Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.754
Filtrar
1.
Artigo em Chinês | MEDLINE | ID: mdl-33794609

RESUMO

Objective:To investigate the risk factors affecting the surgical outcome of severe tracheal stenosis. Methods:The data of 36 patients with severe tracheal stenosis were analyzed retrospectively. All patients underwent tracheal stenosis resection with primary end-to-end anastomosis.Six factors including the location of tracheal stenosis, the length of resected trachea, the degree of stenosis, scar constitution, diabetes and gastroesophageal reflux disease were analyzed by univariate analysis and multivariate Logistic regression analysis. Results:Finally, 23 cases were extubated,including 19 cases with successful extubation and 4 cases with granulation tissue removed by bracing laryngoscope.Univariate analysis showed that the location of tracheal stenosis, the length of resected trachea,scar constitution, diabetes and gastroesophageal reflux disease were the risk factors affecting the surgical efficacy of severe tracheal stenosis.The multivariate Logistic regression coefficients of each factor were 2.857, 1.761, 3.123, -1.066, 3.545 respectively. Conclution: The risk factors affecting the outcome of severe tracheal decannulation rate were the location of tracheal stenosis, the length of resected trachea, scar constitution, diabetes and gastroesophageal reflux disease. Among them, the stenosis position, the length of the resected trachea, scar constitution and gastroesophageal reflux disease had more significant effects on the prognosis of the operation, and the comprehensive evaluation of these risk factors before operation was conducive to improve the surgical effect.


Assuntos
Estenose Traqueal , Anastomose Cirúrgica , Humanos , Estudos Retrospectivos , Fatores de Risco , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Resultado do Tratamento
2.
Ann R Coll Surg Engl ; 103(5): e144-e147, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33682425

RESUMO

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.


Assuntos
/terapia , Intubação Intratraqueal/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Estenose Traqueal/cirurgia , Fístula Traqueoesofágica/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Broncoscopia/métodos , Humanos , Masculino , Salas Cirúrgicas , Isoladores de Pacientes , Respiração Artificial , Tomografia Computadorizada por Raios X , Estenose Traqueal/etiologia , Fístula Traqueoesofágica/etiologia
3.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648488

RESUMO

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Assuntos
Broncopatias/cirurgia , Broncoscopia/métodos , Cicatriz/cirurgia , Laringoestenose/cirurgia , Stents , Estenose Traqueal/cirurgia , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Broncopatias/patologia , Broncopatias/fisiopatologia , Cicatriz/fisiopatologia , Constrição Patológica , Tosse/fisiopatologia , Criocirurgia/métodos , Dilatação/métodos , Combinação de Medicamentos , Dispneia/fisiopatologia , Feminino , Volume Expiratório Forçado , Glucocorticoides/uso terapêutico , Humanos , Injeções Intralesionais , Laringoestenose/fisiopatologia , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fumar , Estenose Traqueal/fisiopatologia , Capacidade Vital , Adulto Jovem
4.
Int J Clin Pract ; 75(5): e14058, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33523519

RESUMO

BACKGROUND: Endoluminal therapy either by dilatation, scar tissue resection or stent insertion is an established treatment for non-malignant airway stenosis although the surgical approach is still considered the "gold standard." No clear consensus exists on the structured role of each modality. AIMS: We aimed to investigate the role of bronchoscopic management in non-operable tracheal stenosis cases, evaluating the effectiveness and safety of each procedure based on a structured algorithmic approach. PATIENTS AND METHODS: This prospective study was carried out on (40) consecutive patients diagnosed between March 2017 and March 2020 with tracheal stenosis not amenable to surgery. All strictures were first evaluated by flexible bronchoscopy and classified as simple or complex. Patients were treated following a standardised therapeutic algorithm approach based on published evidence and our own expertise. RESULTS: The mean age of the study population was 45.25 ± 18.79; lesions were classified as simple (14) and complex (24), while two patients had mixed type stenosis. Long term success rate was 100% in simple stenosis and 87.5% in the complex ones. Stents were deployed in 24 cases, most of which were of the complex type and only two of the simple type. Post-procedural mild to moderate complications were detected overall in 70% of the patients. All complications were non-life threatening, mostly stent-related and were effectively managed. CONCLUSION: We conclude that after accurate classification and a structured algorithmic approach, interventional bronchoscopic management may play a crucial role in the effective treatment of benign tracheal stenosis.


Assuntos
Estenose Traqueal , Broncoscopia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Stents , Estenose Traqueal/cirurgia , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (2): 32-39, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570352

RESUMO

OBJECTIVE: To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection. MATERIAL AND METHODS: At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively. RESULTS: Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient. CONCLUSION: Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Elasticidade , Traqueia , Estenose Traqueal , Adulto , Cicatriz/patologia , Cicatriz/cirurgia , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Endoscopia , Humanos , Tamanho do Órgão , Amplitude de Movimento Articular , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia
6.
J Laryngol Otol ; 135(2): 185-188, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33487184

RESUMO

OBJECTIVE: To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. CASE REPORT: This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. CONCLUSION: For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.


Assuntos
Lesões Acidentais/prevenção & controle , Tronco Braquiocefálico/anormalidades , Pescoço/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Lesões Acidentais/epidemiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/cirurgia , Lesões das Artérias Carótidas/epidemiologia , Lesões das Artérias Carótidas/prevenção & controle , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Estenose Traqueal/diagnóstico por imagem , Traqueostomia/efeitos adversos , Resultado do Tratamento
7.
J Thorac Cardiovasc Surg ; 161(3): 845-852, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33451851

RESUMO

OBJECTIVE: Laryngotracheal resection is still considered a challenging operation and few high-volume institutions have reported large series of patients in this setting. During the 5 years, novel surgical techniques as well as new trends in the intra- and postoperative management have been proposed. We present results of our increased experience with laryngotracheal resection for benign stenosis. METHODS: Between 1991 and May 2019, 228 consecutive patients underwent laryngotracheal resection for subglottic stenosis. One hundred eighty-three (80.3%) were postintubation, and 45 (19.7%) were idiopathic. Most of them (58.7%) underwent surgery during the past 5 years. At the time of surgery, 139 patients (61%) had received tracheostomy, laser, or laser plus stenting. The upper limit of the stenosis ranged between actual involvement of the vocal cords to 1.5 cm from the glottis. RESULTS: There was no perioperative mortality. Two hundred twenty-two patients underwent resection and anastomosis according to the Pearson technique; 6 patients with involvement of thyroid cartilage underwent resection and reconstruction with the laryngofissure technique. Airway resection length ranged between 1.5 and 8 cm (mean, 3.8 ± 0.8 cm) and it was >4.5 cm in 19 patients. Airway complication rate was 7.8%. Overall success of airway complication treatment was 83.3%. Definitive success was achieved in 98.7% of patients. Patients presenting with idiopathic stenosis or postcoma patients showed no increased failure rate. CONCLUSIONS: Laryngotracheal resection for benign subglottic stenosis is safe and effective, and provides a very high rate of success. Careful intra- and postoperative management is crucial for a successful outcome.


Assuntos
Laringoestenose/cirurgia , Procedimentos Cirúrgicos Torácicos , Estenose Traqueal/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Laringoestenose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fatores de Tempo , Estenose Traqueal/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
8.
Khirurgiia (Mosk) ; (1): 5-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395506

RESUMO

OBJECTIVE: To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. MATERIAL AND METHODS: There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). RESULTS: Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. CONCLUSION: Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.


Assuntos
Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Cicatriz/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
9.
J Laryngol Otol ; 135(1): 57-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33487190

RESUMO

OBJECTIVE: The incidence of recurrent stenosis after cricotracheal resection is 3-9.5 per cent. Management of such patients is challenging. This study aimed to review our experience in revision cricotracheal resection. METHODS: The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, on nine patients with recurrent stenosis following cricotracheal resection. Revision cricotracheal resection was performed in all patients. Surgiflo was applied on the site of anastomosis to enhance healing. RESULTS: No intra-operative complications were recorded. Minor post-operative complications occurred in two patients (surgical emphysema and temporary choking); no major complications were reported. Re-stenosis occurred in one patient. Successful decannulation was achieved in eight of the nine patients. CONCLUSION: Revision cricotracheal resection is the definitive curative treatment for recurrent stenosis after previous unsuccessful resection. It has high success rates, provided that careful pre-operative assessment and meticulous operative technique are performed.


Assuntos
Cartilagem Cricoide/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Recidiva , Reoperação , Estudos Retrospectivos , Adulto Jovem
10.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318283

RESUMO

Subglottic stenosis is a disease that causes dyspnoea by congenital or acquired stenosis of the cricoid cartilage and trachea. The cause of acquired subglottic stenosis varies. In this case, we present a case of idiopathic subglottic stenosis. Tracheotomies are performed in many cases, but they require long-term insertion of a tracheal cannula and make treatment difficult. In this case study, we performed a tracheoplasty by resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage and implemented a cannula-free observation protocol.


Assuntos
Cartilagem Cricoide/cirurgia , Laringoestenose/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Anastomose Cirúrgica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tomografia Computadorizada por Raios X
11.
Acta Cir Bras ; 35(11): e351104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331454

RESUMO

PURPOSE: To develop a simpler animal model for benign tracheal stenosis and introduce a low-cost household endoscope for postmodeling endotracheal evaluation. METHODS: Twenty rabbits were randomly divided into a model group (15 rabbits, subjected to transoral nylon brush scraping of the trachea) and a mock group (5 rabbits, merely exempted from scraping), a household endoscope was then introduced for weekly endoscopic examination. Meanwhile, other 15 rabbits (modeling like the model group) underwent batch tracheal resection at different postintervention times for pathological analysis. RESULTS: The model group presented a low mortality and few complications. The endoscope could obtain adequate images for stenosis assessment, which showed that the models presented homogeneous injury after scraping and developed a mature scar stricture at 28 days postoperatively with a mean stenosis degree of 65.9%, and 71.4% (10/14) above Myer-Cotton's grade II. The pathological findings were consistent with the clinicopathological process of human. No stenosis was found in mock group. CONCLUSION: The modified model is simpler, minimally invasive and reliable, while the household endoscope is competent for model's follow-up, providing easily accessible and useful tools for facilitating more extensive studies of benign tracheal stenosis.


Assuntos
Estenose Traqueal , Animais , Modelos Animais de Doenças , Endoscópios , Endoscopia , Coelhos , Traqueia/cirurgia , Estenose Traqueal/cirurgia
12.
Khirurgiia (Mosk) ; (10): 5-10, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047580

RESUMO

Currently, a single classification of cicatricial tracheal stenosis is absent in national and world surgical practice. This issue is actual considering anatomical variability of tracheal structure in people with different constitutional features and previous complications. The proposed classification ensures individualized approach in surgical treatment of patients with cicatricial tracheal stenosis considering anatomical features in a particular patient.


Assuntos
Traqueia/anatomia & histologia , Traqueia/patologia , Estenose Traqueal/classificação , Cicatriz/patologia , Cicatriz/cirurgia , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Humanos , Estenose Traqueal/cirurgia
13.
PLoS One ; 15(9): e0238426, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956400

RESUMO

OBJECTIVE: Laryngotracheal stenosis is one of the most difficult conditions treated by the Otolaryngologist. Open resection of stenosis with primary airway anastomosis is the definitive treatment for this condition. However, some patients are considered high risk candidates for open airway surgery and management and outcomes in this group have not been reported. The purpose of this investigation is to identify a series of high risk patients who underwent open laryngotracheal surgery and detail the lessons learned in regards to their post-operative course and outcomes. METHODS: A retrospective cohort study of all patients that underwent airway resection and primary anastomosis over a fifteen-year period was performed. High-risk patients, those with medical comorbidities that impair wound healing, were identified. Post-operative course, management of complications, and ultimate airway outcomes were noted. RESULTS: Seven patients fitting the high-risk category were identified. Comorbidities were poorly controlled insulin dependent diabetes mellitus (N = 4), poorly controlled hypertension (N = 4), end stage renal disease requiring hemodialysis (N = 3), chronic obstructive pulmonary disease (N = 1), and history of radiation therapy (N = 1). Each patient suffered postoperative complications of varying degrees including postoperative infection (N = 1), formation of granulation tissue at the anastomotic site (N = 3), and postoperative hematoma (N = 1). Management included treatment of infection and complications. Anastomotic dehiscence was managed with tracheostomy and T-tubes. CONCLUSIONS: High-risk medical comorbidities may not be absolute contraindications for open laryngotracheal resection of airway stenosis. However, this experience emphasizes the importance of preoperative medical optimization and comprehensive postoperative care.


Assuntos
Anastomose Cirúrgica/métodos , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Estudos de Coortes , Diabetes Mellitus Tipo 1/complicações , Endoscopia , Feminino , Humanos , Hipertensão/complicações , Falência Renal Crônica/complicações , Laringoestenose/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Estenose Traqueal/complicações , Resultado do Tratamento
14.
Artigo em Chinês | MEDLINE | ID: mdl-32842184

RESUMO

Objective:To investigate the clinical characteristics, management and prognosis of laryngotracheal stenosis induced by relapsing polychondritis. Method:A retrospective analysis was performed of 11 patients with laryngotracheal stenosis induced by relapsing polychondritis. Stenosis was classified as Myer and Cotton grade Ⅱ in 4 patients, grade Ⅲ in 3 and grade Ⅳin 4. Result:Long-term T-tube implantation of thoracic tracheal stenosis was performed in 1 patient, and one patient who had underwent 2 dilations was decannulated, and the tube was successfully extubated in 9 cases who had underwent laryngotracheal reconstruction with sternohyoid myocutaneous flap or costal cartilage. Conclusion:Treatment of laryngotracheal stenosis induced by relapsing polychondritis is challenging. If the surgical intervention was selected properly on an individual basis, favorable clinical outcome can be obtained.


Assuntos
Laringoestenose/cirurgia , Policondrite Recidivante , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/cirurgia , Constrição Patológica , Humanos , Estudos Retrospectivos
15.
Asian Cardiovasc Thorac Ann ; 28(8): 463-469, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32659103

RESUMO

BACKGROUND: Pulmonary artery sling is commonly associated with tracheal stenosis and intracardiac anomalies. While surgical repair is standardized, coexistent anomalies often determine outcomes. With the paucity of risk stratification, this study aimed to review our experience and stratify risk factors for the surgical outcome of complex pulmonary artery sling repair in the presence of airway or intracardiac lesions. METHODS: Seventy-nine consecutive children with pulmonary artery sling were evaluated retrospectively following surgical repair. Median age at surgery was 5 months (interquartile range 3-9). Surgical approaches included pulmonary artery sling alone (n = 10), pulmonary artery sling with tracheoplasty (n = 41), and pulmonary artery sling with both intracardiac and tracheal surgery (n = 28). RESULTS: There were 7 early (8.8%) deaths. Two patients after left pulmonary artery reimplantation needed revision of the anastomosis. The median intensive care and hospital stay were 11 (interquartile range 9.2-24.8) and 17.9 (interquartile range 4.3-19.8) days, and considerably longer when associated tracheal surgery (p = 0.002). Follow-up was complete in 66/69 and 3 (3.8%) children died late: 2.7, 10.2, and 17 months after surgery. Univariate analysis showed abnormal lung and coexisting structural heart disease as risk factors. Multivariate analysis revealed total cardiopulmonary bypass time as an independent predictor of overall mortality. CONCLUSION: Complex pulmonary artery sling repair can be performed with a good surgical outcomes even when associated with airway malformations or structural heart diseases. Lung abnormality and longer cardiopulmonary bypass time as a surrogate marker of complex surgery, are possible risk factors.


Assuntos
Anormalidades Múltiplas , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/cirurgia , Reimplante , Estenose Traqueal/cirurgia , Malformações Vasculares/cirurgia , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Reimplante/efeitos adversos , Reimplante/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/mortalidade , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/mortalidade
16.
Khirurgiia (Mosk) ; (5): 96-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500697

RESUMO

A rare clinical observation of primary tracheal MALT lymphoma is reported and difficulties of differential diagnosis are discussed. Tracheal neoplasms are rare tumors and characterized by delayed diagnosis after clinical manifestation (tracheal stenosis and associated complications). These tumors often occur an advanced age patients that complicates examination and surgical treatment. High risk is determined by type of surgery, possible postoperative complications and senile age.


Assuntos
Linfoma de Zona Marginal Tipo Células B/cirurgia , Neoplasias da Traqueia/cirurgia , Estenose Traqueal/cirurgia , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Humanos , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Traqueia/cirurgia , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/diagnóstico , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia
17.
Khirurgiia (Mosk) ; (6): 18-23, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573527

RESUMO

OBJECTIVE: To analyze contamination of surgical wound during tracheal resection depending on the mode of mechanical ventilation. MATERIAL AND METHODS: There were 976 patients. Circular tracheal resection was made in 396 of these patients. RESULTS: Overall postoperative morbidity was 15.7%, mortality - 0.8%. Bacteriological examination of surgical wound was performed before tracheotomy and after formation of anastomosis depending on the method of mechanical ventilation. Surgical field was sterile before tracheotomy in all cases, contamination was confirmed after tracheotomy in all patients. Minimal contamination was observed in case of apneic oxygenation (100 times less than volumetric mechanical ventilation or high frequency mechanical ventilation). In all cases, several species of pathogenic microorganisms were identified. The number of species was also minimal in case of hypnotic mechanical ventilation. CONCLUSION: Contamination does not directly affect the development of local purulent-inflammatory process. However, this factor should not be ignored and compliance with all preventive measures is required.


Assuntos
Respiração Artificial/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Ferida Cirúrgica/microbiologia , Traqueia/cirurgia , Doenças da Traqueia/cirurgia , Traqueotomia/efeitos adversos , Anastomose Cirúrgica , Humanos , Respiração Artificial/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Traqueia/microbiologia , Doenças da Traqueia/microbiologia , Estenose Traqueal/microbiologia , Estenose Traqueal/cirurgia , Traqueotomia/métodos
18.
Pediatr Cardiol ; 41(7): 1376-1385, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32494877

RESUMO

We performed this meta-analysis to assess the safety and efficacy of tracheoplasty for patients with pulmonary artery sling (PAS) and tracheal stenosis. Published studies that included surgical treatment of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and Cochrane Library databases until May 2020. The outcomes assessed included postoperative ventilation time, early and late mortality, and follow-up respiratory symptoms. The mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CI) was estimated with a random-effects/fixed-effects model. Subgroup analysis was performed stratified by percentage of patients with tracheal rings. A total of eight studies comprising 219 patients with PAS accompanied by tracheal stenosis were included. The pooled estimates of postoperative ventilation time (MD 17.68, 95% CI 6.38 to 28.98, p < 0.01) and early mortality (RR 3.93, 95% CI 1.55 to 9.95, p < 0.01) favored the repair-only group. Late mortality (RR 1.33, 95% CI 0.48 to 3.68, p = 0.58) and respiratory symptoms (RR 1.51, 95% CI 0.50 to 4.57, p = 0.47) at follow-up showed no significant differences between the groups with repair-only and repair with tracheoplasty. The same results were found in subgroup analyses. For the surgical treatment of PAS with tracheal stenosis, repair without tracheoplasty appears to result in shorter postoperative ventilation time and lower early mortality, with no increase in late mortality or respiratory symptoms at follow-up, compared with concomitant tracheoplasty.


Assuntos
Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Razão de Chances , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Respiração Artificial , Resultado do Tratamento
19.
Khirurgiia (Mosk) ; (4): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352669

RESUMO

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Constrição Patológica/cirurgia , Dissecação , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueotomia
20.
Otolaryngol Head Neck Surg ; 163(1): 78-80, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32393105

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for surgical management of laryngotracheal stenosis. High viral concentrations in the upper aerodigestive tract, the ability of the virus to be transmitted by asymptomatic carriers and through aerosols, and the need for open airway access during laryngotracheal surgery create a high-risk situation for airway surgeons, anesthesiologists, and operating room personnel. While some surgical cases of laryngotracheal stenosis may be deferred, patients with significant airway obstruction or progressing symptoms often require urgent surgical intervention. We present best practices from our institutional experience for surgical management of laryngotracheal stenosis during this pandemic, including preoperative triage, intraoperative airway management, and personal protective measures.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/complicações , Transmissão de Doença Infecciosa/prevenção & controle , Laringoestenose/cirurgia , Pandemias , Pneumonia Viral/complicações , Estenose Traqueal/cirurgia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Laringoestenose/etiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estenose Traqueal/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...