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1.
Artigo em Chinês | MEDLINE | ID: mdl-32074745

RESUMO

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions: CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.


Assuntos
Cartilagem Cricoide/cirurgia , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traqueia/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
Khirurgiia (Mosk) ; (1): 80-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994504

RESUMO

We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.


Assuntos
Anastomose Cirúrgica/métodos , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Traqueomalácia/cirurgia , Traqueostomia/efeitos adversos , Humanos , Pessoa de Meia-Idade , Traqueia/lesões , Estenose Traqueal/etiologia , Traqueomalácia/etiologia
3.
Ann Otol Rhinol Laryngol ; 129(1): 46-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31466464

RESUMO

OBJECTIVES: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). METHODS: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. RESULTS: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. CONCLUSION: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. LEVEL OF EVIDENCE: 3b.


Assuntos
Laringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Procedimentos Cirúrgicos Reconstrutivos/educação , Treinamento por Simulação , Traqueia/cirurgia , Animais , Criança , Pré-Escolar , Humanos , Lactente , Laringoestenose/cirurgia , Modelos Animais , Pediatria/educação , Coelhos , Ovinos , Suínos , Estenose Traqueal/cirurgia
4.
Thorac Surg Clin ; 30(1): 91-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761288

RESUMO

The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.


Assuntos
Manuseio das Vias Aéreas , Anestesia/métodos , Estenose Traqueal/cirurgia , Traqueotomia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Humanos , Stents , Traqueotomia/instrumentação , Traqueotomia/métodos
5.
Khirurgiia (Mosk) ; (11): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714523

RESUMO

OBJECTIVE: To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery. MATERIAL AND METHODS: There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients. CONCLUSION: Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.


Assuntos
Constrição Patológica/cirurgia , Stents/efeitos adversos , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Constrição Patológica/etiologia , Humanos , Estudos Retrospectivos , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/etiologia
6.
Medicine (Baltimore) ; 98(40): e17449, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577770

RESUMO

BACKGROUND: Pulmonary artery sling (PAS) is rare, often with tracheal stenosis. And the postoperative mortality is high. For now, there is no consensus on the tracheoplasty for the patients with PAS and tracheal stenosis. METHODS: Studies involving surgical repair of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and the Cochrane Library databases until June 5, 2019. The assessed variables included ventilation time, early and late mortality, and symptom at follow-up. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence interval (CI). RESULTS: This study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will assess the safety and efficacy of tracheoplasty for patients with PAS and tracheal stenosis, and provide more evidence-based guidance in clinical practice. PROSPERO REGISTRATION NUMBER: CRD42019139788.


Assuntos
Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/complicações , Estenose Traqueal/cirurgia , Humanos
7.
Medicine (Baltimore) ; 98(42): e17650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626151

RESUMO

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.


Assuntos
Anestesia Geral/métodos , Oxigenação por Membrana Extracorpórea/métodos , Bócio Subesternal/cirurgia , Posicionamento do Paciente , Tireoidectomia/métodos , Estenose Traqueal/cirurgia , Idoso , Broncoscopia/métodos , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Humanos , Intubação Intratraqueal/métodos , Masculino , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estenose Traqueal/complicações
8.
Rev Med Suisse ; 15(665): 1765-1768, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580021

RESUMO

Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.


Assuntos
Constrição Patológica/congênito , Constrição Patológica/cirurgia , Traqueia/anormalidades , Obstrução das Vias Respiratórias , Constrição Patológica/diagnóstico , Humanos , Traqueia/cirurgia , Estenose Traqueal/congênito , Estenose Traqueal/diagnóstico , Estenose Traqueal/cirurgia
9.
Metas enferm ; 22(8): 49-58, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184997

RESUMO

Objetivo: describir las principales complicaciones asociadas a la cirugía de resección laringotraqueal e identificar los cuidados de Enfermería orientados a reducir las complicaciones asociadas. Método: revisión narrativa, se buscaron artículos en las bases de datos: Pubmed, CINAHL, Cochrane Library Plus y Cuiden, con los términos libres: "estenosis laringotraqueal", "estenosis traqueal", "complicaciones", "cirugía" y "cuidados". Limitados en idioma: inglés o español, edades superiores a 18 años y publicados en los últimos 10 años. Resultados: de un total de 143 artículos encontrados, 12 fueron seleccionados. Se identificaron las complicaciones postoperatorias: las anastomóticas (formación de tejido de granulación, re-estenosis, separación de la anastomosis o la aparición de fístula); y las no anastomóticas (edema laríngeo y la disfunción glótica). Cuidados derivados de la revisión: mantenimiento de la hiperflexión cervical temporal, evitar las náuseas y los vómitos, fomentar la movilización y la deambulación, y el control de los signos de alarma. Mediante estos cuidados se pretende reducir las variaciones inapropiadas de la práctica y promover una atención de calidad basada en la evidencia científica. Conclusiones: la necesidad de estandarizar los cuidados enfermeros a estos pacientes es fundamental para conseguir llevar a cabo un manejo óptimo y seguro para evitar complicaciones asociadas y disminuir el consumo de recursos sanitarios. El personal enfermero es un pilar importante para detectar estas complicaciones de forma precoz, ayudar a prevenir su aparición y favorecer a la autonomía del personal de Enfermería


Objective: to describe the main complications associated with laryngotracheal resection surgery, and to identify the Nursing care measures required to reduce the complications associated. Method: a narrative review. There was a search for articles in the following databases: Pubmed, CINAHL, Cochrane Library Plus and Cuiden, with the free terms: "estenosis laringotraqueal" ("laryngotracheal stenosis"), "estenosis traqueal" ("tracheal stenosis"), "complicaciones" ("complications"), "cirugía" ("surgery") and "cuidados" ("care"). Limited in language: English or Spanish; >18 years and published in the last 10 years. Results: twelve (12) articles were selected from the 143 articles found. Post-surgical complications were identified: anastomotic (granulation tissue formation, restenosis, anastomosis separation or development of fistula); and non-anastomotic (laryngeal oedema and glottic insufficiency). Care measures derived from the review: sustained temporary cervical hyperflexion, prevention of nausea and vomiting, encouraging mobility and ambulation, and control of warning signs. These care measures are intended to reduce any inappropriate variations in practice, and promote quality care based on scientific evidence. Conclusions: there is an essential need to standardize the nursing care for these patients, in order to achieve an optimal and safe management to avoid any complications associated and reduce the use of healthcare resources. Nursing staff plays an important role in the early detection of these complications, to help preventing their development, and to encourage the autonomy of the Nursing staff


Assuntos
Humanos , Cuidados de Enfermagem , Estenose Traqueal/complicações , Estenose Traqueal/prevenção & controle , Estenose Traqueal/cirurgia , Complicações Pós-Operatórias , Anastomose Cirúrgica
11.
Ann Otol Rhinol Laryngol ; 128(12): 1194-1197, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31364384

RESUMO

OBJECTIVES: To describe a case of open airway surgery with postoperative respiratory complications in a paraplegic woman and to review the unique respiratory physiology seen in patients with a history of cervical or thoracic spinal cord injury (SCI). METHODS: Case report and literature review. RESULTS: We describe the case of a 25-year-old paraplegic who developed tracheal stenosis after tracheotomy, eventually requiring tracheal resection and re-anastomosis. Her postoperative course was complicated by mucus plugging and severe atelectasis, necessitating reintubation. After extubation, the patient reported difficulty expectorating secretions ever since her SCI, requiring manual abdominal pressure from her family members to assist her when she needed to cough. CONCLUSION: This first report of cricotracheal resection in a patient with paraplegia following SCI highlights the importance of an adequate cough and demonstrates the unique respiratory management necessary for patients with SCI.


Assuntos
Tosse , Paraplegia/complicações , Complicações Pós-Operatórias/terapia , Traumatismos da Medula Espinal/complicações , Estenose Traqueal/cirurgia , Adulto , Extubação , Feminino , Humanos , Muco , Complicações Pós-Operatórias/etiologia , Estenose Traqueal/etiologia , Traqueotomia/efeitos adversos
12.
J Cardiothorac Surg ; 14(1): 128, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272475

RESUMO

BACKGROUND: Tracheal stenosis caused by tracheotomy and intubation is considered intractable. Although the segmental tracheal resection and endoscopic intervention are available, they usually result in great operation injury or are difficult to perform. CASE PRESENTATION: A patient with acquired tracheal stenosis was treated with tracheotomy-coblation. The patient was followed up by bronchoscopy every 2 months. After 6-month follow-up, the symptoms of dyspnea and hoarseness disappeared and no tracheal stenosis was observed. CONCLUSIONS: The present technique, tracheotomy-coblation, is advantageous with less injury and easy to perform.


Assuntos
Técnicas de Ablação , Estenose Traqueal/cirurgia , Traqueotomia , Adulto , Dispneia/etiologia , Rouquidão/etiologia , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Estenose Traqueal/etiologia , Traqueostomia/efeitos adversos
13.
Otolaryngol Clin North Am ; 52(5): 923-936, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31320105

RESUMO

The management of pediatric airway stenosis has evolved considerably over time. At the outset, dilation was the mainstay of management. In the 1900s, open surgery in the form of cricoid expansion procedures or resection procedures was the primary treatment with subsequent development of the slide tracheoplasty. Now in the twenty-first century, advances in endoscopic management, balloon dilation, and stenting, along with the advent of external scaffolds and tissue replacement continue to advance pediatric airway surgery.


Assuntos
Laringoestenose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Torácicos/tendências , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cateterismo , Criança , Gerenciamento Clínico , Endoscopia , Humanos , Laringoestenose/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/tendências , Stents , Engenharia Tecidual , Estenose Traqueal/diagnóstico , Resultado do Tratamento
14.
J Laryngol Otol ; 133(6): 530-534, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232244

RESUMO

BACKGROUND: The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios. OBJECTIVES: To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery. METHOD: Retrospective case series in a tertiary care aerodigestive centre. RESULTS: Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer. CONCLUSION: It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients' understanding of the surgery, and for teaching residents and fellows.


Assuntos
Laringoestenose/diagnóstico por imagem , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Impressão Tridimensional , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/cirurgia , Adolescente , Manuseio das Vias Aéreas , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Laringoestenose/cirurgia , Masculino , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Amostragem , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Rev. patol. respir ; 22(2): 66-68, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185771

RESUMO

Presentamos a una mujer de 71 años, con antecedentes de hernia de hiato, gastritis erosiva y reflujo gastroesofágico (RGE), en seguimiento durante 11 años, con disnea y estenosis traqueal desde hace 5 años, que precisó dilatación broncoscópica y mitomicina tópica en dos ocasiones, y que consulta por empeoramiento de su disnea en los últimos 6 meses. Mediante tomografía computarizada (TC) y fibrobroncoscopia, se objetiva estenosis traqueal subglótica y se decide resección del segmento estenótico y anastomosis termino-terminal. El postoperatorio transcurre sin incidencias, y la paciente es dada de alta al noveno día postquirúrgico, con evolución posterior satisfactoria. La estenosis traqueal idiopática es extremadamente infrecuente, y se ha descrito su relación con el RGE. El tratamiento de elección es la resección quirúrgica con anastomosis termino-terminal, con resultados postquirúrgicos excelentes en más del 90% de los casos. Dada su escasa incidencia, consideramos de interés su divulgación en la literatura médica


We report a case of a 71-year-old woman with history of hiatus hernia, erosive gastritis and gastroesophageal reflux disease (GERD) 11 years ago, who presented dyspnea and tracheal stenosis for the last 5 years. She required bronchoscopic dilation and topical mitomycin 2 times. She consulted for worsening of her dyspnea in the last 6 months. At computed tomography (CT) and fibrobronchoscopy, subglottic tracheal stenosis was observed, and resection of the stenotic segment and end-to-end anastomosis were decided. The patient was discharged from hospital on the ninth postoperative day, with satisfactory evolution. Idiopathic tracheal stenosis is extremely infrequent, and its relationship with GER has been described. The treatment of choice is surgical resection with end-to-end anastomosis, wich has excellent postsurgical results in more than 90% of the cases. Given its low incidence, we consider its dissemination in the medical literature of interest


Assuntos
Humanos , Feminino , Idoso , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Tomografia Computadorizada por Raios X , Estenose Traqueal/diagnóstico por imagem , Broncoscopia/métodos
16.
Vet Surg ; 48(5): 825-834, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31115067

RESUMO

OBJECTIVE: To describe the surgical placement of a continuous extraluminal tracheal prosthesis (CETP) and report the subsequent postoperative clinical outcomes in dogs with tracheal collapse. STUDY DESIGN: Retrospective case series. ANIMALS: Fifty-four dogs. METHODS: Medical records of dogs in which cervical and/or thoracic inlet tracheal collapse was diagnosed and treated by placement of a CETP between 2010 and 2017 were reviewed to evaluate postoperative complications, changes in respiratory function, and survival. Histological examinations of tracheal tissues performed in 2 dogs at 51 and 57 months after surgery were also reviewed. RESULTS: Fifty-three (98%) dogs survived to discharge. Postoperative complications included laryngeal paralysis (1 dog), disseminated intravascular coagulation (1 dog), and recurrent tracheal collapse (2 dogs). None of the dogs exhibited clinical evidence of tracheal necrosis. Preoperative dry, harsh cough resolved in 87% of the dogs after surgery. Goose honking cough was resolved in 25 of 26 (96%) dogs. Median follow-up time was 30 months (range, 16 days to 76 months). The survival rate at 36 months was 86% (CI: 75%-96%). On histological examination in 2 dogs, the tracheal tissue surrounding the prosthesis was well preserved and without evidence of chronic inflammation. CONCLUSION: Continuous extraluminal tracheal prosthesis placement in dogs with tracheal collapse resulted in low postoperative complication rates and good long-term outcomes. CLINICAL SIGNIFICANCE: Continuous extraluminal tracheal prosthesis placement provides a viable alternative surgical option for managing dogs with tracheal collapse.


Assuntos
Doenças do Cão/cirurgia , Complicações Pós-Operatórias/veterinária , Implantação de Prótese/veterinária , Stents/veterinária , Traqueia/cirurgia , Animais , Cães , Estudos Retrospectivos , Estenose Traqueal/cirurgia , Estenose Traqueal/veterinária , Resultado do Tratamento
17.
Surg Today ; 49(11): 958-964, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31098758

RESUMO

PURPOSE: Although various artificial tracheas have been developed, none have proven satisfactory for clinical use. In-body tissue architecture (IBTA) has enabled us to produce collagenous tissues with a wide range of shapes and sizes to meet the needs of individual recipients. In the present study, we investigated the long-term outcomes of patch tracheoplasty using an IBTA-induced collagenous tissue membrane ("biosheet") in a beagle model. METHODS: Nine adult female beagles were used. Biosheets were prepared by embedding cylindrical molds assembled with a silicone rod and a slitting pipe into dorsal subcutaneous pouches for 2 months. The sheets were then implanted by patch tracheoplasty. An endoscopic evaluation was performed after 1, 3, or 12 months. The implanted biosheets were harvested for a histological evaluation at the same time points. RESULTS: All animals survived the study. At 1 month after tracheoplasty, the anastomotic parts and internal surface of the biosheets were smooth with ciliated columnar epithelium, which regenerated into the internal surface of the biosheet. The chronological spread of chondrocytes into the biosheet was observed at 3 and 12 months. CONCLUSIONS: Biosheets showed excellent performance as a scaffold for trachea regeneration with complete luminal epithelium and partial chondrocytes in a 1-year beagle implantation model of patch tracheoplasty.


Assuntos
Materiais Biocompatíveis , Membranas Artificiais , Procedimentos Cirúrgicos Reconstrutivos/métodos , Engenharia Tecidual , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Animais , Modelos Animais de Doenças , Cães , Feminino , Fatores de Tempo , Resultado do Tratamento
18.
Int J Pediatr Otorhinolaryngol ; 123: 138-140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102968

RESUMO

Laryngotracheal reconstruction is the standard of care for management of high grade pediatric laryngotracheal stenosis. One of the complications of a reconstruction with a posterior costal cartilage graft is graft prolapse. Typically, a revision laryngotracheal reconstruction will be needed to correct this complication. We describe a case in which a non-invasive endoscopic approach using laser was undertaken for a prolapsed posterior costal cartilage graft in a child who had undergone an anterior-posterior costal cartilage laryngotracheal reconstruction for Grade 3 stenosis. This, according to our knowledge, has not been previously described and provides an alternative to revision surgery.


Assuntos
Cartilagem Costal/transplante , Endoscopia , Laringoestenose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/cirurgia , Pré-Escolar , Constrição Patológica/cirurgia , Humanos , Prolapso , Reoperação
19.
Otolaryngol Head Neck Surg ; 161(1): 164-170, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30961421

RESUMO

OBJECTIVE: This study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty. STUDY DESIGN: Case series with review. SETTING: Tertiary pediatric academic medical center. SUBJECTS/METHODS: Medical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented. RESULTS: Of 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings (P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation. CONCLUSIONS: This is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.


Assuntos
Traqueia/crescimento & desenvolvimento , Traqueia/cirurgia , Estenose Traqueal/congênito , Estenose Traqueal/cirurgia , Broncoscopia , Feminino , Humanos , Lactente , Masculino , Traqueostomia
20.
J Cardiothorac Surg ; 14(1): 49, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30823928

RESUMO

BACKGROUND: Congenital tracheal malformations are less common than congenital cardiac diseases and surgical repair of these anomalies is complex. We sought to examine the surgical treatment and outcomes in cases of tracheal anomalies presenting with or without associated congenital malformations. METHODS: We retrospectively reviewed the demographic, clinical, and imaging data of 49 children who underwent surgery for congenital tracheal malformations between August 2013 and September 2017. Data were collected from the hospital records. RESULTS: In all, 49 patients (male, 30; female, 19) underwent surgeries at our center. The children were of ages between 3 and 36 months (average: 9.7 months). Associated congenital lesions included sling in31/49 (63%), vascularring: in 2/49; ventriculoseptaldefectin5/49; Fallot's tetraology in 2/49 (4.1%), and imperforate anus in 3/49 (6.1%). The outcomes of surgery were excellent in 42(85.7%) cases, good in 3 cases, while mortality occurred in 4(8.1%) cases. All cases of tracheal stenosis without any change in tracheobronchial arborization, 10/12 cases of bridge carina, and all cases of tripod carina were reconstructed using the slide tracheoplasty technique. Antetracheal translocation was performed for correction of associated pulmonary sling, without reimplantation of the pulmonary artery. CONCLUSIONS: Reconstructive surgery is a feasible treatment option for congenital tracheal malformations. Slide tracheoplasty can be safely applied in all cases for the correction of tracheal stenosis. Segment resection was not required for any portion of the trachea. Pulmonary artery translocation is safe and effective for patients with pulmonary artery sling, rather than reimplantation. Mortality was associated with severe cardiac complications.


Assuntos
Artéria Pulmonar/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Malformações Vasculares/cirurgia , Pré-Escolar , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Traqueia/anormalidades , Traqueia/diagnóstico por imagem , Estenose Traqueal/congênito , Estenose Traqueal/diagnóstico por imagem , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos
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