient (small sub-cricoid tear) was treated in a conservative way. Discussion: Good surgical results in the treatment of non- neoplastic tracheal lesions are based on: (1) patient selection; (2) tim- ing of surgery; (3) preoperative therapy; (4) meticulous surgical technique.
Surgical Treatment of Non Malignant Tracheal Lesions: A Single Center Experience
DADDI, NICCOLO';Tassi V;
2007
Abstract
Introduction: Different etiologies are responsible for a wide spectrum of tracheal injuries. Some of these, such as cicatricial laryngo-tracheal stenosis and tracheoesophageal fistula (T-E) not rarely represent a challenge in tracheal surgery. Aim of this study is to retrospectively review the pattern of post-intubation lesions, extension of surgery and long term results in 49 patients. Methods: From December 1987 to February 2007, 49 patients (23 males and 26 females), mean age 50 (range 15–78), were submit- ted to surgical treatment: cicatricial tracheal stenosis (Group A), T-E fistula (Group B), and tracheal tear (Group C). All patients were symptomatic. Results: No post-operative deaths. In Group A (n = 34) the stricture was considered moderate (residual lumen:30–50%) in 27 patients, and severe (<30%) in 7. Tracheal resection and reconstruc- tion (RR) was performed in 24 cases, laryngo-tracheal RR in 10. Two major complications were observed (partial dehiscence of the suture). In group B (n = 10): all patients underwent tracheal RR and direct closure of the T-E fistula. One patient died 10 days postop; 1 with minimal recurrence of the T-E fistula was treated by a temporary T- tube. In group C (n = 5): 3 patients (tear of the membranous wall) were submitted to immediate tracheal suture (right thoracotomy) protected with an intercostal-muscle flap. A trans-tracheal approach trough cervico-sternotomy was adopted in one case. One patient (small sub-cricoid tear) was treated in a conservative way. Discussion: Good surgical results in the treatment of non- neoplastic tracheal lesions are based on: (1) patient selection; (2) tim- ing of surgery; (3) preoperative therapy; (4) meticulous surgical technique.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
