INTERVENTIONAL BRONCHOSCOPY FOR THE MANAGEMENT OF THE POSTINTUBATION AND POSTTRACHEOSTOMY TRACHEAL STENOSIS

Objective: Benign airway obstruction isconsidered as curable by therapeutic bronchoscopic methods. Compared to surgical therapies, these methods are comfortable and safe for the patients.Methods: We used therapeutic bronchoscopic methods (laser and stenotic silicon stent) in seven patients who were admitted to our department due to tracheal stenosis, which developed after tracheostomy and endotracheal intubation. In 4 patients after vaporization of membranous stricture by YAP-laser, stenotic stent was implanted mechanically and/or by means of balloon dilatation. The membranous stricture area was coagulated by YAP-laser in 3 other cases and anatomic airway diameter wasmaintained mechanically and by balloon dilatation.Results and Conclusion: In the follow up period, we applied a stenotic silicone stent after second laser resection to patients, who developed restenosis. Patients who had stenotic silicon stenting had no problem related with the stent in the follow up period were considered as cured.Key Words: Postintubation tracheal stenosis, Therapeutic bronchoscopy, Laser, Stent

___

  • I. Seijo LM, Sterman DPI. Interventional Pulmonology, n Engl J Med 2001 ;344:740- 749
  • ERS/ATS Statement on Interventional Pulmonology. Eur Respir J 2002; 19:356-373
  • Dumon JF, Rebuond E, Aucomte F, Meric B. Treatment of tracheobronchial lesions by laser photoresection. Chest 1982;81:278-284
  • Dumon JE, Shapsay S, Borcerau J, et al. Principles for safety in the application of Pid- YAG laser in bronchology. Chest 1984;96:163-168.
  • Cavaliere S, Foccoli P, Farina P. Hd-YACi laser bronchoscopy: a 5-years experience with 1396 applications in 1000 patients. Chest 1988;94:15-21.
  • Cavaliere S, Venuta E, Foccoli P, et al. Endoscopic treatment of airway obstruction in 2008 patients. Chest 1996; 110:1536-1542.
  • Baugnee PE, Marquette Cli, Ramon Ph, et al. Endoscopic treatment of postintubation tracheal stenosis: a review of 58 cases. Rev Mai Respir 1995;12:585-592
  • Brutinel WM, Cortese DA, McDougal JC, et al. A 2- year experience with the rtd-YAG laser in endobronchial obstruction. Chest I987;91: 159-165.
  • LeBrigand ff. Faudrait-il condamner la tracheotomie? Ann Chir Thorac Cardiovasc 1967;6:489-490
  • Andrews MJ. The incidence and pathogenesis of tracheal injury following tracheostomy with cuffed tube and assisted ventilation. Analysis of 3 year prospective study. Br J Surg 1971; 58:749-755
  • Whited RE. A prospective study of laryngotracheal sequelae in long term intubation. Laryngoscope 1984;94:367-377
  • Straus J. Management of postintubation tracheal stenosis with stent implantation. J BronchoI 1997;4:294-296
  • Metha AC, Lee FY, Cordasco EM, Eliachar I, De Boer G. Concentric tracheal and subglottic stenosis: management using the Pid-YAQ laser for mucosal sparing followed by gentle dilatation. Chest 1993;104:673-677.
  • Shapsay SM, Beamis JF, flybels RL, et al. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilatation. Ann Otol Rhinol Laryngol I987;96: 661-664.
  • Freitang L, Eicker R, Donovan J.T, Dimov D. Mechanical Properties of Airway stent. J BronchoI 1995;2:270-278
  • Unger M. Tracheobronchial stents, stunts and medical ethics revisite. Chest 1996,110:1133-1135
  • Güler Karaağaç, et al.
  • Freitag L. Flexible versus rigid bronchoscopie placement of tracheobronchial prostheses pro flexible bronchoscope. J Bronchol 1995;2:245-251
  • Becker FI. Flexible versus rigid bronchoscopie placement of tracheobronchial prostheses pro flexible bronchoscopye controversy. J Bronchol 1995;2:252-256
  • Grillo FIC. Surgical treatment of post intubation tracheal injuries. J Thorac Cardiovasc Surg 1979;78:860-875
  • Dumon JF, Meric B, Cavaliere S, Vilcog P. Indwelling tracheobronchial prostheses. Chest 1998;94.685-689