Analysis of 42 patients who underwent tracheal resection

Year 2010, Volume: 37 Issue: 4, 375 - 381, 01.12.2010

Gönül Sağıroğlu

Abstract

Objectives: We aimed to analyze the etiology, diagnostic and surgical methods, complications and mortality of the patients who underwent tracheal resection for tracheal stenosis. Materials and methods: Between January 2006 and January 2010, 42 patients who underwent tracheal resection and reconstruction was retrospectively analyzed in terms of age, sex, co-morbid disease, etiology of tracheal stenosis, symptoms, the location of stenosis, surgical approach, incision techniques, length of resected segment, types of different suture materials, length of anesthesia and surgery, the ratio of prolonged intubation, morbidities and mortality ratios were analyzed. Results: There were 26 men and 16 female with the mean age was 48 (9-79) years. The etiology was tracheal stenos in 30 patients, tracheal tumor in 10 patients, trauma and congenital tracheal stenos in one each. Symptoms were dispnea, cough, stridor and hemoptysis. Surgical technique was performed through cervical incision (n=36) and cervical incision plus partial sternotomy (n=4) in patients with high tracheal stenosis where the stenosis is lower then complete sternotomy was performed. The mean tracheal segmental resection was 4.1 cm (2-5.2 cm). The morbidities were respiratory insufficiency, secretion retention and atelectasis, pneumonia, sepsis and tracheal re-stenosis. The postoperative mortality was seen in 4 (%9.5) patients. Conclusion: The most important issue leading to complication during tracheal surgery is the ventilation and aspiration towards bronchus. The intense collaboration between surgeon, anesthesiologist and intensive care physician is a necessity in order to reduce complication rates and mortality.

Keywords

Endotracheal intubation, tracheal resection, tracheal stenosis

Analysis of 42 patients who underwent tracheal resection

Abstract

Amaç: Çalışmamızda trakea rezeksiyonu uygulanan tre­akeal stenoz olgularını etiyoloji, tanı, tedavi, komplikas­yon ve mortalite açısından değerlendirmeyi amaçladık. Gereç ve yöntem: Ocak 2006-Ocak 2010 tarihleri arasın­da trakea rezeksiyonu ve rekonstrüksiyonu uygulanan 42 olgu retrospektif olarak incelendi. Vakaların yaş, cinsiyet, yandaş hastalıklar, trakea stenozu nedenleri, semptomlar, stenozun yeri, cerrahi yaklaşım biçimi, insizyon teknikleri, rezeke edilen trakea uzunluğu, sütur materyali, anestezi süresi, cerrahi süre ve postoperatif yoğun bakım ünitesi­ne entübe transport oranı, morbidite nedenleri, mortalite oranı analiz edildi. Bulgular: Yaş ortalaması 48 (9-79) yıl olan olguların 26\'sı erkek 16\'sı kadındı. Trakeal stenoz nedenleri 30 hasta­da entübasyon sonrası trakea stenozu, 10\'unda trakea tümörleri, 1 travmatik trakea yaralanması ve 1 konjenital trakea stenozu idi. Semptomlar dispne, öksürük, stridor ve hemoptizi idi. Trakea üst yarısında olan olgulara sade­ce servikal (n=36) veya servikal ve üst kısmi sternotomi (n=4); trakea alt yarısında olanlara ise total sternotomi yapılmıştı. Rezeke edilen trakea kısmı 2-5.2 cm arasında (3-9 halka) değişmekte olup ortalama 4.1 cm (7.2 halka) rezeke edilmişti. Vakalarımızın morbidite nedenleri so­lunum yetersizliği, sekresyon retansiyonu ve atelektazi, pnömoni, sepsis ve trakeal restenoz olarak tespit edildi. Postoperatif mortalite 4 (%9.5) olguda gözlendi. Sonuç: Trakeal rezeksiyon ve rekonstrüksiyon ameliyat­larında komplikasyona yol açan en önemli sorun venti­lasyon ve bronş sistemine aspirasyondur. Komplikasyon ve mortaliteyi azaltmak için cerrah, anestezist ve yoğun bakım uzmanının yakın işbirliği en önemli yaklaşımdır.

Keywords

Endotrakeal entübasyon, trakea ste­nozu, trakea rezeksiyonu

References

• Gaebler C, Mueller M, Schramm W, et al. Tracheobronchial ruptures in children. Am J Emerg Med 1996;14:279-84.
• Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995;109:486-92.
• Grillo HC, Suen HC, Mathisen DJ, Wain JC. Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg. 1992;54:3-9.
• Yalav E, Ökten İ. Trakea Cerrahisi, 1. baskı. Ankara: Ankara Üniversitesi Tıp Fakültesi Yayınları, 1979:11-180.
• Wynn R, Har-El G, Lim JW. Tracheal resection with end- to-end anastomosis for benign tracheal stenosis. Ann Otol Rhinol Laryngol 2004;113(8):613-7.
• Wright CD, Grillo HC, Wain JC. Anastomotic complications after tracheal resection: Prognostic factors and manage- ment. J Thorac Cardiovasc Surg 2004;128:731-9.
• Rea F, Callegaro D, Loy M, et al. Benign tracheal and lar- yngotracheal stenosis: surgical treatment and results. Euro- pean Journal of Cardio-Thoracic Surgery 2002;22:352-6.
• William C. Wilson, Jonathan L. Benumof Miller RD. An- esthesia for thoracic surgery. In: Miller RD, eds. Miller’s anesthesia, 6th edn. New York: Elsevier Churchill Living- stone, 2005:1911-4.
• Morgan GE Jr, Mikhail MS, Murray MJ. Anesthesia for tho- racic surgery. In: Morgan GE Jr, Mikhail MS, Murray MJ, eds. Clinical anesthesiology, 3rd edn. New York: Mc Graw- Hill Professional, 2002:525-51.
• Özkaptan Y, Gerek M, Akçam T. Boyun travmaları. In: Çe- lik O, ed. Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi. İstanbul, Turgut Yayıncılık, 2002:824.
• Gaissert HA, Grillo HC, Wright CD, Donahue DM, Wain JC, Mathisen DJ. Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardio- vasc Surg 2003;126:744-7.
• Şahin E, Nadir A, Çelik B ve ark. Trakea stenozlarında te- davi yaklaşımları: On beş olgunun analizi Türk Göğüs Kalp Damar Cer Derg 2010;18:200-4.
• Bayram AS, Özcan M, Gebitekin C. Postentübasyon trakea stenozlarında cerrahi tedavi. Türkiye Klinikleri J Surg Med 2006;2:73-7.
• Hadi U, Hamdan AL. Diagnosis and management of tra- cheal stenosis. J Med Liban 2004;52:131-5.
• Cordos I, Bolca C, Paleru C, Posea R, Stoica R. Sixty tra- cheal resections-single center experience. Interact Cardio- vasc Thorac Surg 2009;8:62-5.
• Behrend M, Klempnauer J. Influence of suture material and technique on end-to-end reconstruction in tracheal surgery: an experimental study in sheep. Eur Surg Res 2001;33:210-6.
• Benumof JL. Anesthesia for Thoracic Surgery, 2nd ed. Phil- adelphia: WB Saunders Company, 1995:530-41.
• Brichet A, Verkindre C, Dupont J, et al. Multidisciplinary approach to management of postintubation tracheal stenos- es. Eur Respir J 1999;13:888-93.
• Türkyılmaz A, Aydın Y, Ermancık M, Erdem AF, Eroğlu A. Postentübasyon trakeal stenozun cerrahi tedavisi. EAJM 2007;39:189-93.
• Rea F, Callegaro D, Loy M, et al. Benign tracheal and lar- yngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg 2002;22:352-6.
• Sarper A, Ayten A, Eser I, Ozbudak O, Demircan A. Tra- cheal stenosis aftertracheostomy or intubation: review with special regard to cause and management. Tex Heart Inst J 2005;32:154-8.