Comparison of Surgery and Stent Application in the Treatment of Tracheal Stenosis
Year 2024,
Volume: 14 Issue: 3, 282 - 289, 30.09.2024
Özgür Güzey
,
Murat Yaşaroğlu
Abstract
Introduction: Tracheal stenosis is a pathology that is gradually increasing and requires intervention. Surgical treatment has been used as the gold standard for years, but it is difficult to decide on surgery in patients with comorbidities and high surgical risk. We aimed to evaluate the data of both treatment methods applied in our center.
Materials: Our study was designed as retrospective and observational. The data of 61 patients who underwent resection & reconstruction and Methods or stent due to tracheal stenosis in our center between May 2002 - May 2019 were analyzed. Tracheal stenosis classifications, etiology, demography and treatment data, imaging measurements, and a satisfaction survey were used.
Results: 53 patients who met the inclusion criteria were studied. Both treatment methods were found to be effective in reducing the stenosis and regressing the complaints. The average age in the stent group was higher than in the surgery group. As the intensive care period in the intubated state increases; Severe stenosis and deterioration of cartilage integrity increased. The satisfaction score of the surgery group was higher than the stent group.
Conclusion: Both treatment methods are effective in improving respiratory functions and quality of life. The lesion was located higher in the surgical group and was longer in the stent group. Hospitalization times were longer in patients with severe stenosis and antibiotic changes were more frequent in patients using steroids. No statistically significant difference was found.
References
- Grillo, H., Donahue, D., Mathisen, D., Wain, J. and Wright, C., 1995. Postintubation tracheal stenosis. The Journal of Thoracic and Cardiovascular Surgery, 109(3), pp.486- 493.
- Liberman, M. and Mathisen, D., 2009. Treatment of Idiopathic Laryngotracheal Stenosis. Seminars in Thoracic and Cardiovascular Surgery, 21(3), pp.278-283.
- Pearson, F. (1968). Tracheal Stenosis Complicating Tracheostomy with Cuffed Tubes. Archives of Surgery, 97(3), 380
- Pearson, F. and Patterson, G., 2008. Pearson’s Thoracic & Esophageal Surgery. Philadelphia: Churchill Livingstone/ Elsevier, p.235
- Eren, T. (2019). Torasik Cerrahi (1st ed., pp. 729). İstanbul: İstanbul Medikal Sağlık ve Yayıncılık
- Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, Riker DR, Beamis JF Jr. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med. 2008 Sep 21;8:18
- Wright CD, Grillo HC, Wain JC, et al: Anastomotic complications after tracheal resection: Prognostic factors and management. J Thorac Cardiovasc Surg 128:731–739, 2004.
- Ciccone A., Degiacomo, T., Venuta, F., Ibrahim, M., Diso, D et al. 2004. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. European Journal of Cardio-Thoracic Surgery, 26(4), pp.818-822
- Marty-Ané C H, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995;60(5):1367–1371
- Massard G, Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996
- Massard G, Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996
- Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997
- Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997
- Spaggiari L, Rusca M, Carbognani P, Solli P. Tracheobronchial laceration after double-lumen intubation for thoracic procedures. Ann Thorac Surg. 1998 Jun;65(6):1837-9
- Özdemir C., Kocatürk C., Sökücü S., Sezen B., Kutluk A., Bilen S., & Dalar L. (2018). Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach. Annals of Thoracic and Cardiovascular Surgery, 24(6), 288-295.
- Martínez-Ballarín J, Díaz-Jiménez J, Castro M, Moya J (1996), Silicone Stents in the Management of Benign Tracheobronchial Stenoses. Chest, 109(3), 626-9.
- Dalar, L., Karasulu, L., Abul, Y., Özdemir, C., Sökücü, S. N., Tarhan, M., & Altin, S. (2016). Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis. The Annals of thoracic surgery, 101(4), 1310–7
- Marulli, G., Rizzardi, G., Bortolotti, L., Loy, M., Breda, C., & Hamad, A. et al. (2007). Single-staged laryngotracheal resection and reconstruction for benign strictures in adults. Interactive Cardiovascular And Thoracic Surgery, 7(2), 227-230
- Ulusan A, Sanli M, Işık A, Celik İ, Tuncozgur B, Elbeyli L, Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center, Asian Journal of Surgery, 2017.
- Ashiku SK, Kuzucu A, Grillo HC, Wright CD, Wain JC, Lo B, Mathisen DJ. Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg. 2004 Jan;127(1):99-107.
- Ciccone A., Degiacomo, T., Venuta, F., Ibrahim, M., Diso, D et al. 2004. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. European Journal of Cardio-Thoracic Surgery, 26(4), pp.818-822.
- Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: Surgical treatment and results. Eur J Cardiothorac Surg. 2002;22: 352–356.
Trakeal Stenoz tedavisinde Cerrahi ve Stent Uygulamasının Karşılaştırılması
Year 2024,
Volume: 14 Issue: 3, 282 - 289, 30.09.2024
Özgür Güzey
,
Murat Yaşaroğlu
Abstract
Amaç Trakeal stenoz giderek artan ve müdahale gerektiren bir patolojidir. Cerrahi tedavi yıllardır altın standart olarak uygulanmaktadır fakat komorbiditeleri olan ve cerrahi riski yüksek hastalarda operasyon kararı vermek zordur. Merkezimizde uygulanan her iki tedavi yönteminin verilerini değerlendirmeyi amaçladık.
Yöntem ve Gereçler Çalışmamız retrospektif ve gözlemsel olarak tasarlandı. Merkezimizde Mayıs 2002 - Mayıs 2019 arasında trakeal stenoz nedeniyle rezeksiyon & rekonstrüksiyon veya stent uygulanan 61 hastanın verileri analiz edildi. Dahil edilme kriterlerini karşılayan 54 hasta çalışmaya dahil edildi.
Bulgular Dahil edilme kriterlerini karşılayan 44 hasta ile çalışıldı. Her 2 tedavi yöntemi de darlığın azaltılmasında ve şikayetlerin gerilemesinde etkili bulundu. Stent grubunda yaş ortalaması cerrahi gruba göre daha yüksekti. Entübe durumda yoğun bakım süresi uzadıkça; ciddi darlık ve kıkırdak bütünlüğünün bozulması arttı. Steroid kullananlarda antibiyotik değişim oranlarında artış gözlendi. İşlem sonrası komplikasyon oranı ameliyat grubunda %22.5, stent grubunda %53.5idi. Cerrahi grup memnuniyet skoru stent grubuna göre daha yüksekti.
Sonuç İki tedavi yöntemi de solunum fonksiyonlarını ve yaşam kalitesini arttırmada etkilidir. Cerrahi grupta lezyon daha üst yerleşimli, stent grubunda daha uzundu. Ciddi darlığı olan hastaların yatış süreleri daha uzundu ve steroid kullanan hastalarda antibiyotik değişimi daha fazlaydı, istatistiksel olarak anlamlı fark bulunamadı.
References
- Grillo, H., Donahue, D., Mathisen, D., Wain, J. and Wright, C., 1995. Postintubation tracheal stenosis. The Journal of Thoracic and Cardiovascular Surgery, 109(3), pp.486- 493.
- Liberman, M. and Mathisen, D., 2009. Treatment of Idiopathic Laryngotracheal Stenosis. Seminars in Thoracic and Cardiovascular Surgery, 21(3), pp.278-283.
- Pearson, F. (1968). Tracheal Stenosis Complicating Tracheostomy with Cuffed Tubes. Archives of Surgery, 97(3), 380
- Pearson, F. and Patterson, G., 2008. Pearson’s Thoracic & Esophageal Surgery. Philadelphia: Churchill Livingstone/ Elsevier, p.235
- Eren, T. (2019). Torasik Cerrahi (1st ed., pp. 729). İstanbul: İstanbul Medikal Sağlık ve Yayıncılık
- Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, Riker DR, Beamis JF Jr. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med. 2008 Sep 21;8:18
- Wright CD, Grillo HC, Wain JC, et al: Anastomotic complications after tracheal resection: Prognostic factors and management. J Thorac Cardiovasc Surg 128:731–739, 2004.
- Ciccone A., Degiacomo, T., Venuta, F., Ibrahim, M., Diso, D et al. 2004. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. European Journal of Cardio-Thoracic Surgery, 26(4), pp.818-822
- Marty-Ané C H, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995;60(5):1367–1371
- Massard G, Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996
- Massard G, Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996
- Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997
- Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997
- Spaggiari L, Rusca M, Carbognani P, Solli P. Tracheobronchial laceration after double-lumen intubation for thoracic procedures. Ann Thorac Surg. 1998 Jun;65(6):1837-9
- Özdemir C., Kocatürk C., Sökücü S., Sezen B., Kutluk A., Bilen S., & Dalar L. (2018). Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach. Annals of Thoracic and Cardiovascular Surgery, 24(6), 288-295.
- Martínez-Ballarín J, Díaz-Jiménez J, Castro M, Moya J (1996), Silicone Stents in the Management of Benign Tracheobronchial Stenoses. Chest, 109(3), 626-9.
- Dalar, L., Karasulu, L., Abul, Y., Özdemir, C., Sökücü, S. N., Tarhan, M., & Altin, S. (2016). Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis. The Annals of thoracic surgery, 101(4), 1310–7
- Marulli, G., Rizzardi, G., Bortolotti, L., Loy, M., Breda, C., & Hamad, A. et al. (2007). Single-staged laryngotracheal resection and reconstruction for benign strictures in adults. Interactive Cardiovascular And Thoracic Surgery, 7(2), 227-230
- Ulusan A, Sanli M, Işık A, Celik İ, Tuncozgur B, Elbeyli L, Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center, Asian Journal of Surgery, 2017.
- Ashiku SK, Kuzucu A, Grillo HC, Wright CD, Wain JC, Lo B, Mathisen DJ. Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg. 2004 Jan;127(1):99-107.
- Ciccone A., Degiacomo, T., Venuta, F., Ibrahim, M., Diso, D et al. 2004. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. European Journal of Cardio-Thoracic Surgery, 26(4), pp.818-822.
- Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: Surgical treatment and results. Eur J Cardiothorac Surg. 2002;22: 352–356.